Anemia in Pregnancy

Blood is the life-maintaining fluid that circulates through the body's heart, arteries, veins, and capillaries. It carries away waste matter and carbon dioxide, and brings nourishment, electrolytes, hormones, vitamins, antibodies, heat, and oxygen to the tissues.

What is anemia?

Anemia is a condition of too few red blood cells, or a lowered ability of the red blood cells to carry oxygen or iron. Tissue enzymes dependent on iron can affect cell function in nerves and muscles. The fetus is dependent on the mother's blood and anemia can cause poor fetal growth, preterm birth, and low birthweight.

What are the most common types of anemias to occur during pregnancy?

There are several types of anemias that may occur in pregnancy. These include:

  • anemia of pregnancy

    In pregnancy, a woman's blood volume increases by as much as 50 percent. This causes the concentration of red blood cells in her body to become diluted. This is sometimes called anemia of pregnancy and is not considered abnormal unless the levels fall too low.

  • iron deficiency anemia

    During pregnancy, the fetus uses the mother's red blood cells for growth and development, especially in the last three months of pregnancy. If a mother has excess red blood cells stored in her bone marrow before she becomes pregnant, she can use those stores during pregnancy to help meet her baby's needs. Women who do not have adequate iron stores can develop iron deficiency anemia. This is the most common type of anemia in pregnancy. It is the lack of iron in the blood, which is necessary to make hemoglobin - the part of blood that distributes oxygen from the lungs to tissues in the body. Good nutrition before becoming pregnant is important to help build up these stores and prevent iron deficiency anemia.

  • vitamin B12 deficiency

    Vitamin B12 is important in forming red blood cells and in protein synthesis. Women who are vegans (who eat no animal products) are most likely to develop vitamin B12 deficiency. Including animal foods in the diet such as milk, meats, eggs, and poultry can prevent vitamin B12 deficiency. Strict vegans usually need supplemental vitamin B12 by injection during pregnancy.

  • blood loss

    Blood loss at delivery and postpartum (after delivery) can also cause anemia. The average blood loss with a vaginal birth is about 500 milliliters, and about 1,000 milliliters with a cesarean delivery. Adequate iron stores can help a woman replace lost red blood cells.

  • folate deficiency

    Folate, also called folic acid, is a B-vitamin that works with iron to help with cell growth. Folate deficiency in pregnancy is often associated with iron deficiency since both folic acid and iron are found in the same types of foods. Research shows that folic acid may help reduce the risk of having a baby with certain birth defects of the brain and spinal cord if taken before conception and in early pregnancy.

What are the symptoms of anemia?

Women with anemia of pregnancy may not have obvious symptoms unless the cell counts are very low. The following are the most common symptoms of anemia. However, each woman may experience symptoms differently. Symptoms may include:

  • pale skin, lips, nails, palms of hands, or underside of the eyelids

  • fatigue

  • vertigo or dizziness

  • labored breathing

  • rapid heartbeat (tachycardia)

The symptoms of anemia may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is anemia diagnosed?

Anemia is usually discovered during a prenatal examination through a routine blood test for hemoglobin or hematocrit levels. Diagnostic procedures for anemia may include additional blood tests and other evaluation procedures.

  • hemoglobin - the part of blood that distributes oxygen from the lungs to tissues in the body.

  • hematocrit - the measurement of the percentage of red blood cells found in a specific volume of blood.

Treatment for anemia:

Specific treatment for anemia will be determined by your physician based on:

  • your pregnancy, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Treatment depends on the type and severity of anemia. Treatment for iron deficiency anemia includes iron supplements. Some forms are time-released, while others must be taken several times each day. Taking iron with a citrus juice can help with the absorption into the body. Antacids may decrease absorption of iron. Iron supplements may cause nausea and cause stools to become dark greenish or black in color. Constipation may also occur with iron supplements.

Prevention of anemia:

Good pre-pregnancy nutrition not only helps prevent anemia, but also helps build other nutritional stores in the mother's body. Eating a healthy and balanced diet during pregnancy helps maintain the levels of iron and other important nutrients needed for the health of the mother and growing baby.

Good food sources of iron include the following:

  • meats - beef, pork, lamb, liver, and other organ meats

  • poultry - chicken, duck, turkey, liver (especially dark meat)

  • fish - shellfish, including clams, mussels, oysters, sardines, and anchovies

  • leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards

  • legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans

  • yeast-leavened whole-wheat bread and rolls

  • iron-enriched white bread, pasta, rice, and cereals

The following is a list of foods that are a good source of iron. Always consult your physician regarding the recommended daily iron requirements.

Iron-Rich Foods

Quantity

Approximate Iron

Content (milligrams)

Oysters

3 ounces

13.2

Beef liver

3 ounces

7.5

Prune juice

1/2 cup

5.2

Clams

2 ounces

4.2

Walnuts

1/2 cup

3.75

Ground beef

3 ounces

3.0

Chickpeas

1/2 cup

3.0

Bran flakes

1/2 cup

2.8

Pork roast

3 ounces

2.7

Cashew nuts

1/2 cup

2.65

Shrimp

3 ounces

2.6

Raisins

1/2 cup

2.55

Sardines

3 ounces

2.5

Spinach

1/2 cup

2.4

Lima beans

1/2 cup

2.3

Kidney beans

1/2 cup

2.2

Turkey, dark meat

3 ounces

2.0

Prunes

1/2 cup

1.9

Roast beef

3 ounces

1.8

Green peas

1/2 cup

1.5

Peanuts

1/2 cup

1.5

Potato

1

1.1

Sweet potato

1/2 cup

1.0

Green beans

1/2 cup

1.0

Egg

1

1.0

Vitamin supplements containing 400 micrograms of folic acid are now recommended for all women of childbearing age and during pregnancy. These supplements are needed because natural food sources of folate are poorly absorbed and much of the vitamin is destroyed in cooking. Food sources of folate include the following:

  • leafy, dark green vegetables

  • dried beans and peas

  • citrus fruits and juices and most berries

  • fortified breakfast cereals

  • enriched grain products

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