Anaemia in pregnancy

When you have anaemia, your blood doesn't have either enough healthy red blood cells or haemoglobin. This affects how your body carries oxygen around your body and to your baby.

Red blood cells are made in your bone marrow. They contain a protein known as haemoglobin, which carries oxygen around your body.

You need enough iron, vitamin B12 and folate to produce all the haemoglobin you need. If you don't have enough of these nutrients, you may become anaemic.

Anaemia in pregnancy is a common condition, happening in about 1 in every 4 pregnancies. It can be managed by your doctor.

Iron deficiency anaemia can be made more likely by:

• a vegetarian or vegan diet
• a poor diet
• severe morning sickness
• having pregnancies that are close together
• having a history of anaemia

Symptoms of anaemia can include feeling:

• weak
• tired
• dizzy

You may also have:

• a headache
• shortness of breath
• chest pain

Iron deficiency is the main cause of anaemia during pregnancy. You need more iron when you are pregnant. Low iron levels may be caused by:

• not enough iron in your diet
• poor iron absorption
• blood loss due to parasites

Anaemia in pregnancy can also be caused by:

• a lack of folate (folic acid)
• a lack of vitamin B12 in your diet
• blood disorders — such as thalassaemia and sickle cell disease

You will have a blood test when you first see a doctor or midwife about your pregnancy. You will usually have another blood test when you are about 28 weeks pregnant. These blood tests check your full blood count and haemoglobin level.

If your haemoglobin levels are low, your doctor or midwife might arrange for you to have more blood tests. These help to find the cause of your anaemia.

The way that your anaemia is treated will depend on what is causing it.

Iron-deficiency anaemia

If you are diagnosed with iron deficiency anaemia during pregnancy, your doctor may recommend iron supplements (tablets).

Some people who take iron supplements get side effects that include nausea or constipation.

If you don't get better with the supplements, your doctor may offer iron treatment by an intravenous injection (into your veins). If you need an iron infusion, ask your doctor if you should expect any side effects.

Your doctor will continue to monitor your haemoglobin levels.

Your doctor may treat you for hookworm if they think this could be the cause of your anaemia.

Severe iron-deficiency anaemia (haemoglobin concentration <70 mg/dL) can cause cardiac (heart) failure. It may also mean that your body is less able to cope with blood loss at birth.

Anaemia during pregnancy can affect your baby's iron stores.

Anaemia due to either a lack of folate or vitamin B12 are linked to neural tube defects in your baby.

If you're planning a pregnancy

If you are planning a pregnancy, you should see your doctor. At this time, you will get advice about anaemia. Your doctor or midwife will also talk to you about taking supplements — particularly folate (or folic acid).

Folate supplements

You will be advised to take a folic acid supplement for at least a month before becoming pregnant. The standard dose is 0.4-0.5mg of folic acid per day.

You should continue to take a folic acid supplement for the first 3 months of your pregnancy.

Taking folic acid supplements will decrease the risk of you getting anaemia due to folate deficiency. It will also decrease the chance that your baby will have neural tube defects such as spina bifida.

Eating well

Eating well while pregnant may help to protect you from developing anaemia. Iron is found in:

• meat, chicken and fish
• legumes
• nuts
• wholegrain breads and
• cereals
• leafy green vegetables

Eating citrus fruit may help you absorb the iron in your food.

Find out more about healthy eating during your pregnancy.

The Dietitians Australia website allows you to search for an Accredited Practising Dietitian.