What to Know About Anemia

By Jeffrey Boyle, MD Feb 20, 2017

Anemia is a low concentration of red blood cells or hemoglobin in your blood stream. It is a common complication during pregnancy because of all the hormone changes that occur in preparing your body for delivery and a healthy baby.

Screening for anemia

All pregnant women should be screened for anemia during pregnancy. Your doctor will likely check your blood count in the first trimester. Your levels of hemoglobin and hematocrit will determine if you have anemia or a safe concentration of red blood cells for the pregnancy. When a patient is found to have anemia in pregnancy, other tests should be done to determine the cause and possible treatment options.

Anemia from pregnancy

Pregnancy is associated with hormone changes that may cause anemia or make it more difficult to determine the type of anemia a patients has that exists before pregnancy. Normal physiologic changes in pregnancy involve an increase in total blood volume to provide extra nutrition for the developing baby and extra blood cells for the mother who will have blood loss at delivery. The amount of fluid in the blood is greater than the increase in red blood cells and, therefore, the level of red blood cells is often decreased in pregnancy resulting in anemia.

Iron deficiency

Iron deficiency is the most common cause of anemia in pregnancy. Because this type of anemia is so common in pregnancy, iron supplements are recommended for all pregnant women and all prenatal vitamins include iron. Additional iron pills may be added to that if your levels continue to be low while on a prenatal vitamin alone. This is important because most women do not get enough iron from their diet alone for the increased requirement of pregnancy. Iron deficiency anemia during pregnancy is associated with increased risk of low birth weight, preterm delivery, and fetal and neonatal loss. There is also an increased risk of postpartum depression.

Iron supplements

There are many different forms of iron supplements that are safe in pregnancy. Check to see that your prenatal vitamin or extra supplement contains the required amount of iron. Ferrous gluconate contains 34 mg iron per 300 mg tablet, ferrous sulfate contains 65 mg iron per 325 mg tablet, and ferrous fumarate contains 106 mg iron per 325 mg tablet. Sustained-release (slow release) or enteric-coated iron pills dissolve poorly and may be less effective. Iron is best absorbed taking it with vitamin C or orange juice if possible.

Other types of anemia

In addition to iron deficiency, other types of anemia occur including folic acid deficiency, B12 deficiency, liver disease, alcoholism, and abnormal thyroid function. Folic acid deficiency is the most common of these anemias in the United States and is usually from diets lacking fresh leafy vegetables, legumes or animal proteins. Treatment includes improving your diet and taking 1 mg of folic acid supplement daily. Vitamin B12 deficiency in pregnancy is often associated with women who have had partial or total gastric resection or in women with Crohn’s disease.

Other treatments

Severe anemia can result in poor oxygenation of the developing baby, low amniotic fluid, decreased growth and fetal loss. Pregnant women should therefore be given blood during pregnancy (transfusion) if needed. Women with severe iron deficiency or who cannot tolerate extra oral iron can be treated with intravenous or intramuscular iron.

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