Amy Marlow, MPH, RD, CDN
Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low the body does not get enough oxygen. This can cause symptoms such as fatigue, pale skin, or irregular heartbeat.
Liquid blood and plasma increases by about 50% during pregnancy but RBCs only increase by about 30%. This imbalance may lead to anemia.
The most common cause of anemia in pregnancy is a low level of iron. Iron is the mineral that makes hemoglobin. During pregnancy, your iron requirements increase from 15 mg (milligrams) per day to 30 mg per day as your blood volume increases. The total iron requirement during pregnancy is 1,000 mg. If this need is not met or if your iron stores are low, you may develop anemia.
Other less common causes of anemia in pregnancy include:
Factors that can increase your chance of getting anemia in pregnancy include:
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:
Your practitioner will test your blood for anemia at your first prenatal visit. It will also be tested again late in the second trimester or early in the third trimester.
Your practitioner will look at the following:
The treatment for anemia in pregnancy depends on the cause of the anemia. Dietary changes usually are not enough. 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 that are high 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. 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, then 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.
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 developing anemia in pregnancy:
The American Congress of Obstetricians and Gynecologists
American Pregnancy Association
National Women’s Health Information Center
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.
Anemia & pregnancy. American Society of Hematology website. Available at:
http://www.hematology.org/patients/blood-disorders/anemia/5227.aspx. Accessed December 18, 2012.
Anemia in pregnancy.
The American Congress of Obstetricians and Gynecologists, Practice Bulletin No 95. July 2008 (Reaffirmed 2010).
Beers MH, Berkow R, Burs M, eds.
The Merck Manual of Diagnosis and Therapy. Whitehouse Station, New Jersey: Merck Research Laboratories; 1999.
Gordon D. Obstetrics, Gynecology, and Infertility. 5th ed. Arlington, VA: Scrub Hill Press; 2001.
Hemoglobinopathies in Pregnancy, American College of Obstetricians and Gynecologists, Practice Bulletin, no. 78, January 2007.
Last reviewed November 2012 by Andrea Chisholm
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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