Articles

Key takeaways

• Anaemia is common in pregnancy and can be treated.
• Routine blood tests check for anaemia at your booking and 28-week appointments.
• Treatment options include dietary changes, iron supplements, or intravenous iron.
• Untreated anaemia can increase risks for both you and your baby.

Why screening for anaemia in pregnancy is important

Your blood contains red blood cells that carry oxygen around your body and to your baby. They do this using an iron-rich protein (haemoglobin). Anaemia is a condition where you do not have enough red blood cells, or not enough haemoglobin in those cells.

Iron deficiency anaemia is the most common type of anaemia. It affects about 4 in 10 pregnant people in the UK.

Your body needs more iron than usual during pregnancy. This need increases as your pregnancy progresses. In the second half of pregnancy, your body's need for iron doubles compared to before pregnancy.

Iron deficiency anaemia is often caused by not getting enough iron from food. It can also happen if you have problems absorbing iron, such as with coeliac disease. Losing too much iron through bleeding is another cause of iron deficiency anaemia.

Symptoms of anaemia

Symptoms of anaemia can include tiredness and a lack of energy. You might also feel short of breath. A noticeably fast-beating, fluttering, or pounding heart (heart palpitations) can also be a sign. Your skin may look paler than normal. If you have Black or Brown skin, it might look greyish or yellowish-white.

Mild anaemia is common during pregnancy. Your haemoglobin level is checked routinely at your first pregnancy appointment and at around 28 weeks.

Severe anaemia means your haemoglobin level is very low. It can make you feel very unwell with dizziness, breathlessness, and chest pain.

Risks of untreated anaemia

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. These risks can affect both you and your baby.

Complications for your baby can include low birth weight. There is also a risk of premature labour and birth. Your baby may also have iron deficiency in their first three months of life.

For you, untreated anaemia can lead to extreme tiredness (fatigue) in the first few months after birth. It can also increase your risk of infection and illness. Postnatal depression is another possible risk.

Your midwife will offer you a blood test at your booking appointment. You will have another test 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.

If you think you have anaemia symptoms at any time, contact your GP or midwife. You do not need to wait for your routine appointments.

Understanding anaemia screening and test results

You will be offered screening for iron deficiency anaemia at your booking appointment. This is usually before 10 weeks of pregnancy. You will have another screening at 28 weeks.

The main blood test used to check for anaemia is a full blood count (FBC). This test measures different parts of your blood. This includes haemoglobin, the protein in red blood cells that carries oxygen. Low haemoglobin levels indicate anaemia.

Another important test is the ferritin test, which measures the amount of iron stored in your body. Low ferritin levels indicate iron deficiency.

For pregnant people, anaemia is typically diagnosed if your haemoglobin level is:

• Below 110 g/L in the first trimester.
• Below 105 g/L in the second and third trimesters.
• Below 100 g/L postpartum.

Your healthcare provider will discuss your specific results with you.

What blood tests check for

At your booking appointment, you will be offered a blood test to check several things, including:

• Your blood group and rhesus status.
• Infections like hepatitis B, HIV, or syphilis.
• Iron deficiency anaemia.
• If you carry the gene for sickle cell anaemia or thalassaemia.

At 28 weeks, you may be offered more blood tests. These tests check your iron levels again.

They also check if you have developed gestational diabetes or are at risk. If you are rhesus-negative, they will check if you have developed anti-D antibodies.

Blood is made up of red blood cells, platelets, and white blood cells in a fluid called plasma. Each part has a different job.

• Red blood cells – contain haemoglobin, which carries oxygen around the body.
• Platelets – help the blood to clot, controlling bleeding.
• White blood cells – fight infection and are part of your body's immune system.

Treatment options for anaemia during pregnancy

If your iron levels are low during pregnancy, you should try to eat more iron-rich foods. However, it is often not possible to get all the iron you need from food alone once you are iron-deficient. Your doctor will usually then prescribe iron to take as tablets or a liquid.

Taking iron supplements

Your doctor will probably suggest you take iron supplements early in the morning. Take them on an empty stomach. Drinking orange juice or another source of vitamin C with the supplement can help your body absorb the iron.

Take any other multivitamins or medicine at a separate time.

Some people experience side effects from taking iron supplements. These can include:

• tummy pain
• nausea
• constipation
• diarrhoea

Your poo may also become dark or black.

Any side effects should get better over time. If they do not, your doctor may change the dose or type of iron supplement. You will likely have your blood tested again to check your iron levels. If your symptoms do not improve after a few weeks, speak to your GP. Your GP may refer you to a specialist in the hospital (which may be an obstetrician or haematologist).

This might happen if your haemoglobin levels do not rise after supplements. It can also happen if you cannot cope with the side effects.

Other treatment options

You may be offered iron in liquid form through a needle directly into a vein (intravenous, or IV iron). This is usually given in your arm.

• It may be offered if taking supplements is not working.
• It can be an option if supplements cause too many difficult side effects.
• You may need it if you cannot absorb iron well.
• It is also used if you need fast-working treatment.

An iron infusion can be given after the first three months of pregnancy. It is safe for you and your baby. Side effects are rare. An iron infusion works more quickly than iron tablets or syrup. You may be advised to take folic acid in addition to iron to raise your haemoglobin level.

Blood transfusions for anaemia

You may also be offered a blood transfusion if you are very anaemic just before your baby is due. This is because there is a risk you could become more anaemic if you bleed during birth.

After you have had your baby, you may choose iron tablets or syrup instead of a blood transfusion. This is an option if your symptoms are mild and you have support at home. This avoids the minimal risks linked with blood transfusions.

Other types of anaemia

Vitamin B12 or folate (B9) deficiency anaemia happens when a lack of these vitamins causes your body to make red blood cells. These red blood cells are too large and do not work properly.

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

Vitamin B12 and folate are also important for many body functions. This includes keeping your nervous system healthy.

Symptoms of vitamin deficiency

If you don't have enough of these vitamins, you might notice a range of symptoms, such as:

• 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
• Problems with your memory, understanding, and judgement

It's possible to have these symptoms even if the deficiency hasn't led to anaemia yet. If you notice any of these signs, it's a good idea to talk to your GP or midwife. They can diagnose this with a blood test.

Treatment involves supplements or injections to replace the missing vitamins. It is also important to have a balanced diet.

Foods rich in vitamin B12 and folate

People who eat fish and dairy products usually get enough vitamin B12 from their food. Eggs also contain vitamin B12. If you follow a vegan diet, you may need a vitamin B12 supplement.

You can also have milk alternatives or foods fortified with vitamin B12.

Good sources of folate include broccoli, sprouts, and asparagus. Peas, chickpeas, and brown rice also contain a lot of folate.