Why Are Pregnant Women Prone To Anemia?
During pregnancy your blood volume increases by about 30 per cent in order to deal with all the demands of pregnancy and a growing baby. This increase is maintained until shortly before term when there is a fall, but the original non-pregnant level is not reached until about 6 weeks after delivery. Dietary iron is an essential ingredient in the formation of red blood cells. If you don't have enough iron (and you will need more than before you were pregnant), you can't produce enough healthy red blood cells and you become tired due to lack of oxygen. Red blood cells carry oxygen around the body and deliver it to cells to function normally. Women who do not increase their iron intake while pregnant are at risk of becoming anemic.
What Are The Symptoms?
During pregnancy the most common symptoms of anemia are:
• Pale skin, nails and lips.
• Feeling exhausted and weak.
• Shortness of breath.
• Dizziness (see dizziness while pregnant for other causes).
• Racing heartbeat.
• Difficulties concentrating.
In the early stages of anemia you may not experience any obvious signs - or signs may be mistaken for normal pregnancy symptoms. Your doctor will perform a blood test to check for anemia as part of your routine prenatal checkup. If anemia is found, more frequent testing will be required.
What Causes It?
1. Iron Deficiency Anemia
In America, by far the most common type of anemia during pregnancy is due to iron deficiency as a result of a poor diet, or due to the woman failing to take tablets which were prescribed for her. In less severe cases women often show no symptoms and anemia is only discovered during a routine prenatal blood test. In severe cases the patient may look pale (although this not a particularly reliable sign) and she may have noticed tiredness, breathlessness, palpitation or fainting.
Why anemia can be dangerous:
• Should a hemorrhage occur in pregnancy or labor, the risk is greater for both mother and baby. For this reason every effort must be made to treat anemia before term is reached.
• The baby is more likely to be preterm or low birth weight (intrauterine growth restriction).
• Mom is more likely to suffer from postpartum depression.
2. Folate-Deficiency Anemia.
Folate, also called folic acid, is a type of B vitamin. It is essential for the production of new cells in the body, including red blood cells. Women need extra folate in pregnancy. As most now take prenatal vitamin supplements containing folic acid, this type of deficiency is relatively rare in the Western world. If it occurs it is more likely to do so in multiple pregnancies (pregnant with twins, triplets etc). Folate deficiency can directly contribute to certain types of birth defects.
3. Vitamin B12 Deficiency.
Vitamin B12 is also important for the formation of healthy red blood cells. If you don't consume enough B12 in your diet, you can't produce enough healthy red blood cells. The best food sources of B12 are meat, poultry, dairy products and eggs. A vitamin B12 deficiency raises the risk of birth defects.
Blood loss during and after delivery (if there was hemorrhaging) can also cause anemia. Read more about bleeding during pregnancy.
5. Megaloblastic Anemia
Megaloblastic anemia is a common complication of pregnancy in some tropical countries. These cases also appear to be due to folic acid deficiency but they are complicated by additional dietary deficiencies of protein or iron, by blood destruction by malaria or by blood loss from hook worm infestation.
How Is It Diagnosed?
During your first prenatal visit your doctor will perform a blood test. Blood tests typically include:
Hemoglobin Test: Measures the amount of hemoglobin in your blood volume. Hemoglobin is the iron-rich protein in the red blood cells that transports oxygen around the body.
Hematocrit Test: Measures the percentage of red blood cells in a sample of blood.
If you have lower levels of either substance you probably have iron-deficiency anemia. Your obgyn may carry out other blood tests to confirm the excact cause of your anemia.
How Is It Treated?
There is usually time to treat a pregnant anemic patient with iron supplements (taken orally). It is essential to make sure that adequate doses are swallowed. The ordinary doses can be doubled but nothing is gained by increasing the dose still further. There is a limit to the amount of iron that can be absorbed by the body in one go and with larger doses stomach upsets may occur. If the patient does not respond to oral medications (and full diagnostic tests have not shown any other type of anemia or other condition such as chronic kidney infection during pregnancy), she may be treated with iron injections (parenteral iron).
Parenteral iron may also be used if pregnancy is near term and time is short. However if the woman is very near term a blood transfusion may be the only way to raise the hemoglobin levels quickly enough. As a general rule no woman should be allowed to go into labor with a hemoglobin level below 10 g/dl.
Parenteral iron is given by a deep injection into the muscle. It contains an iron dextran compound (Imferon) or an iron sorbitol compound (Jectofer). Each of these contains the equivalent of 50 mg of iron per ml and the patient is given a daily injection of 2 ml until a satisfactory response is obtained. Iron dextran (but not iron sorbitol) may also be given in a single 'total dose' intravenous infusion, and this method may be useful for women with severe iron-deficiency anemia who are can't attend their doctors office for a series of injections. The patient is admitted to hospital for six hours and 1 liter of normal saline containing the calculated dose of iron dextran is administered by slow intravenous drip. It is assumed that 250 mg of iron are required to raise the hemoglobin level by 1 g/dl, and the dose is calculated accordingly. Serious allergic reactions to intravenous iron occasionally occur, so the initial drip rate should be very slow and the infusion closely supervised by a healthcare worker.
Preventing Anemia In Pregnant Women
Women who are taking a well-balanced diet with a high iron content do not need supplemental iron during pregnancy. Those on less adequate diets need additional iron, which is often combined with a small dose of folic acid in a single tablet. Although simple ferrous sulphate, 200 mg three times daily, is the cheapest form of supplement, it tends to cause constipation in pregnancy and sometimes nausea. A slow-release preparation containing ferrous sulphate 150 mg with folic acid 0.5 mg is preferable, and has the advantage that the woman is only required to take one tablet a day. If ferrous sulphate causes gastrointestinal upset a good alternative is ferrous fumarate, 300 mg daily. It is best to postpone taking iron supplements until any nausea or vomiting of early pregnancy (morning sickness) has passed.
Well Balanced Diet
Aim for at least 3 servings of iron-rich foods a day, these include:
• Lean red meat, poultry and fish.
• Dark green leafy veggies (spinach, kale and broccoli).
• Iron enriched cereals and grains.
• Tofu, beans and lentils.
• Seeds and nuts.
Additionally, eat foods high in vitamin C which is necessary for the absorption of iron:
• Oranges and other citrus fruits and juices.
• Fruits, strawberries and kiwis.
• Tomatoes and bell peppers.
Will pregnancy raise my blood pressure?
What tests do you need during pregnancy?