Pregnancy & Anaemia

What is anaemia?

Red blood cells are produced in the bone marrow, and their average life expectancy is about 120 days. Anaemia is the decrease in red blood cells, which can lead to a lack of oxygen-carrying ability and causing unusual tiredness.

What are the causes of anaemia?

The deficiency occurs either through the reduced production or an increased loss of red blood cells. To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anaemia will develop. The main causes of anaemia include:

  • Poor intake of iron in diet: Iron is needed to make red blood cells. When women lose blood, they also lose iron. This happens in pregnancy due to the fact that the woman must supply iron to both herself and her baby. Iron is replaced by vitamin supplements or in the diet.
  • Folic acid deficiency: Folic acid is vitamin B, which is needed to produce red blood cells.
  • Chronic illness
  • Blood loss from bleeding haemorrhoids or gastrointestinal bleeding
  • Even if iron and folic acid intake are sufficient, a pregnant woman may become anaemic because pregnancy alters the digestive process. The unborn child consumes some of the iron or folic acid normally available in the mother’s body.

What are the signs and symptoms of anaemia?

The symptoms of anaemia include tiredness and general weakness, which are similar to those of any other type of anaemia. In severe cases, the women will be short of breath even at rest. If the anaemia is prolonged, other signs of iron-deficiency anaemia may develop such as a smooth shiny tongue and tenderness of the skin at the corners of the mouth. However, these advanced signs are rare.

How is anaemia diagnosed?

Routine blood tests during antenatal care show low haemoglobin concentration as well as the characteristic small, pale red blood cells under the microscope (in the case of iron deficiency anaemia).

The diagnosis of iron deficiency anaemia can be confirmed by measuring the amount of storage of iron as well as the levels of iron binding proteins in the blood. The diagnosis of folate deficiency is confirmed by estimating the red blood cell folate levels.

What are the effects of anaemia on pregnancy?

Patients with severe anaemia are more likely to deliver early and have small babies. Women with severe anaemia may have symptoms such as weakness, fatigue, shortness of breath and headaches.

Birth is also associated with blood loss. Therefore, if a woman is anaemic, she should take iron for several months after delivery in order to help the body replace the lost blood cells and iron stores. Breastfeeding women may also need to take iron because iron is lost in breast milk.

As long as the anaemia is treated and corrected, there should be no problems.

How is anaemia managed during pregnancy?

A well balanced diet is always recommended, but iron and folate supplementation is indicated in pregnancy.

Iron supplements in the form of ferrous sulphate tablets should not be taken more than twice daily, since the side effects of iron are increased in doses of more than two daily. The side effects are stomach upsets and constipation which are problematic in pregnancy.

RANZCOGCalvary John James HospitalCanberra HospitalAustralian  National UniversityWomens HealthICS