Anaemia in Pregnancy

Feeling exhausted during pregnancy is hardly unusual. Growing a baby is quite a demanding project for your body, after all.

But sometimes that tiredness has another explanation. Anaemia is common during pregnancy, and the most common type is iron deficiency anaemia. It happens when you don't have enough haemoglobin in your blood to carry oxygen around your body effectively.

The good news is that anaemia can usually be treated, and finding it during pregnancy gives you the opportunity to do something about it.

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What is Anaemia?

 

Your red blood cells contain a protein called haemoglobin, which carries oxygen around your body. Anaemia means that the level of haemoglobin in your blood is lower than it should be. There are different types of anaemia, but iron deficiency is the most common cause. Pregnancy increases your body's need for iron because you're making more blood to support both you and your growing baby. Pregnancy also naturally changes the amount of fluid in your blood. Your plasma volume increases more than your red blood cell mass, which can make your blood more diluted. Some degree of this physiological change is normal, but your haemoglobin is still monitored during pregnancy to identify anaemia that needs treatment. 

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What Are The Symptoms?

 

Anaemia can cause:

• tiredness and lack of energy

• feeling weak

• breathlessness

• headaches

• dizziness or feeling faint

• noticeable heartbeats or palpitations

• looking paler than usual

 

Some people have very few symptoms, particularly if the anaemia develops gradually.  And because tiredness, breathlessness and headaches can all happen during pregnancy anyway, it isn't always obvious that anaemia is the reason. That's one reason your blood tests are useful.

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How is Anaemia Diagnosed?

 

Your haemoglobin level is checked with a blood test. In England, blood tests are routinely offered at your booking appointment and again at around 28 weeks of pregnancy. If your haemoglobin is low, your healthcare team may look at other parts of your blood test to help work out what type of anaemia you have and what might be causing it. Iron deficiency is common, but not every type of anaemia is caused by a lack of iron. Other causes include deficiencies in nutrients such as vitamin B12 or folate, and inherited conditions such as sickle cell disease or thalassaemia.  So if you're told you're anaemic, it is reasonable to ask: "Do you know what's causing my anaemia?"

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Why Does Anaemia Matter During Pregnancy?

 

Mild anaemia is common during pregnancy and can usually be treated. More significant or untreated anaemia can leave you feeling increasingly unwell and may increase the risk of complications during pregnancy and around birth.  One reason your maternity team will want to address anaemia before birth is that blood loss is a normal part of giving birth. If you already have a very low haemoglobin level, you have less reserve if you experience heavier-than-expected bleeding. This doesn't mean that having anaemia means you will have a haemorrhage. It means that getting your haemoglobin to a healthier level before birth can be an important part of preparing for birth. 

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Does Anaemia Affect my Baby?

 

Your healthcare team will monitor and treat anaemia because significant untreated anaemia can affect both your health and your pregnancy. The important thing is that being diagnosed with anaemia doesn't mean something is wrong with your baby. It means your blood results have identified something that may need attention. If your anaemia is significant, your maternity team will advise you about the appropriate treatment and any additional monitoring you may need.

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Do I Need to Take Iron?

 

Not everyone needs an iron supplement during pregnancy. The RCOG advises that most women do not need routine extra iron unless they are found to be anaemic or are at increased risk of becoming anaemic. Taking unnecessary iron can cause unpleasant side effects such as constipation, diarrhoea and heartburn. If your blood tests show that you are anaemic or iron deficient, your midwife or doctor may recommend an iron supplement. It's worth taking it as advised rather than simply assuming that more iron is always better.

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What Can I Eat to Support my Iron levels?

 

A varied diet can help you get the iron your body needs. Iron-containing foods include:

• meat

• poultry

• eggs

• beans and lentils

• dark green leafy vegetables

• fortified breakfast cereals

• fortified breads

• dried fruit such as apricots, prunes and raisins

 

Vitamin C helps your body absorb iron, so including fruit and vegetables alongside iron-rich foods can be useful. If you're vegetarian or vegan, there are plenty of plant-based sources of iron, but you may want to ask your midwife, GP or dietitian for personalised advice if your iron levels are low. And importantly, diet alone isn't always enough to correct anaemia. If you've been prescribed iron, food is supportive but isn't necessarily a replacement for treatment.

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What are Iron Tablets Like?

 

Iron tablets are commonly used as the first-line treatment for iron deficiency anaemia. Unfortunately, they aren't always the most exciting addition to your pregnancy routine. Possible side effects include:

• constipation

• diarrhoea

• stomach pain

• heartburn

• nausea

• darker-coloured poo

 

These side effects are common enough that it's worth knowing about them before you start. If you're struggling with side effects, tell your midwife or doctor rather than simply stopping the tablets. There may be different preparations or ways of taking them that could work better for you. Follow the instructions you've been given about how and when to take your particular iron supplement.

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What if Iron Tablets Don't Work?

 

Sometimes oral iron isn't enough. If your haemoglobin doesn't improve as expected, you're unable to tolerate the tablets, or your anaemia needs to be corrected more quickly, your healthcare team may discuss an iron infusion. An iron infusion gives iron directly into your bloodstream through a drip. RCOG guidance says this can be offered after the first three months of pregnancy when appropriate. It works more quickly than iron tablets or syrup, and side effects are uncommon.  Whether an infusion is appropriate will depend on your individual circumstances. You can ask your healthcare team why they are recommending it and what the alternatives are.

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Does Anaemia Affect how I Give Birth?

 

Having anaemia does not automatically mean you need a particular type of birth. You can still plan for the type of birth that is appropriate for you and your circumstances. However, your maternity team may want to make sure your haemoglobin is as healthy as possible before birth, particularly if your anaemia is significant. This is about giving you the best possible reserve for birth and any blood loss that might occur, rather than predicting that something will go wrong. If you've been told your anaemia is significant, you could ask:

• What is my haemoglobin level?

• How low is it?

• Do you know what is causing the anaemia?

• What treatment are you recommending?

• How quickly should I expect my levels to improve?

• When will my blood be checked again?

• What happens if the tablets don't work?

• Would an iron infusion be appropriate for me?

• Does my anaemia affect any aspect of my birth plan?

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What Happens After Birth?

 

Your haemoglobin may be checked again after birth depending on your circumstances, particularly if you've experienced significant blood loss or have symptoms of anaemia. If you're still anaemic, you may be advised to continue taking iron after your baby is born.

If you're very anaemic or unwell following blood loss, your healthcare team will discuss appropriate treatment with you. This might include iron tablets, an iron infusion or, in some circumstances, a blood transfusion. 

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What About Blood Transfusion?

 

Hearing the words "blood transfusion" can understandably be frightening. Most people with iron deficiency anaemia during pregnancy do not need a blood transfusion. A transfusion is generally considered when someone has become severely anaemic and is significantly unwell, or when there has been substantial blood loss.  If a transfusion is ever recommended for you, your healthcare team should explain why, what the benefits and risks are, and what alternatives may be available in your particular situation.

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A Note About Iron and Pregnancy

 

It can be tempting to assume that if iron is good, more iron must be better. It isn't quite that simple. Most pregnant women don't need to take additional iron unless they have anaemia or are at increased risk. Iron supplements can cause unpleasant side effects, so they should be taken when they're recommended for you rather than simply added to an already impressive collection of pregnancy supplements.  If you're unsure whether you need an iron supplement, ask your midwife or GP.

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Questions You Might Want to Ask

 

If you've been told you're anaemic, you could ask:

• What is my haemoglobin level?

• Is my anaemia mild, moderate or severe?

• Do you think it's caused by iron deficiency?

• Do I need any other tests?

• Do I need iron tablets?

• How should I take them?

• What side effects should I expect?

• When will my blood be checked again?

• What happens if my haemoglobin doesn't improve?

• Could an iron infusion be an option?

• Does my anaemia affect my pregnancy or birth plans?

• What should I do if I feel increasingly breathless, dizzy or unwell?

 

You are allowed to ask for your results to be explained in plain English. You don't need to know what every number on your blood test means before you can make decisions about your care.

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The Important Bits to Remember

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• Anaemia means your haemoglobin level is lower than normal.

• Iron deficiency is the most common cause of anaemia.

• Anaemia is common during pregnancy and your blood will routinely be checked.

• Tiredness, breathlessness, headaches and palpitations can all be symptoms.

• Not all anaemia is caused by iron deficiency, so it is worth understanding what's causing yours.

• Iron tablets are commonly used to treat iron deficiency anaemia.

• If tablets don't work or aren't suitable, an iron infusion may sometimes be offered.

• Anaemia does not automatically mean you will need an induction, caesarean or blood transfusion.

• Treating significant anaemia before birth can help improve your health and give you more reserve if you experience blood loss.

• If you're unsure about your results or treatment, ask questions.

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Explore Next

 

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Pregnancy Appointments
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Know which symptoms and changes in pregnancy are worth contacting your maternity team about.

 

Preparing for Birth
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