Understanding anaemia in pregnancy

Anaemia in pregnancy occurs when a pregnant woman has decreased levels of haemoglobin in her blood. Haemoglobin is an iron-rich protein found in red blood cells, responsible for transporting oxygen to tissues in the body, including the developing foetus.

Types of anaemia in pregnancy

There are several types of anaemia that can occur during pregnancy.

1. Iron-deficiency anaemia is the most common type of anaemia that occurs during pregnancy. It happens when the body does not have enough iron to produce haemoglobin that carries oxygen to the body's tissues. Iron requirements increase during pregnancy due to the expansion of blood volume and the needs of the developing foetus.
2. Folic acid (vitamin B9) deficiency anaemia is caused by inadequate intake of folate, which is essential for the production of red blood cells. Folate requirements increase during pregnancy to support foetal growth and development.
3. Vitamin B12 deficiency anaemia or megaloblastic anaemia is relatively rare but can occur in pregnant women with a diet lacking in vitamin B12 or have absorption issues. Vitamin B12 is necessary for the production of healthy red blood cells.
4. Haemolytic anaemia occurs when red blood cells are destroyed faster than they are produced. This type of anaemia can be caused by autoimmune disorders, infections, or inherited conditions.
5. Aplastic anaemia is a rare condition where the bone marrow does not produce enough red blood cells, white blood cells, and platelets. It can occur during pregnancy but is highly uncommon.

Risk factors for anaemia in pregnancy

Several risk factors that can contribute to the development of anaemia during pregnancy include the following:

• Insufficient dietary intake of iron-rich foods
• History of anaemia in a previous pregnancy
• Pre-existing medical conditioning such as chronic kidney disease, autoimmune disease
• Short interpregnancy intervals
• Heavy menstrual bleeding
• Multiple pregnancies (having twins or triplets)

Symptoms of anaemia during pregnancy

• Fatigue or feeling more tired and weaker than usual despite adequate rest
• Weakness
• Shortness of breath
• Pale skin, lips, and nails
• Rapid or irregular heartbeat
• Dizziness or light-headedness
• Headaches
• Cold hands and feet

Diagnosis of anaemia in pregnancy

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Complete blood count (CBC): This blood test that provides valuable information about your haemoglobin levels, red blood cell count, haematocrit (the percentage of blood volume occupied by red blood cells), etc. Abnormalities in these parameters can indicate the presence and severity of anaemia.
2. Iron studies: Additional blood tests may be ordered to assess iron levels and iron storage in the body to help determine if the anaemia is due to iron deficiency. These tests include serum iron, total iron-binding capacity (TIBC), transferrin saturation, and ferritin levels.
3. Other tests: Tests for folate and vitamin B12 levels and tests for underlying conditions may be ordered depending on the suspected cause of anaemia.

Treatment options for anaemia in pregnancy

The treatment of anaemia in pregnancy aims to restore and maintain adequate levels of haemoglobin and iron in the body.

Your doctor may prescribe iron, vitamin B12 or folic acid supplementation. You are also advised to increase consumption of iron-rich foods such as lean red meat, chicken, fish, green leafy vegetables, beans, and lentils. To enhance iron absorption, you should also consume food sources of vitamin C such as citrus fruits, strawberries, and tomatoes.

A blood transfusion may be performed in severe cases of anaemia that require immediate intervention. This involves receiving blood from a compatible donor to rapidly increase the haemoglobin and red blood cell count.

Q&As for anaemia in pregnancy

Q: Does anaemia in pregnancy cause infection?

A: Anaemia does not directly cause an infection but can weaken the immune system and increase the risk of developing infections.

Q: Does anaemia in pregnancy cause low birth weight?

A: Anaemia during pregnancy can impact foetal growth and development, potentially leading to lower birth weight due to a reduction in oxygen supply to the foetus, premature birth and complications during pregnancy. Compared to women who do not have anaemia during pregnancy, pregnant women with low haemoglobin levels are more likely to deliver a low-birth-weight baby (less than 2.5kg at birth).

Q: When should I worry about anaemia in pregnancy?

A: If you are pregnant and concerned about anaemia, it is important to discuss your concerns with your healthcare provider. While mild anaemia is relatively common in pregnancy, certain signs and symptoms may indicate a more severe condition.

• Significant weakness
• Chest pain
• Difficulty performing daily activities
• Extreme fatigue

If you experience ongoing symptoms of anaemia, such as excessive fatigue, shortness of breath, dizziness, or rapid heartbeat, it is vital to consult your doctor. Persistent or worsening symptoms may indicate more significant underlying anaemia or other health issues that require evaluation and management.

Make an appointment at Gleneagles Hospitals

Attending routine prenatal visits and maintaining open communication with your doctor are essential for monitoring your well-being and addressing any questions or worries that may arise during pregnancy.

If you are experiencing any of the symptoms of anaemia during your pregnancy, get in touch with us to find out more about our Obstetrics & Gynaecology Services at your nearest Gleneagles Hospital.