Anemia during pregnancy – causes, symptoms, treatment, prevention

Even if you have healthy hemoglobin levels during the start of your pregnancy, you could still face the wrath of anemia during pregnancy

India is one of the countries with very high prevalence of anemia in the world. Not only the lower socioeconomic strata it is also prevalent in the fairly educated upper to middle class people caused due to faulty diet and lifestyle practices.

According to the statistics by WHO almost 58 percent of women inIndia are anemic and it is estimated that anemia is the underlying cause for 20 to 40 percent of maternal deaths in India. Also India contributes to about 80 percent of the maternal deaths due to anemia in South Asia.

The statistics are enough to scare you and make you believe that when it comes to anemia during pregnancy prevention is better than cure. ‘As a good practice one should get a blood test done to check for the condition while planning the pregnancy. This would make it easy to manage and treat the problem of anemia during pregnancy, says Dr Richa Jagtap, clinical director & consultant reproductive medicine, Nova IVI Fertility Centre, Mumbai. Know more about the consequences of anemia. 

Read more about causes, symptoms, diagnosis and treatment ofanemia.

Are women prone to become anemic during pregnancy?

‘There is a physiological drop in the hemoglobin levels during the first three months of pregnancy. Also, given the demands of a growing fetus it will eventually draw all nutrition required from the mother; this leaves the pregnant woman without adequate nutrition levels to last a pregnancy and lactation period which can lead to severe consequences,’ says Dr Jagtap. In case of pre-pregnancy anemia, this gets escalated and has more severe repercussions.

Girls who face pregnancy during their teens stands a greater chance of suffering from this condition. ‘For women when the difference between two pregnancies is less than three years she might not have adequate store of iron to last the demanding period of the pregnancy and might suffer from anemia,’ says Dr Jagtap.

There are several types of anemia that one can suffer from during pregnancy

Iron-deficiency anemia: This is the most common of all the conditions and happens when the body doesn’t have enough iron to produce adequate amounts of hemoglobin. Hemoglobin is a protein in the red blood cells that carries oxygen from the lungs to the rest of the body.

Folate-deficiency anemia: Your doctor gave you folic acid pills and it had a purpose to serve. Folate is needed by the body to produce new cells during pregnancy including healthy red blood cells. In the absence of normal red blood cells oxygen supply throughout the body retards and it poses to be a treat to the growing baby. Know why folic acid is important during pregnancy.

Vitamin B12 deficiency anemia: This vitamin is essential for the body to help in the formation of healthy red blood cells. Vitamin B12 deficiency is prevalent in women who refrain from having dairy products, poultry and meat.

What are the signs and symptoms of anemia during pregnancy?

It’s not wise to look for just the physiological signs to diagnose anemia during pregnancy because only a blood test revealing the hemoglobin count can give you an accurate status about your health. Moreover the symptoms that can suggest you are suffering from anemia will overlap with that of symptoms of pregnancy in general. But beware of these following signs and symptoms that suggest a drop in your hemoglobin levels.

• Extreme fatigue
• Less than adequate weight gain
• Pregnancy induced hypertension
• Dizziness
• Shortness of breath
• Rapid heartbeat
• Lack of concentration

 ‘If you had experienced the anemia symptoms pre pregnancy you would suffer from an exaggeration of the symptoms during pregnancy,’ says Dr Jagtap.

What causes anemia during pregnancy?

Some of the most common reasons that can give rise to anemia during pregnancy are listed below: 

• Insufficient quantity of iron-rich foods in the diet
• Inclusion of tea, coffee or other calcium rich food that comes in the way of iron absorption in the blood
• Poor stores of iron from infancy and childhood deficiencies and adolescent anemia.
• Teenage pregnancy
• Less gaps between two pregnancies like  getting pregnant in a gap of two years
• Iron loss due to illness like malaria, intestinal worms etc.
• Anemic before pregnancy. This can get aggravated during pregnancy.

 How does anemia affect pregnancy?

Severe anemia during pregnancy impairs oxygen delivery to the fetus and interferes with normal intra-uterine growth, resulting in intrauterine growth retardation, stillbirth, LBW and neonatal deaths. Hence timely correction of anemia is of utmost importance. ‘The newborn of an anemic mother can be born premature leading to a lot of health issues like low birth weight, decreased aptitude, anemia, feeding disabilities,’ informs Dr Jagtap. Also post childbirth chances are that the baby born to a mother suffering from severe anemia can suffer from growth retardation which again has long term effects on metabolic and cognitive functions. Anemia predisposes to low birth weight of baby, preterm delivery and it can also lead to post partum hemorrhage and failure to lactate.

How can one control anemia during pregnancy?

Anemia should be diagnosed well before a pregnancy is contemplated and effectively corrected before conception. However if it is diagnosed during pregnancy, a good antenatal care is mandatory.

Iron requirements are highest for pregnant women –1.9 mg/1,000 Kcal of dietary energy in the second trimester and 2.7 mg/1,000 Kcal in the third trimester. These should be well adjusted in her diet plan.

‘The woman will need 100 mg of elemental iron and 500 mcg of folic acid daily for 100 days during pregnancy. Followed by same dose for 100 days in the post-partum period is the WHO anemia initiative recommendation,’ informs Dr Jagtap.

To control anemia effectively keep a tab on your hemoglobin levels:

• If the hemoglobin level is between 8-10 gm/dl, oral therapy should be started.
• For women with hemoglobin 7-8gm/dl injectable iron doses would be necessary to build up the reserve, especially if in mid or last trimester of pregnancy.
• If the hemoglobin is less than 7 gm/dl, depending upon the time till delivery, injectable therapy or packed blood cell transfusion is required.

Hemoglobin should be tested monthly and if there is improvement same therapy should be continued. If no improvement, the treatment should move to next step, with the help of a hematologist.

If the woman is in last few months of pregnancy, and there is not much time to effect improvement with oral medication, packed cell transfusion is advised as per the reports.

To effectively control anemia during pregnancy your doctor would give you iron medications right at the start to build on the reserves, it makes sense to take those pills regularly.

What diet changes are suggested to help control anemia during pregnancy?

Though anemia can be only controlled through proper medications, but some diet changes can also up your iron intake. The pregnant moms are advised to increase intake of:

• Spinach and other dark green leafy vegetables
• Tofu 
• Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
• Dried fruits, such as prunes, raisins, and apricots, jaggery, peanuts.
• Prune juice
• Iron-fortified cereals and breads
• Whole wheat and whole grain flour rather than refined flour
• Non-vegetarians are suggested to increase meat and include chicken, turkey, fish and shellfish in their diet. keep in mind to cook the food correctly as raw meat or fish can do your growing baby more harm than any good.