Articles

Key takeaways

• Anaemia means you have too few red blood cells or not enough haemoglobin.
• Iron-deficiency anaemia is the most common type in pregnancy.
• Routine blood tests check for anaemia during your antenatal care.
• Oral iron supplements and iron-rich foods are key treatments.

What is anaemia in pregnancy?

Anaemia is a condition where you do not have enough red blood cells. It can also mean you do not have enough haemoglobin in your red blood cells. Haemoglobin is needed to carry oxygen around your body and to your baby.

The most common type of anaemia is iron-deficiency anaemia. It affects around 4 in 10 pregnant people in the UK. Anaemia means the level of haemoglobin in your blood is lower than normal.

Why anaemia is common in pregnancy

Your body needs iron to make red blood cells for both you and your baby. Red blood cells carry oxygen to your organs, tissues, and baby.

The amount of blood in your body increases by around 50% when you are pregnant. This means more iron is needed to make the extra red blood cells.

Your body needs more iron than usual in pregnancy, and this increases as your pregnancy goes on. In the second half of pregnancy, you need twice as much iron as you did before you were pregnant.

To produce haemoglobin, your body needs iron, vitamin B12, and folic acid. Because of these extra needs during pregnancy, your risk of anaemia is higher.

How anaemia can affect you and your baby

Most people with iron-deficiency anaemia in pregnancy have a healthy pregnancy and baby. However, if it is not treated, it can increase the risk of some complications.

For you, these can include:

• Extreme tiredness (fatigue) during pregnancy and in the months after birth
• Infection and illness
• Postnatal depression

It's important to remember that these complications are not common, and getting treatment for anaemia greatly reduces these risks. For your pregnancy, severe anaemia, If left untreated, can increase the risk of:

• Low birthweight
• Your baby being born too early (preterm birth)
• Iron deficiency in the first 3 months of their life of your baby

Your care team will help you manage your anaemia to reduce these risks. In very rare cases, severe and untreated anaemia can increase the risk of stillbirth. This is why getting treatment is so important.

Symptoms and diagnosis

Symptoms of anaemia include:

• Tiredness and lack of energy
• Shortness of breath
• A noticeably fast-beating, fluttering, or pounding heart (heart palpitations)
• Skin that is paler than normal—this can happen in a person with any skin tone

Mild anaemia is common during pregnancy. Severe anaemia is when your haemoglobin level is very much lower than normal. It can make you feel very unwell with dizziness, breathlessness, and chest pain.

How anaemia is diagnosed

You will be checked for iron-deficiency anaemia during your routine antenatal appointments. Your midwife will offer you a blood test at your booking appointment and again when you are 28 weeks pregnant. If you are pregnant with more than one baby, you will be offered an extra blood test at 20-24 weeks.

You can contact your GP or midwife at any time if you think you have symptoms of anaemia. You do not have to wait for your antenatal appointments or for routine tests.

Other types of anaemia

You will not routinely be tested for vitamin B12 or folate deficiency anaemia as part of your antenatal care. You will only be tested if you have a condition, are taking certain medications, or have symptoms.

Symptoms of vitamin B12 or folate deficiency anaemia can include:

• Extreme tiredness and lack of energy
• A sore and red tongue
• Mouth ulcers
• Pins and needles
• Muscle weakness
• Problems with vision
• Depression, anxiety, or confusion
• Difficulty with your memory, understanding things, or making decisions (cognitive problems)

You should contact your GP if you have symptoms of vitamin B12 or folate deficiency anaemia. They can diagnose this with a blood test.

Vitamin B12 or folate deficiency anaemia is a specific type. It causes the body to make red blood cells that are too large and do not work properly.

Your body may need more folate than usual in pregnancy. Vitamin B12 helps the body use folate.

It is important to correct a diagnosed vitamin B12 deficiency for the health of both you and your baby. Taking vitamin B12 can help prevent and treat anaemia and symptoms like extreme tiredness. Vitamin B12 treatment can also help with the normal development of your baby in the womb.

A B12 deficiency in pregnancy can increase the chance of your baby having a neural tube defect, such as spina bifida. If you need vitamin B12 treatment your care provider will discuss treatment options with you.

Treatment for iron-deficiency anaemia

If you are iron-deficient in pregnancy, try to eat more foods that have a lot of iron. However, it is often not possible to get all the iron you need just from food once you are iron-deficient. Your doctor will likely prescribe iron to take as tablets or a liquid.

Tips for taking iron supplements

1. Take iron supplements early in the morning on an empty stomach.
2. Drinking orange juice or another source of vitamin C with or after your iron can help your body absorb it.
3. Take any other multivitamins or medicines at a separate time.

Iron-rich foods

The following foods are good sources of iron:

• Red meat – such as beef, lamb, and pork (cooked thoroughly)
• Oily fish – such as canned sardines and canned tuna (no more than 4 medium-sized cans a week)
• Poultry – such as chicken or turkey
• Pulses and legumes – such as beans (including baked beans), peas, and lentils
• Dark green leafy vegetables – such as spinach, kale, and broccoli
• Eggs – cooked thoroughly
• Raisins and dried apricots
• Tofu
• Nuts and seeds
• Wholemeal bread/flour
• Bread that has been fortified with iron in the UK (this includes white bread)
• Fortified breakfast cereals

Foods and drinks that help or hinder iron absorption

Some fruits and vegetables containing vitamin C can help your body absorb iron. Drinking one glass a day of fruit or vegetable juice or a smoothie with a meal can help.

Try to avoid drinking tea and coffee (including decaffeinated) with or soon after a meal. They contain tannins, which can stop iron from being absorbed into your body.

It is also a good idea to eat and drink less milk and dairy. Large amounts of these can make it harder for your body to absorb iron.

Managing common side effects of iron supplements

Some people have side effects from taking iron supplements, such as:

• Tummy pain
• Nausea
• Constipation or diarrhoea
• Dark or black poo

Any side effects should get better over time. If they do not, your doctor may change the dose or the type of iron supplement. You will likely have your blood tested again to check your iron levels.

If your symptoms are not improving after a few weeks, please speak to your GP.

Managing constipation

Constipation can be a side effect of iron supplements. Hormonal changes in pregnancy can also cause constipation.

• Fibre – Make sure you are getting enough fibre. Good sources include fruit, vegetables, and wholemeal products.
• Water – Drink plenty of water.
• Activity – Stay active with regular light or moderate exercise like walking or swimming.

If you are still struggling with constipation after making these changes, talk to your midwife or GP. They may suggest trying stool softeners and will prescribe the appropriate ones for you.

Severe anaemia

Advanced treatment for severe anaemia

If you are very anaemic during pregnancy or find it difficult to take tablets, iron can be given intravenously (through a drip). This is called an iron infusion.

You may be offered this type of iron treatment through a needle directly into a vein (usually in your arm) if:

• Taking iron tablets or liquid is not working.
• The supplements are causing too many difficult side effects.
• You cannot absorb iron this way.
• You need fast-working treatment.

An iron infusion can be given after the first 3 months of pregnancy. It is safe for you and your baby, and side effects are rare. An iron infusion works more quickly than iron tablets or syrup.