Iron deficiency anemia (IDA) in pregnancy means that there is a lack of iron in your body during your pregnancy months. There are certain risk factors that make you prone to this condition. You may develop some symptoms of this condition and some complications can also set in. Therefore, though IDA can be treated, it is always a good idea to prevent this condition.

Anemia is defined as a condition in which your body lacks sufficient healthy red blood cells or hemoglobin to carry sufficient oxygen to your body’s tissues and organs. If left untreated, it can cause health issues.

According to The British Committee for Standards in Haematology (BCSH) guidance, anemia in pregnancy is defined as

  • Hemoglobin (Hb) during the first trimester is less than 110 g/l,
  • Hb during the second/third trimester less than 105 g/l, and
  • Postpartum Hb less than 100 g/l.

Iron deficiency (ID) is the commonest cause of anemia in pregnancy. The prevalence of iron deficiency anemia (IDA) amongst pregnant Indian women is one of the highest in the world.

The recommended daily allowance (RDA) of iron during pregnancy is 27 mg. In a non-pregnant woman, the RDA for iron is 18 mg.

The requirement or need for iron in pregnancy increases by almost 50%. In pregnancy, therefore, there lies a risk of iron deficiency and the development of anemia. Care, therefore, should be taken to have enough iron in your pregnancy diet and prevent anemia.

Why do you require more iron during pregnancy?

  • The red blood cells of the blood contain a protein called hemoglobin, a significant part of which is made of iron. This hemoglobin carries oxygen in the blood to be supplied to various parts of the body. Lack of iron, therefore, results in less oxygen being received by the body cells. The result is anemia.
  • Due to an increase in blood volume and circulation during pregnancy by almost 50%, the iron requirement increases to make that much more hemoglobin. Besides the increased need by the fetus, having extra iron by the pregnant mother also helps to combat blood loss during delivery. About two-thirds of iron in the body is stored in hemoglobin. It is important to fulfill this increased requirement in order to fuel the increased production of hemoglobin and avoid anemia.
  • Towards the end of pregnancy, the baby too starts storing a good six months’ requirement of iron, as it does not get enough of it from the mother’s milk. After six months, solid foods (which are often fortified) begin the iron supply to the infant.
  • Iron also helps in the development of muscles in the mother and baby.
  • Sufficient intake of iron also reduces the risk of premature delivery and low birth weight baby.

When is testing for iron done during pregnancy?

All pregnant women should have a full blood examination in early pregnancy.

Besides, women are tested for iron levels in their blood twice during the course of pregnancy. The first is during the beginning of pregnancy and then during the end of the second trimester or beginning of the third trimester (ie around the 28th week of pregnancy).

It is during the second half of pregnancy that there is a surge of formation of blood and plasma and the red blood cell (RBC) formation may not keep up at the same pace.

If anemia is detected at this period, retesting is done after about two weeks to allow the RBCs to form and show the true levels of iron in the blood.

What risk factors make you prone to anemia during pregnancy?

Certain factors increase your risk of developing anemia during pregnancy. They include:

  • If you have been dieting to lose weight
  • If your diet does not give you enough iron
  • If your pregnancies have been close to each other (less than 2 years)
  • If you have bled more during your periods

Signs and symptoms of iron deficiency anemia in pregnancy

Many a time, you may not experience any symptoms though you are anemic. This may happen especially when your anemia is mild. The symptoms and signs when present can manifest as follows:

  • Your skin appears paler than usual. Paleness is also seen in your fingernails, conjunctiva of the eyes, and on your tongue.
  • You will feel tired, fatigued, weak, and dizzy.
  • Feeling cold in your hands and feet
  • Frequent headaches and irritability
  • You will have trouble concentrating
  • You will have palpitations (of the heart).
  • There is shortness of breath
  • Your doctor will notice a rapid heartbeat.

Complications of anemia in pregnant mother and fetus

  • Untreated iron deficiency anemia has significant adverse effects on the fetus and the pregnant woman. Preventing iron deficiency during pregnancy, therefore is imperative, in lieu of the effects it can have on the mother and fetus.
  • Anemic mothers who have iron deficiency are at a greater risk of prenatal death, premature delivery, and low birth weight babies.
  • The immunity of the anemic mother is also compromised.
  • Anemia during pregnancy also increases risks of fetal abnormalities, fetal deaths, and long-lasting defects in mental development.
  • Iron deficiency in pregnant mothers also increases the risk of severe morning sickness.

Treatment of iron deficiency anemia in pregnancy

Treatment for IDA includes dietary modification to include iron-rich foods (a list of which is given below) and oral iron supplements.

Oral supplements

Oral iron supplements contain ferrous sulfate or ferrous gluconate or ferrous fumarate. The dose will depend on the severity of the anemia.

You should take iron supplements with water and not with tea, coffee, or milk. The calcium in milk interferes with iron absorption. Secondly, do not exceed the dose advised by your doctor.

You may experience stomach upset when taking oral iron supplements. In such cases, your doctor may change the tablets or lower the dose or divide the dose over the day. You should always take your iron supplements after meals.

Within a week after starting iron supplements, your hemoglobin (Hb) levels will begin to rise and it may be two months for Hb levels to come to normal. Your doctor will advise you to take Iron supplements for several months to replenish your iron reserves.

Stools may darken in color due to iron supplements and this is normal and harmless. But, if you notice blood in your stools, talk to your doctor.

Intravenous iron

Iron deficiency anemia in the third trimester is treated with intravenous iron to replete iron stores quickly in preparation for delivery.

Intravenous iron is also indicated when anemia is severe (< 8 g/dL) in the second trimester or in the third trimester.

Ferritin < 15micrograms/L indicates iron exhaustion throughout pregnancy. Treatment should be initiated before iron deficiency develops with ferritin between 15- 30micrograms/L.

Blood transfusion

Most transfusions given during pregnancy and after delivery are mostly red blood cells only. Occasionally, however, platelets and plasma may also be required.

The two primary reasons a blood transfusion is required during pregnancy include the development of severe anemia just before the due date or hemorrhaging at some time during pregnancy.

Prevention of iron deficiency anemia in pregnancy

It is always wise to prevent than to cure if you can help it. You can prevent anemia in pregnancy by religiously taking your prenatal supplements, which your doctor has advised.

Secondly, follow your pregnancy diet religiously. This is enough to keep anemia away. Below are some foods that are rich sources of iron. Do incorporate them into your diet.

Iron-rich foods for pregnancy

Expecting mothers need 18 mg of iron a day. The best way to get the vitamins, minerals, and nutrients for you and your developing baby for healthy development is from a well-balanced diet that contains iron-rich foods as well.

Food sources rich in iron include:

  • Beef
  • Pork
  • Shrimp
  • Spinach and other green vegetables
  • Broccoli
  • Green beans
  • Tomato juice
  • Legumes
  • Dried fruits
  • Enriched and whole grains (wheat, rice, barley, cornmeal)
  • Oatmeal
  • Potatoes
  • Raisins
  • Dates
  • Tofu (bean curd made by coagulating soymilk)
  • Jaggery