What to Know About Anemia and Pregnancy

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Anemia in pregnancy is a decrease in the total red blood cells or hemoglobin in the blood during pregnancy or in the period following pregnancy. The most common form of anemia is caused by a lack of iron. Iron deficiency is the most common nutritional deficiency and the leading cause of anemia in the United States.

Many people can get all the iron they need from a balanced diet and supplements, but if you have any of the following chronic conditions, you might be at greater risk of developing anemia:

Anemia can affect your fertility and your pregnancy and can impact postnatal recovery. Severe, untreated anemia during pregnancy can increase the risk of complications, including preterm birth. That’s why it’s vital that you attend all your prenatal appointments and make sure your blood is regularly tested for anemia.

Learn more about how anemia can affect your pregnancy and more.

Pregnant woman taking pill at home

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Anemia and Fertility

There seems to be a link between iron levels and fertility. One long-term study, of more than 18,000 people with a uterus, showed that supplementing with iron appeared to decrease the risk of ovulatory infertility (an inability to produce healthy baby-making eggs) compared with those who didn't supplement.

Taking a prenatal vitamin once a day is an easy way to supplement a healthy diet with essential vitamins and minerals for sufficient red blood cell production. It’s ideal to start a prenatal vitamin two to three months prior to trying to conceive.

Anemia and Gestation

Several types of anemia can develop during pregnancy. These include:

  • Iron-deficiency anemia: This occurs when the body doesn't have enough iron to produce adequate amounts of hemoglobin, a protein in red blood cells. It is the most common type of pregnancy-related anemia.
  • Folate-deficiency anemia: Folate is a vitamin found naturally in certain foods like green leafy vegetables. A folate deficiency can directly contribute to certain types of birth defects, such as neural tube abnormalities (spina bifida) and low birth weight.
  • Vitamin B12 deficiency: The body needs vitamin B12 to form healthy red blood cells. Pregnant people who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin B12 deficiency, which could lead to preterm labor.

During pregnancy, your body produces about 20% to 30% more blood to support the growth of your baby. If you're not getting enough iron through your diet or nutritional supplements, your body might not be able to produce the number of red blood cells it needs to make this additional blood and you can become anemic.

The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant people need double the amount of iron that a nonpregnant person needs in order to supply oxygen to the fetus—an intake of 27 milligrams (mg) of iron a day.

Prevalence of Anemia in Pregnancy

According to data from the World Health Organization (WHO), the prevalence of anemia in pregnant people (ages 15 to 49) living in the United States was 11.5% in 2019.

Risk Factors

You might be at a higher risk of developing anemia during your pregnancy if you:

  • Are pregnant with multiples
  • Have two or more pregnancies in quick succession
  • Aren't eating enough foods rich in iron
  • Experienced heavy periods before becoming pregnant
  • Are routinely vomiting as a result of morning sickness

Complications

If anemia is left untreated in pregnancy, it can become severe. Untreated severe anemia, especially during the first two trimesters, can increase the risk of:

  • Poor fetal growth
  • Preterm birth 
  • A low-birth-weight baby
  • Needing a blood transfusion during delivery
  • Postpartum depression

Treatment

In most cases, the treatment for pregnancy-induced anemia is simple: more iron. Your healthcare provider may prescribe a daily iron supplement to take in addition to your prenatal vitamin. Other ways to optimize your iron intake include:

  • Eating foods containing iron: Iron-rich foods include lean meat and chicken, beans, and dark, leafy vegetables.
  • Ingesting foods that help your body absorb iron: Options include orange juice, strawberries, broccoli, or other fruits and vegetables with vitamin C.
  • Making healthy food choices: Most people who make healthy, balanced food choices get the iron and vitamins their bodies need from the foods they eat.
  • Avoiding drinking coffee or tea with meals: These drinks make it harder for your body to absorb iron.

Since treatment depends on the cause, it’s important to talk with your healthcare provider about your particular needs. If your anemia is due to a vitamin deficiency or illness, you may require other treatments to address the underlying disease.

Treatment for Severe Anemia

Intravenous (IV) iron therapy should be the first option in the presence of severe anemia because IV therapy is more effective and rapid than oral therapy for resolving anemia.

Concerning Symptoms

While mild cases of anemia may have no symptoms at all, moderate to severe cases may present with the following symptoms:

  • Excessive fatigue or weakness
  • Pale skin
  • Shortness of breath, heart palpitations, or chest pain
  • Lightheadedness
  • Cold hands or feet
  • Pica (cravings for nonfood items like dirt, clay, or cornstarch)

You may experience all or none of these symptoms if you have anemia during your pregnancy.

Anemia and Postpartum

Some pregnant people may still experience anemia after childbirth. This is typically caused by an inadequate iron intake during pregnancy and blood loss during delivery.

Bleeding exceeding normal blood losses of approximately 300 milliliters (ml) may lead to rapid depletion of body iron reserves and, unless treated, may cause iron deficiency in the postpartum period.

You can breastfeed while anemic, and taking iron supplements while breastfeeding poses no harm to your baby. But if postpartum anemia is left untreated, it can be associated with insufficient milk supply and early breastfeeding cessation.

Postpartum anemia can also increase symptoms related to anxiety, stress, and depression.

Monitoring Iron During the Postpartum Period

Because of the continued risks in the postpartum period, your healthcare provider will screen you for anemia, especially if you had excessive blood loss during delivery or had anemia during pregnancy. Severe anemia after delivery can sometimes require IV iron or a blood transfusion.

A Word From Verywell

While not all cases of anemia in pregnancy are preventable, getting enough iron in your diet goes a long way in helping you to avoid the condition.

Follow a well-rounded diet, take prenatal vitamins, and speak with your healthcare provider if you’re experiencing symptoms of anemia. The implications for untreated anemia can be serious for you and your baby, so seek medical advice if you think you might be anemic.

If you’re at risk for anemia, your healthcare provider should walk you through all the steps to manage this condition before pregnancy, during pregnancy, and in the postpartum period.

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14 Sources
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