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Anemia in Pregnancy

Last updated March 20, 2018

Approved by: Maulik P. Purohit MD, MPH

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Anemia in Pregnancy refers to low hemoglobin levels or decreased red blood cell count causing decreased oxygen-carrying capacity in a pregnant woman. This reduced oxygen-carrying capacity results in reduced oxygen supply both to the mother and to the developing baby.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Anemia during Pregnancy
  • Folate Deficiency Anemia in Pregnancy
  • Iron Deficiency Anemia in Pregnancy

What is Anemia in Pregnancy? (Definition/Background Information)

  • Anemia in Pregnancy refers to low hemoglobin levels or decreased red blood cell count causing decreased oxygen-carrying capacity in a pregnant woman. This reduced oxygen-carrying capacity results in reduced oxygen supply both to the mother and to the developing baby
  • A lack of sufficient amount of iron in the red blood cells (RBCs) is a common cause of anemia in pregnant women. This condition is termed Iron Deficiency Anemia in Pregnancy
  • Mild anemia is common in most pregnant women due to an increase in blood volume without a corresponding increase in the number of red blood cells. However, there are many risk factors that may lead to more severe cases of anemia, the most notable one being nutritional deficiency
  • Anemia in Pregnancy may give rise to fatigue and tiredness, pale skin, and shortness of breath. Severe anemia due to iron or folic acid deficiency can cause neural tube defects in the growing fetus or even a preterm delivery
  • Treatment of the condition mainly involves adequate dietary intake of the essential vitamins and minerals with supplementation (if required) throughout the pregnancy period. An early identification of Anemia in Pregnancy can lead to an excellent prognosis for both the mother and child

Who gets Anemia in Pregnancy? (Age and Sex Distribution)

Anemia in Pregnancy is commonly seen in all pregnant women to some extent. Generally, without suitable treatment, anemia progresses and gets worse as the pregnancy progresses. Hence, women who are in advanced stages of pregnancy are more likely to get signs and symptoms associated with the condition.

  • Anemia during Pregnancy may affect any pregnant woman of reproductive age, generally between 18 and 49 years
  • All racial and ethnic groups are affected. Nevertheless, this condition is more prevalent in pregnant women who come from poor socioeconomic backgrounds (such as from developing countries of Asia and Africa)
  • In the US, Mexican American and African American women are at a higher risk for developing Anemia in Pregnancy. The prevalence of the disorder is higher in these groups than that of Caucasian Americans

Studies show that the incidence rates of anemia among the general population have declined. However, no evidence of a concurrent decline in Anemia and Pregnancy is observed.

What are the Risk Factors for Anemia in Pregnancy? (Predisposing Factors)

The risk factors for Anemia in Pregnancy are mainly due to the changes the body experiences during pregnancy. The risk factors include:

  • Nutritional deficiency of iron, folic acid, and/or vitamin B12
  • A narrow time frame between 2 consecutive pregnancies: Women, who get pregnant again after a recent delivery, are at an increased risk. This may be because the body has not fully recovered from depleted iron stores that occurred during a pregnancy
  • Being pregnant with twins or multiple babies
  • Regular and heavy vomiting as a result of morning sickness

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Anemia in Pregnancy? (Etiology)

Anemia in Pregnancy is the result of 2 main factors: Increased plasma (the fluid part of blood) volume and proportionally lower amounts of blood proteins and minerals.

  • During the first 2 trimesters of pregnancy, the body produces more blood to assist in nourishing the growing fetus. Anemia during Pregnancy is primarily due to an increase in the fluid volume of blood without a proportional increase in the number of red blood cells. Effectively, this leads to diluted blood that cannot supply the body with enough oxygen
  • Deficiencies in certain vitamins and minerals (e.g., iron and folic acid) may exacerbate the mild anemia already inherent in pregnant women
  • Reduced levels of folic acid, also known as vitamin B9, have been linked to an increased risk of Anemia in Pregnancy. Folic acid is required to maintain an adequate number of blood cells in circulation

Red blood cells (RBCs) returning from the tissues pass back through the lungs to pick up oxygen. The oxygen binds to hemoglobin, a protein present in the RBCs. From the lungs, oxygenated RBCs travel back to the heart and then are pumped to the tissues to deliver oxygen.

  • Iron is an important structural component in hemoglobin. Inadequate levels of iron can lead to a decrease in the amount of hemoglobin present in RBCs, and a subsequent decrease in the amount of oxygen delivered to the body
  • Mild, possibly asymptomatic anemia is common due to the inherent problems associated with the fluid portion of blood increasing in volume faster than the red blood cells can increase in numbers. This means that the iron stores in the body are diluted by the fluid accumulation that occurs during a normal pregnancy. This condition is often referred to as physiologic iron deficiency

What are the Signs and Symptoms of Anemia in Pregnancy?

The signs and symptoms of Anemia in Pregnancy are similar to those of other anemia types. These include:

  • Fatigue
  • Pallor of the skin or pale skin
  • Tachycardia (increased heart rate)
  • Shortness of breath
  • Dizziness
  • Headache

The main signs and symptoms of Anemia in Pregnancy are a result of inadequate oxygen being supplied to the body.

How is Anemia in Pregnancy Diagnosed?

The diagnosis for Anemia in Pregnancy in women usually begins with a complete medical exam, followed by an analysis of prior medical history by a healthcare professional.

  • The methods for diagnosis can include both a qualitative assessment of the previously mentioned symptoms; as well tests that quantitatively measure certain components of blood
  • A common test performed to diagnose anemia is a complete blood count (CBC). A CBC measures the numbers of various types of blood cells in circulation. Importantly for anemia, it gives the red blood cell number, levels of hemoglobin, and hematocrit (the amount of red blood cells present per volume of blood). Decreased levels of any of these three components, in addition to the presenting signs and symptoms, could be an indication of Anemia in Pregnancy

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Anemia in Pregnancy?

In addition to complications common to anemia in general, complications for Anemia in Pregnancy also may extend to the growing fetus.

  • In addition to the general symptom of fatigue, there may be complications for both the expectant mother and growing fetus resulting from different types of anemia
    • Folate deficiency anemia can lead to neural tube (spinal cord) defects in the infant
    • Iron deficiency anemia may result in premature delivery and reduced birth weight
  • General damage to other organs due to inadequate oxygen supply
  • Anemia in Pregnancy may lead to irregular heartbeats (arrhythmias)

How is Anemia in Pregnancy Treated?

Anemia in Pregnancy as a result of iron and folate deficiencies can be treated through changes in diet or by taking supplements (as recommended by a healthcare professional).

  • Foods high in iron include red meat, dark green leafy vegetables, legumes, and iron-enriched breads and pasta. Oftentimes, an iron supplement will be prescribed when the cause of anemia is identified
  • Foods high in folic acid include lentils, dark green vegetables, and citrus fruits. These should form part of a pregnant woman’s diet (even during the period before pregnancy)

How can Anemia in Pregnancy be Prevented?

There are many measures that women may take to lower their chances of developing Anemia during Pregnancy.

  • Eating healthy during pregnancy such that there is a dietary intake of all the necessary vitamins and minerals
  • Similar to taking more concentrated oral supplements, eating foods high in iron and folic acid can help prevent severe cases of Anemia in Pregnancy
  • It is recommended that women take folic acid supplements both before becoming pregnant and during the first trimester of pregnancy

What is the Prognosis for Anemia in Pregnancy? (Outcomes/Resolutions)

  • The prognosis for Anemia in Pregnancy is good, if it is identified early and treated suitably. As long as a proper diet is maintained and supplements are taken as needed, Anemia in Pregnancy is generally manageable
  • However, if anemia is left untreated for longer periods of time (into the pregnancy); then, it can lead to a worse prognosis, exposing both the mother and child to various health conditions. The longer the fetus is exposed to anemic conditions in utero, the higher are the chances of certain adverse effects on fetal development

Additional and Relevant Useful Information for Anemia in Pregnancy:

The World Health Organization informs that Anemia in Pregnancy affects over 50% of the pregnant women in the developing nations and about 20% in the developed nations. Socioeconomic and lifestyle factors play a key role in explaining this vast difference between the two.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 21, 2016
Last updated: March 20, 2018