Fertility

Anemia During Pregnancy: Management & Prevention Tips For Low Iron

Updated on 30 June 2021 • 8 minute read
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Overview

Did you know that moms with untreated iron deficiency anemia may be more likely to have children with ADHD and schizophrenia? (1) (2)

Anemia affects 56 million pregnant women globally. 

That’s something that should be taken seriously, especially because severe anemia increases the risk of stillbirth and infant death immediately after birth. (3)

You might have a higher risk of postpartum depression and having a low-birth-weight baby, too.

The good news? Plenty of foods and proper supplementation can improve your low iron levels and help manage anemia during pregnancy. (You’ll find out more about iron-rich foods below.)

Remember: Protecting yourself from anemia also protects your baby! So it’s a win-win situation.

 

Types of Anemia During Pregnancy 

First, let’s understand what anemia is and what levels are considered dangerous for you and your baby.

If you have anemia, your body lacks healthy red blood cells to bring enough oxygen to the tissues in your body, likely making you feel weak and tired.

But as a pregnant woman, anemia is especially a cause for concern because your baby can be greatly affected by your low iron stores

Severe degrees of untreated anemia may even lead to congenital disabilities, preterm birth, or stillbirth.

It’s important for you to know more about anemia and how you can prevent it for your baby’s sake.

These are the types of anemia that you can experience during pregnancy: (4)

  • Iron deficiency anemia
  • Folate deficiency anemia
  • Vitamin B12 deficiency anemia

 

The most common of all types, iron deficiency anemia affects up to 52% of pregnant women globally. (5)

Knowing the type of anemia you’re suffering from ensures that proper treatment can be provided before it’s too late. 

 

Causes of Anemia In Pregnancy 

First, let’s take a look at iron deficiency anemia.

Our bodies need iron to produce a protein called hemoglobin used by red blood cells to carry oxygen to tissues in our bodies. In pregnant women, this also brings oxygen to the baby in the womb.

During pregnancy, your body demands double the amount of iron to ensure that there’s enough oxygen for you and your baby. Low iron stores may lead to anemia. (5)

Moms should also watch out for anemia caused by a deficiency in vitamin B9 (folate) or vitamin B12.

If you don’t have enough of these B vitamins, your body might produce red blood cells that are abnormally large and can’t function properly.

Insufficient iron, folate, and vitamin B12 in your diet play a big part in causing all these types of anemia. 

That’s the reason why proper nutrition is important throughout your pregnancy.

Aside from these causes of anemia, ACOG (American College of Obstetricians and Gynecologists) adds acute blood loss to the list. (6)

ACOG assures worried moms that bleeding is actually common in pregnancy. In fact, implantation bleeding occurs in as many as 15-25% of pregnant women in early pregnancy.

Moreover, pregnancy makes you more prone to bleeding because more blood vessels develop in your womb. That’s why you might notice light bleeding or spotting after a pelvic exam, pap smear, or sexual intercourse.

While these aren’t likely to be cause for concern, moms should watch out for heavy bleeding because that may be due to problems with the placenta or a sign of miscarriage or preterm labor. (6)

 

Symptoms Of Anemia During Pregnancy 

Because severe and untreated anemia can harm you and your baby, it’s important to watch out for these symptoms: (7)

  • Breathlessness
  • Fatigue (extreme tiredness)
  • Feeling faint or lightheadedness
  • Chest pain
  • Headaches
  • Lethargy (lack of energy)
  • Loss of appetite and weight loss
  • Mouth ulcers
  • Muscle weakness
  • Pale skin
  • Palpitations (noticeable faster heart rate)
  • Paraesthesia (feeling pins and needles in your hand)
  • Tinnitus (hearing sounds coming from inside your ears, not from an outside source)

 

However, because these symptoms are also associated with other medical conditions, it’s best to visit a doctor who specializes in OB-GYN (obstetrics and gynecology) just to be sure.

 

Risk Factors For Anemia During Pregnancy 

As many as 52% of pregnant women have iron deficiency anemia worldwide; so, it’s a good idea to know whether you’re at risk. (5)

These conditions make it more likely for you to have iron deficiency anemia:

  • Living in developing countries
  • Low meat or animal protein intake
  • Menorrhagia (your period is heavier than normal) before pregnancy
  • Multiple pregnancies
  • Frequent vomiting due to severe morning sickness
  • Chronic aspirin intake (8)

 

You’re more likely to have folate or vitamin B12 deficiency anemia if you: (7)

  • Lack vitamins B9 (folate) and B12 in your diet or supplementation
  • Take anticonvulsants such as Diazepam (Valium) or Clonazepam (Klonopin)
  • Take PPIs (proton pump inhibitors such as Omeprazole (Prilosec) and Lansoprazole (Prevacid)

 

How Anemia Can Impact Your Pregnancy & Baby 

Severe anemia during pregnancy puts you at risk of these complications: (9)

During pregnancy:

  • Miscarriage or preterm delivery
  • Premature rupture of membranes
  • Preeclampsia (serious pregnancy complication involving high blood pressure with possible organ damage to kidney and liver)
  • Delay in fetal growth
  • Stillbirth
  • Bleeding or hemorrhage

 

During childbirth:

  • Prolonged labor
  • Increased rates of operative delivery and induced labor
  • Fetal distress (unstable fetal heart rate, decreased movement)
  • Abruption (placenta breaks away from the wall of the uterus)

 

After childbirth:

  • Postpartum hemorrhage (heavy bleeding after giving birth)
  • Puerperal sepsis (dangerous bacterial infection)
  • Lactation failure (low supply of breast milk)
  • Pulmonary thromboembolism (blood clots)
  • Subinvolution (shrinking) of the uterus 
  • Postpartum depression

 

In severe cases of anemia, it’s also possible for moms to experience cardiac failure. (5)

Aside from moms with anemia possibly experiencing these problems, their babies may also be at a higher risk of complications. 

A study in the Annals of Medical and Health Science Research, published in 2014, found a link between iron deficiency anemia in pregnant moms and ADHD (attention deficit hyperactivity disorder) in their children. (1)

Your child may also be at risk of these complications:

  • Low birth weight
  • Premature birth
  • Birth asphyxia (no oxygen at birth)
  • Infections
  • Congenital malformation or defects
  • Neonatal anemia
  • Abnormal cognitive development
  • Delayed language and motor development
  • Increased risk of schizophrenia (2)

 

Do note that babies born to moms with folate deficiency anemia have a higher risk of developing congenital heart defects and NTDs (neural tube defects). 

The following are the different kinds of NTDs:

  • Spina bifida (deformed spine and spinal)
  • Chiari malformation (brain tissue leaks into the spinal canal)
  • Anencephaly (deformed skull)
  • Encephalocele (brain and membranes poke through the skull)

 

Testing For Anemia 

Considering the many complications that you and your baby may experience due to anemia, it’s important to get tested so that low levels can be addressed immediately.

Most OB-GYNs test you various times throughout your pregnancy so check with your doctor to ask them when they usually perform these blood tests

Your health care provider is likely to order a CBC (complete blood count). This will check levels of the following in your blood:

  • Red blood cells (carry oxygen)
  • White blood cells (fight infections)
  • Platelets (helps in clotting)
  • Hemoglobin (proteins that carry oxygen)
  • Hematocrit (ratio of red blood cells to fluid component)

 

All these components are important, but your doctor will be most concerned about your hemoglobin levels.

Pregnant women have anemia if they have hemoglobin levels of: (4)

  • First trimester: less than 11 g/dl 
  • Second trimester: less than 10.5 g/dl
  • Third trimester: less than 11 g/dl

 

WHO further classifies the severity of anemia in pregnant women with Hgb (hemoglobin) levels as follows: (10)

  • Non-anemia: 11 g/dl or higher
  • Mild: 10-10.9 g/dl 
  • Moderate: 7-9.9 g/dl 
  • Severe: less than 7 g/dl 

 

While all types of anemia can have an impact on your pregnancy, severe anemia requires immediate attention. 

Aside from CBC, the blood tests may also include serum vitamin B12 and folate levels. 

  • Vitamin B12 deficiency: below 200 pg/ml
  • Folate deficiency: below 3 mcg/l (11)

 

The Best Food Sources For Anemia 

Pregnant women need to seek immediate treatment for anemia to minimize the risks of developing the complications listed above.

Treatment for anemia depends on the underlying condition. However, good nutrition along with proper supplementation may be enough for most cases of anemia. 

Registered dietitian and nutrition authority Kelly Leveque recommends an increased intake of food sources rich in heme iron to manage iron deficiency anemia. This type of iron is similar to the ones in our bodies. (12)

You can get plenty of iron from animal meat:

  • Liver, 3.5 oz = 6.5 mg
  • Bison, 6 oz = 5.4 mg
  • Venison, 3 oz = 3.8 mg
  • Clams, 3.5 oz = 3 mg
  • Beef, red meat, 3.5 oz = 2.7 mg
  • Sardines, 3 oz = 2.5 mg
  • Chicken, 3.5 oz = 1.5 mg
  • Lamb, 3 oz = 1 mg
  • Pork, 3.5 oz = 1 mg
  • Turkey, 3.5 oz = 1 mg
  • Salmon, 3.5 oz = 0.5 mg

 

Although non-heme sources (from plants and plant-eating animals) aren’t the best options for iron deficiency anemia, you can also add these into your diet: (12)

  • Dark chocolate, 1oz = 3.4 mg
  • Lentils, ½ cup = 3.3 mg
  • Spinach, 1 cup = 2.7 mg
  • Pumpkin seeds, 1oz = 2.5 mg
  • Black beans, ½ cup = 1.8 mg
  • Quinoa, ½ cup = 1.4 mg
  • Broccoli, 1 cup = 1 mg

 

For management of vitamin B12 deficiency anemia, you can increase your intake of the following animal products:

  • Eggs
  • Low-mercury fish like wild-caught sockeye salmon and cod
  • Milk/Dairy (if you can tolerate it)
  • Poultry
  • Red meat

 

Take note: Dairy products interfere with iron absorption. So, if you’re deficient in both iron and vitamin B12, make sure to eat dairy products around two hours before or after taking iron supplements.

 

Management of folate deficiency anemia includes increasing your intake of the following:

  • Citrus fruits
  • Dry beans 
  • Nuts
  • Green leafy vegetables
  • Foods with yeast

 

Treatment For Anemia Caused By Blood Loss

For anemia caused by acute blood loss or in cases of severe anemia (hemoglobin levels lower than 7 g/dl), blood transfusions can quickly increase mom’s blood volume.

But it’s up to the health care provider to determine the amount of blood that needs to be transfused based on how much blood was estimated lost.

For severe anemia without acute blood loss, intravenous iron therapy provides a faster way of restoring hemoglobin and iron stores. So it may be considered a safer alternative to blood transfusion. (13)

 

Is Supplementation Necessary?

Because the baby’s needs come first, pregnant women have an increased demand for iron and other nutrients. 

Supplementation may be necessary, so you’ll have enough iron to support your baby’s growth and development.

The CDC (Centers for Disease Control and Prevention) recommends iron supplements with 30 mg elemental iron per day. 

The WHO (World Health Organization) recommends 30-60 mg of iron plus 400 mcg folic acid supplements for pregnant women. (14)

The recommended dose for folic acid increases to 4,000 mcg/day for women who’ve had a baby with a neural tube defect. If possible, this increased dose is given one month before a planned pregnancy and continues up to the end of the first trimester. (11)

Most OB-GYNs recommend prenatal vitamins for pregnant women instead of just oral iron pills and folic acid supplements.

Do note that prenatal vitamins don’t have the same amounts of iron, folic acid, and other nutrients you and your baby need. So, check the label and compare before making your choice. (15)

There may be times that you’ll need to supplement with a separate iron supplement to increase levels. This is because many prenatal supplements don’t contain enough iron to support an anemic mama’s needs. 

 

Prevention & Management Tips

The saying “an ounce of prevention is better than a pound of cure” remains relevant, particularly in most pregnancy anemia cases. 

So, it would help if you aimed for a healthy pregnancy by increasing your intake of foods rich in iron, folate, and vitamin B12.

When taking iron supplements, remember that iron absorption is affected by various factors in your diet. 

Absorption increases if iron-rich foods or supplements are taken with foods or drinks rich in vitamin C

So, it’s a good idea to add these to your diet:

  • Broccoli
  • Tomatoes
  • Strawberries
  • Melons
  • Orange juice and other citrus fruits or juices

 

Meanwhile, these foods inhibit iron absorption and should not be taken at the same time as your iron supplements: (16)

  • Antacids
  • Calcium supplements
  • Dairy products
  • Caffeinated products (coffee, tea, and energy drinks)

 

Be careful of drinking excessive amounts of coffee and other caffeinated beverages during pregnancy. 

ACOG (American College of Obstetricians and Gynecologists) limits caffeine intake to less than 200 mg per day. So, don’t go beyond 1-2 cups of regular coffee a day. (17)

And better yet, switch to swiss-water processed decaffeinated coffee instead. 😉

Iron supplementation might cause the following side effects: 

  • Constipation
  • Diarrhea
  • Loss of appetite
  • Dark or black poop
  • Nausea
  • Metallic taste in the mouth
  • Vomiting
  • Heartburn

 

Some of these side effects may be avoided by eating a small amount of food before taking the iron pills. Just don’t eat too much because iron is best absorbed on an empty stomach. (18)

If that still upsets your stomach, you can take your iron supplements around two hours after a meal. But don’t take the pills with milk or any dairy product or calcium-rich food.

 

References 

(1) https://pubmed.ncbi.nlm.nih.gov/25364604/ 

(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656467/

(3) https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/en/

(4). https://www.cdc.gov/mmwr/preview/mmwrhtml/00051880.htm

(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375689/

(6) https://www.acog.org/womens-health/faqs/bleeding-during-pregnancy 

(7) https://www.nhsinform.scot/illnesses-and-conditions/nutritional/vitamin-b12-or-folate-deficiencyanaemia

(8) https://www.ncbi.nlm.nih.gov/books/NBK235217/

(9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885006/

(10) https://www.who.int/vmnis/indicators/haemoglobin.pdf

(11) https://www.msdmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/folate-deficiency

(12) https://kellyleveque.com/pregnancy

(13) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444565/ 

(14) https://www.who.int/elena/titles/guidance_summaries/daily_iron_pregnancy/en/ 

(15) https://dsld.od.nih.gov/dsld/index.jsp 

(16) https://pubmed.ncbi.nlm.nih.gov/11029010/ 

(17) https://pubmed.ncbi.nlm.nih.gov/18591330/

(18) https://www.nhs.uk/medicines/ferrous-fumarate/ 

 

 

 

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