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Anemia in Pregnancy

Definition

Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. The body does not get enough oxygen when RBCs are lower than normal.

Blood is made up of many blood cell types and plasma. These all increase during pregnancy. RBCs do not go up as much, which can lead to anemia.

Red Blood Cells
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Causes

The most common cause is low iron levels. Iron is a mineral found in hemoglobin. Hemoglobin is the part of the RBC that carries oxygen. The body needs more iron during pregnancy. Anemia happens when these needs are not met.

Other causes are:

  • Low amounts of folic acid or vitamin B12
  • Loss of blood because of injury, a bleeding ulcer, or bleeding hemorrhoids
  • Problems in the genes causing less hemoglobin to be made or hemoglobin that does not work as it should

Risk Factors

Things that may raise the risk of this problem are:

  • Having anemia before pregnancy
  • Very heavy bleeding during periods before pregnancy
  • Morning sickness with frequent vomiting
  • Pregnancies that are close together
  • Being pregnant with more than one baby
  • Eating foods low in iron
  • Problems with hemoglobin—more common in those of African, Mediterranean, Southeast Asian, or West Indian descent

Symptoms

Some people may not have symptoms. Those who do may have:

  • Weakness
  • Tiredness
  • Lightheadedness or fainting
  • Pale skin in the palms of the hands, lips, nails, and eyelids
  • Rapid heartbeat
  • Problems breathing
  • Dry hair or hair loss
  • Dry skin or nails
  • A sore, red tongue
  • Cravings for non-food items such as clay, ice, and paper

Diagnosis

Your healthcare provider will ask about your symptoms and health history. A physical exam may be done. This may be enough to suspect the diagnosis.

Your blood will be tested for:

  • Hematocrit level—the number of RBCs in the blood compared to total amount of blood
  • Hemoglobin level—the amount of hemoglobin in the blood

Other testing of the blood will help look for a cause.

Treatment

The treatment for anemia will depend on the cause. This may include:

  • Dietary changes—Eating iron-rich foods such as meat, poultry, fish, or dark green vegetables.
  • Iron pills—To help raise iron levels in the blood
  • Folic acid and vitamin B12 pills—If these are causing anemia.

Prevention

The risk of this problem may be lowered by getting regular prenatal care and:

  • Taking a prenatal vitamin with iron
  • Eating foods that are high in iron, such as meats and green vegetables
  • Eating foods with folic acid, such as enriched grains and green vegetables
RESOURCES:

The American College of Obstetricians and Gynecologists
https://www.acog.org

American Pregnancy Association
https://americanpregnancy.org

CANADIAN RESOURCES:

Canadian Women's Health Network
http://www.cwhn.ca

The Society of Obstetricians and Gynaecologists of Canada
https://www.sogc.org

REFERENCES:

Anemia & pregnancy. American Society of Hematology website. Available at: https://www.hematology.org/education/patients/anemia/pregnancy. Accessed September 21, 2021.

Anemia and pregnancy. UCSF Medical Center website. Available at: https://www.ucsfhealth.org/education/anemia-and-pregnancy. Accessed September 21, 2021.

Iron deficiency anemia in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/iron-deficiency-anemia-in-adults. Accessed September 21, 2021.

Treatment of iron deficiency anemia in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/treatment-of-iron-deficiency-anemia-in-adults. Accessed September 21, 2021.

Last reviewed July 2021 by Chelsea Skucek, MSN, BS, RNC-NIC  Last Updated: 9/21/2021