Anemia in Pregnancy
Anemia]]> is a low level of hemoglobin-containing red blood cells in the blood. Red blood cells and hemoglobin are required for carrying oxygen to your body’s cells. During normal pregnancy, liquid blood and plasma increase by approximately 50%, however blood cells increase by only 30%. This results in a physiologic anemia. If you are anemic before you become pregnant, this normal change may result in your blood count becoming too low.
If untreated, anemia in pregnancy may increase the risk of preterm delivery, low birth weight, and poor iron status in your baby. It may also increase your risk of infection after childbirth. Anemia in pregnancy may be prevented with appropriate prenatal care and can be easily treated. Contact your doctor when you learn you are pregnant and at any time during your pregnancy if you think you have anemia.
Red Blood Cells
The most common cause of anemia in pregnancy is a low level of iron, the mineral responsible for making hemoglobin. During pregnancy, your iron requirements increase from 15 milligrams (mg) per day to 30 mg per day as your blood volume increases. If this need is not met or if your iron stores are depleted, you may develop anemia.
Other less common causes of anemia in pregnancy:
- Deficiency of folic acid or vitamin B12, the vitamins responsible for producing red blood cells
- Loss of blood due to injury, bleeding ulcer]]> , or bleeding ]]>hemorrhoids]]>
- Hemoglobinopathies (abnormalities in the genes for the hemoglobin protein that results in less or poorly functioning hemoglobin)
A risk factor is something that increases your chance of getting a disease or condition.
The following factors increase your chance of developing anemia in pregnancy:
- Anemia before pregnancy
- Very heavy menstrual flow before pregnancy
- Morning sickness with frequent vomiting
- Pregnancies that are close together
- Carrying twins or multiples
- A diet that is low in iron
- Abnormal hemoglobins (more common in individuals of African, Mediterranean, S.E. asian or west Indian ethnicity or descent)
If you have any of these risk factors, tell your doctor.
Anemia might not cause any symptoms. If symptoms do occur they may include the following:
- Dizzy spells
- Pale skin, especially the palms of the hands, lips, nails, and eyelids
- Rapid heartbeat
- Heart palpitations
- Shortness of breath
- Cravings for nonfood items like clay (a condition called “pica”), ice, and paper
Your practitioner will test your blood for anemia at your first prenatal visit and again late in the second trimester or early in the third trimester.
Your practitioner will look at the following:
- Hematocrit level—the percentage of red blood cells in your blood
- Hemoglobin level—the amount of hemoglobin in your blood
The treatment for anemia in pregnancy depends on the cause of the anemia. Dietary changes usually are not sufficient. Treatment options include:
Your doctor may prescribe an iron supplement of 60 mg-120 mg of iron per day. For best results, take iron supplements on an empty stomach. Foods rich in vitamin C, like oranges and other citrus fruits, will help your body absorb iron. Coffee, tea, milk, and calcium supplements can block absorption of iron, so avoid consuming these at the same time as your iron supplement.
Iron supplements may cause constipation and/or nausea. If your iron supplement causes constipation try increasing your fluid and fiber intake. If your iron supplement causes an upset stomach, your practitioner may advise that you take it with food or may prescribe a different formula.
Folic Acid or Vitamin B12 Supplementation
If a folic acid or vitamin B12 deficiency is causing your anemia, your practitioner may prescribe a vitamin supplement.
Do the following to help reduce your chances of getting anemia in pregnancy:
- Seek early prenatal care.
- Take a prenatal vitamin containing 30 mg of iron, as prescribed by your practitioner, from the beginning of pregnancy.
- Eat foods that are high in iron including red meat, poultry, pork, shellfish, beans, iron-fortified breads and cereals, dried fruits, and leafy green vegetables.
- Eat foods that contain folic acid including whole grains, wheat germ, broccoli, beans, orange juice, and leafy green vegetables.
American Pregnancy Association
National Women’s Health Information Center
Canadian Council on Food and Nutrition
The Society of Obstetricians and Gynaecologists of Canada
American Dietetic Association. Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J Am Diet Assoc . 2002; 102:1470-1490.
Beers MH, Berkow R, Burs M, eds. The Merck Manual of Diagnosis and Therapy . Whitehouse Station, New Jersey: Merck Research Laboratories; 1999.
Hemoglobinopathies in Pregnancy, American College of Obstetricians and Gynecologists, Practice Bulletin, no. 78, January 2007.
Last reviewed November 2008 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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