Anemia During Pregnancy
Anemia is a medical condition, which is commonly caused by an iron deficiency, and during pregnancy, anemia can often make you feel tired and weak. Severe anemia during pregnancy increases the risk of having a low birth weight, premature birth, maternal mortality, postpartum depression, and in some cases increases the risk of death of the infant, immediately before or after the birth. Pregnancy induced anemia is extremely common, but with a few nutritional adjustments, knowing the risk factors, and symptoms, you can still have a healthy pregnancy.
How Does Anemia Affect in Pregnancy?
It is extremely rare for a baby to have an iron-deficiency, even if you have had anemia throughout or most of your pregnancy. This is because the fetus absorbs all the iron it needs to grow and develop from the very beginning of the pregnancy. However, this does not mean that anemia cannot affect the fetus. If anemia is left untreated in pregnancy, then it can cause poor fetal growth, preterm birth, or low birth weight, or postpartum depression. In a more severe case of anemia during pregnancy, the mother may be treated using IV iron supplements, or even a blood transfusion if her hemoglobin level falls to 6 grams Per Deciliter (g/dl) or less. If you are anemic, your doctor will be able to inform you early on, as you would get blood tests done early in your pregnancy and then when you are in your second and third trimester, during the prenatal appointments.
If you have severe anemia during pregnancy, and it does not get better with initial treatment, then you may need to see a hematologist or a maternal-fetal medicine (MFM) specialist to gauge if there some other condition which is causing your anemia in pregnancy.
How to Know if You are at a Risk of Becoming Anemic During Pregnancy?
Pregnancy does increase the chances of you becoming anemic due to an increase in blood volume, which helps provide nutrients for your baby. The recommended amount of iron increases during pregnancy, from 18 mg per day to 27 mg per day. This is because your body during pregnancy requires the extra dose of iron to support additional red blood cells, the placenta, and to provide proper nutrients to your growing baby. In addition to that, the extra iron intake also prepares your body, in case of any blood loss that might occur during the process of giving birth.
Outside pregnancy, there are other factors that could increase the risk of you being anemic during Pregnancy and some of these factors are:
- Low iron-rich foods in your diet.
- Low vitamin-C rich foods (which helps in absorbing iron).
- Eating food that reduces iron absorption (such as dairy products, soy products, and products containing caffeine like tea or and coffee).
- Heavy menstrual flow (also heavy pre-pregnancy menstrual flow).
- Having two pregnancies close together.
- Pregnant with more than one child.
- Getting pregnant while you’re younger than 20 years of age.
- Having certain types of surgeries that decrease the absorption of nutrients.
- Having a stomach or intentional disease, as it alters the level of nutrients your body absorbs.
- Taking medications that interfere and affect your body’s absorption of nutrients from foods.
- Loss of a lot of blood during and after delivery in previous pregnancy.
What Are The Different Types Of Anemia During Pregnancy?
This is one of the most common types of anemia during pregnancy. It is caused due to low levels of iron in the blood. Iron is a mineral, which is present in red blood cells, that helps carry oxygen from the lungs to the rest of the body, it also helps your body to store and use oxygen. Having low levels of iron, makes the body weak, makes you feel fatigued, and it also lowers the resistance to infections, especially during pregnancy.
Folate is a vitamin. It is also referred to as Folic Acid, which is present naturally in certain fortified foods, such as leafy green vegetables, bananas, melons, pulses and cereals, as well as legumes. Folic Acid is known to be a water-soluble vitamin that is said to prevent neural tube defects during pregnancy. Folic Acid can be taken in the form of supplements as well. It is in fact taken by a lot of pregnant women. If your diet lacks Folic Acid, then it could lead to reduced number of red blood cells in your body, which would lead to a deficiency.
Vitamin B12 Deficiency Anemia
Vitamin B-12 is a necessary vitamin for your body, as it helps with the production of red blood cells. If your body does not get enough vitamin B-12 during pregnancy, it cannot produce enough healthy red blood cells, which would lead to a deficiency during pregnancy. Vitamin B-12 is found in abundance in meats, poultry, dairy products and eggs. Vitamin B-12 deficiency may lead to birth defects, neural tube abnormalities, and it could even lead to preterm labor.
Low red blood cells count in your body and a lack of enough hemoglobin during pregnancy is the true cause of anemia. Low levels of hemoglobin are caused by the expansion of volume of the plasma compared with the increase in the volume of red blood cells. The disproportionate levels between the plasma and erythrocytes are most prevalent during the second trimester of pregnancy.
What are the Signs and Symptoms of Anemia During Pregnancy?
Some of the signs and symptoms to look out for, if you think you might be Anemic while pregnant are:
- Irregular heartbeats.
- Shortness of breath.
- Pale or yellowish skin.
- Dizziness or lightheadedness.
- Cold hands and feet.
- Chest pain.
- Irritability or poor concentration.
- Unusual cravings (pica).
- Glossy tongue.
- Pale lips, inner eyelids and the insides of your mouth.
- Cracks in the corner of your mouth.
Some of these symptoms are common during pregnancy, and might not necessarily mean that you are anemic. You may not even experience some of the symptoms, especially in the early stages of anemia during pregnancy. It is best to get routine blood tests done to check for anemia during your prenatal appointments.
How is Anemia Diagnosed in Pregnancy?
Your doctor will get your blood tests done, during your first prenatal appointment. This is for your doctor to check whether or not you have anemia. A blood test typically includes a Hemoglobin test, which measures the amount of hemoglobin in the red blood cells, and a Hematocrit Test, which measures the percentage of red blood cells through a sample of blood. If your blood tests show that you have a lower than normal levels of either hemoglobin or hematocrit, then you have iron-deficiency anemia. Your doctor may take other blood tests to check if you have iron deficiency or another cause for your anemia in pregnancy.
Your doctor might recommend that you get another blood test done to check for anemia in your second or third trimester of pregnancy, as it is possible that you might not have anemia at the beginning of the pregnancy, but might become anemic at a later stage of your pregnancy. The risk connected to developing anemia during pregnancy rises solely from your blood lacking enough red blood cells to carry oxygen to your tissues and your baby during pregnancy.
Treatment of Anemia During Pregnancy & Its Prevention
Taking prenatal vitamins that contain iron can help both prevent and treat iron deficiency anemia during pregnancy. Most prenatal vitamins contain iron. As you need 27 milligrams of iron per day, your doctor might prescribe separate iron supplement during your pregnancy. If you are diagnosed with iron-deficiency anemia before your pregnancy, then let your doctor know that. It would help your doctor to keep your condition controlled and managed and help treat your condition effectively during preconception and throughout your pregnancy.
A good diet is the key to prevent iron deficiency anemia during pregnancy. You may want to include iron-rich foods in your diet like lean red meat, poultry, fish, leafy green vegetables, lentils, tofu, nuts and seeds, vitamin-C rich foods to help absorb the nutrients. Other fortified food options include breakfast cereals that are rich in iron, prune juice, orange juice, dried beans and peas, pulses and legumes.
It is essential to take plant sources and supplements that enhance the absorption of iron. It would be extremely beneficial to pair food or drinks with vitamin C (such as orange juice, tomato juice, strawberries, citrus fruit juices, kiwis, and bell peppers). If you plan to take iron supplements with a drink of orange juice, make sure to avoid the calcium-fortified variety. Even though calcium is an essential nutrient during pregnancy, it could lead to a decrease in the iron absorption levels. If you have any history of gastric bypass or small bowel surgery, which alters the gut and might lead to a decrease in your absorption levels, or if you are unable to tolerate oral iron, then you might need intravenous iron administration during your pregnancy.
Some more tips for treating anemia during your pregnancy are to take your vitamins and iron supplements prescribed by your doctor regularly. Make sure not to take iron pills with milk, as milk or dairy interferes with the efficiency of iron to work in your body. Avoid in all cases taking antacids along with iron pills as this can too affect the efficiency of iron supplements in your body. Iron supplements sometimes cause issues with bowel movements, to avoid this, eat more foods that are high in fiber, like fruits, vegetables, and cereals. About 6 to 8 glasses of water is extremely essential to drink throughout your pregnancy. Do not worry or panic if your bowels turn dark black, as this is normal. Sometimes, iron supplements could make you feel nauseous or make your nausea worse, in this case, try some of the basic and standard treatments for morning sickness, such as eating smaller and more frequent meals (six small meals instead of three big meals, is what is recommended). Another helpful tip is to cook in cast iron cookware, as this would also help boost your iron intake, as well as absorb some of the iron from the pan itself. Even though animal-based iron is absorbed quicker and better by the body than plant-based iron, you should eat what you are more comfortable with. If you follow a vegetarian or vegan diet, it is advisable to speak to your doctor about whether you should start taking vitamin B12 supplements when you are pregnant or breastfeeding.
Pregnancy in itself can be quite daunting and challenging, and when combined with anemia, it might seem like a cause of serious concern, it is best not to panic or feel helpless. Remember to speak to your doctor and open up about your concerns about your pregnancy. If you follow your doctor’s advice and maintain your diet with the right foods and supplements, then it will surely help and go a long way in your pregnancy. Eating healthy and maintaining a proper, healthy and a wholesome diet during your pregnancy will also ensure a healthy growth of your baby. Try and remain positive and have a calm state of mind when pregnant. This will not only help with the treatment and prevention of anemia in pregnancy, but also ensure the good health and proper growth of your baby.
- American Society of Hematology: Iron-Deficiency Anemia and Pregnancy – https://www.hematology.org/education/patients/anemia/pregnancy
- National Institute of Health: Folate-Deficiency Anemia – https://medlineplus.gov/ency/article/000551.htm
- American Journal of Perinatology Reports: Vitamin B12 Deficiency and Pregnancy – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164194/
- Centers for Disease Control and Prevention (CDC): Iron and Iron Deficiency – https://www.cdc.gov/nutrition/InfantandToddlerNutrition/vitamins-minerals/iron.html
- The American Journal of Clinical Nutrition: Iron absorption from the whole diet: comparison of the effect of two different distributions of daily calcium intake – https://pubmed.ncbi.nlm.nih.gov/9511035/
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