Anemia is a common blood disorder where the blood’s capacity to carry oxygen is reduced. Most cases are due to iron-deficiency anemia. It is particularly common in women of reproductive age due to menstruation. The risk of anemia increases greatly during pregnancy. Fortunately it is easily treated and prevented with dietary changes and supplementation. In rare instances of severe anemia, other medical options need to be considered during pregnancy.
What is pregnancy anemia?
Pregnancy anemia is where the blood’s oxygen-carrying capacity is reduced during the course of pregnancy. Sometimes the anemia started prior to conception and can continue for a long period after childbirth. In this case pregnancy simply worsened the pre-existing anemia. It is mainly a consequence of the increased demands of the growing fetus on the mother’s body which leads to nutritional deficiencies if the necessary precautions are not taken through dietary change and supplementation.
Anemia is a problem with the red blood cells, the cells that carry gases in the bloodstream. The quantity, shape and structure of red blood cells plays a role in the oxygen-carrying capacity of blood and anemia is a broad term referring to such abnormalities. In pregnancy anemia, the disorder with the red blood cells is mainly due to deficiencies in iron, folate and vitamin B12. However, women with other types of anemia can also experience blood-related problems during pregnancy.
Types of Pregnancy Anemia
There are three types of anemia that are likely to occur in pregnancy:
- Iron deficiency anemia where there is a lack of iron, an important component of hemoglobin which is a part of red blood cells.
- Folate deficiency anemia where there is insufficient folate (folic acid) which leads to abnormally large red blood cells.
- Vitamin B12 deficiency anemia where there is low levels of vitamin B12 which leads to reduced numbers of red blood cells.
These types of anemia either develop during the course of anemia or may have been present prior to falling pregnant. Significant blood loss during childbirth can also lead to anemia.
Causes of Anemia in Pregnancy
Pregnancy-related anemia arise for several reasons. First there is an increased nutritional demand on the mother’s body by the growing fetus. The fetus requires micronutrients like iron, folate and vitamin B12. Usually a woman loses anywhere between 4 to 100 mg of iron with each period but in pregnancy loss is as much as 500mg of iron. Not only do these nutritional deficiencies have consequences for the mother, like anemia, but can also impact fetal growth and development as is the case with neural tube defects due to a folic acid deficiency.
The second contributing factor is that a range of gastrointestinal disturbances may lead to a loss of appetite, like with morning sickness. This is associated with the rise in certain hormone levels during pregnancy particularly in early pregnancy and further complicated by the enlarged uterus in later pregnancy. Reduced food intake especially at a time where there is increased nutritional demands will quickly lead to nutritional deficiencies.
Women who have two pregnancies close to each other, have multiple fetuses (twins, triplets and so on) and are fasting for prolonged periods during pregnancy are more likely to develop anemia. Teen mothers are also at a greater risk. People with eating disorders are also at an increased risk of developing pregnancy-related anemia. Vegetarians and vegans may also be at risk if they are avoiding dairy, not taking supplements and not maintaining a balanced diet.
Signs and Symptoms
The presence of signs and symptoms of anemia depend on the severity of the condition. Mild anemia may be asymptomatic. One of the problems with pregnancy anemia is that the symptoms may be masked by the physiological changes that occur in the body during this time. General anemia signs and symptoms include:
- Pale skin, including paleness of the lips and nails
- Dizziness which is worse with physical activity
- Shortness of breath sometimes even with mild activity
- Feeling tired and weak
- Difficulty concentrating
- Rapid heart rate sometimes with low blood pressure
As is evident from the symptoms above, most of these symptoms are considered as a normal part of pregnancy. It is therefore important that pregnant women have blood tests to confirm or exclude anemia in pregnancy. This is usually done as part of antenatal monitoring. The effects of anemia is not limited to the mother. It can also affect the growth and development of the fetus. This may include low birth weight, preterm birth, neural tube defects, baby with anemia and development delays.
Diet for Pregnancy Anemia
Most pregnancy-related anemias can be easily remedied with balanced meals. Foods rich in deficient nutrients should be consumed in larger quantities. Fortunately many of the same foods are rich in the required micronutrients.
- Leafy vegetables
- Beans and lentils
- Fortified cereals and breads
- Seeds and nuts
- Meat (red meat, poultry, fish) and eggs
Vitamin B12 is found in meat and dairy and vegans in particular therefore need to consider supplementation. Foods rich in vitamin C should also be included as vitamin C helps with iron absorption. It has been established that certain beverages, like tea, may impair iron absorption especially if it is consumed a short while before and after meals. It should therefore be avoided.
Treatment for Pregnancy Anemia
Mild to moderate anemia usually does not require medical treatment. Prenatal vitamins containing most of the required micronutrients is always advisable for every pregnant woman even if there are no deficiencies or related complications. These supplements along with a balanced diet are usually sufficient to prevent deficiencies and the development of anemia. Ideally prenatal vitamins should be commenced prior to conception to build up stores of the necessary micronutrients.
Severe anemia requires prompt medical treatment. In severe cases that are not responding to supplementation in the desired time, blood transfusions may be a consideration. This is usually done for significant blood loss at the time of delivery. Vitamin B12 injections may be necessary particularly for vegans. Contributing factors like severe morning sickness should be medically treated in order to help the mother return to a normal diet. Women who are planning a pregnancy should ensure that all nutritional deficiencies are treated prior to conception.