What is anaemia in pregnancy? Symptoms, causes, treatment options, the place of iron given through a vein, and questions to ask your doctor.
Anaemia in pregnancy is a state in which the blood does not have enough red blood cells or haemoglobin; haemoglobin carries oxygen to the tissues. Because blood volume and the need for iron and folate increase in pregnancy, the likelihood of anaemia is higher. Symptoms such as tiredness and dizziness can be mixed up with other complaints of pregnancy, so the diagnosis is made with a blood test; the doctor plans treatment according to the cause.
Why is anaemia more common in pregnancy?
In pregnancy your blood volume increases and your need for nutrients such as iron and folate rises. If this need is not met, anaemia can develop. Developing anaemia is not your fault.
Is all anaemia iron deficiency?
No. Iron deficiency is an important cause, but other nutrient deficiencies such as folate, B12 and vitamin A can also lead to anaemia. For this reason your doctor investigates the cause of the anaemia, and treatment is determined according to the cause.
Which symptoms can be seen in anaemia?
In anaemia, tiredness, dizziness or a lightheaded feeling, cold hands and feet, headache and shortness of breath, especially on effort, can be seen. Many of these symptoms overlap with the complaints of pregnancy itself. For this reason the symptoms alone do not give a diagnosis; telling your doctor about your tiredness and other complaints at check-ups is important so that they can be assessed with a blood test.
Which findings can appear when anaemia advances?
When anaemia advances, findings such as paleness of the skin and nails, rapid breathing, a fast pulse or fast heartbeat, dizziness on standing up and easy bruising can be seen. Tiredness and dizziness due to anaemia can also appear in pregnancy for other reasons.
How is anaemia detected?
Anaemia is detected with a blood count, that is, by measuring haemoglobin; this test may be done at antenatal check-ups. The threshold values that define anaemia in pregnancy can differ according to the stage of pregnancy; the doctor makes the assessment. When needed, additional tests that show the body's iron stores may be requested.
What can it mean for the mother and baby?
Anaemia is linked with outcomes such as adverse effects on maternal and birth outcomes, preterm birth and low birth weight. This information is based on large-scale data and does not mean these outcomes will be experienced by everyone with anaemia. Detecting anaemia and treating it according to the cause is the basis of managing this link.
How is your diet plan arranged?
A varied diet rich in iron and folate is recommended to prevent anaemia. You should arrange your diet plan together with your doctor or dietitian, according to the cause of the anaemia and your circumstances.
When and how are iron supplements used?
Daily oral iron supplements in pregnancy may reduce the likelihood of anaemia and iron deficiency close to birth. Supplements should be used only when a competent health professional recommends them. Your doctor determines the type, amount and length of use of the supplement; do not start or stop an iron or vitamin supplement on your own.
What can be done if oral treatment is not enough?
When oral treatment is insufficient or not suitable, the doctor may consider iron treatment given through a vein. The benefits and possible risks of this option are discussed with the doctor.
How can you support yourself?
- Do not miss blood count check-ups.
- Use the recommended supplement as your doctor has stated.
- If you notice side effects of the supplement, tell your doctor before stopping it.
- Note down complaints such as tiredness, dizziness and shortness of breath, and when they increase.
- Go to your appointment with your list of questions; if you have low mood or anxiety, share that too.
What can you ask your doctor when discussing your treatment?
- Ask whether the cause of my anaemia is iron deficiency or something else.
- Find out which changes to my diet would be suitable for me.
- If a supplement is to be started, discuss its type, how it is used and when it will be checked.
- Ask what I should do if I have side effects.
- Find out whether treatment through a vein would be considered if oral treatment is not enough, and its benefits and risks.
Frequently Asked Questions
Is iron treatment through a vein safe?
In iron deficiency anaemia in pregnancy, iron treatment through a vein may not increase serious adverse events compared with oral treatment. But these events are rare and have been under-reported in studies; a possible harm cannot be ruled out. The reliability of the evidence ranges from moderate to very low. For this reason your doctor talks with you about whether the treatment is suitable for you, with its benefits and possible risks.
Does iron supplementation change outcomes for the baby?
According to research, the likelihood of low birth weight may fall; no clear difference has been found for preterm birth. For other outcomes for the mother and baby the evidence is limited. That is, treating anaemia is important, but it does not mean it will change every outcome.
Does anaemia affect birth or the time after birth?
Blood loss during and after birth, especially bleeding after birth, is counted among the causes of anaemia. Measures taken to prevent and treat bleeding at birth also help to reduce anaemia. You can talk beforehand with the doctor following you about monitoring during birth and possible blood loss.
Do tiredness and dizziness alone give a diagnosis of anaemia?
No. These complaints can be seen in pregnancy for other reasons. Anaemia is assessed with a blood count and haemoglobin measurement.
Is all anaemia in pregnancy due to iron deficiency?
No. Other nutrient deficiencies such as folate, B12 and vitamin A can also be the cause. Treatment is planned according to the cause your doctor has determined.
Can additional tests that assess iron stores be requested?
Yes. In addition to the blood count, tests that show iron stores can be requested when needed. Your doctor interprets the results according to the stage of pregnancy.
Should I start an iron or vitamin supplement on my own?
No. Your doctor determines the type, amount and length of the supplement. You should talk with your doctor before starting or stopping.
If I see side effects from the supplement, should I stop it straight away?
Tell your doctor before stopping. You can talk together about how to continue the use and the treatment plan.
Is there another option if oral treatment is not enough?
Yes. If oral treatment is insufficient or not suitable, iron given through a vein can be considered. Its benefits and possible risks are discussed with your doctor.
If I have anaemia, are preterm birth or low birth weight certain?
No. Although a link with these outcomes has been reported, it does not mean they will be experienced by everyone. Finding the cause and treating accordingly is important.
Should I also arrange my diet according to the cause of the treatment?
Yes. A varied diet rich in iron and folate is recommended; the plan suited to you is arranged with your doctor or dietitian according to the cause of the anaemia and your circumstances.
Has the possibility of harm from iron through a vein been completely ruled out?
No. Serious adverse events are rare and have been under-reported in studies. Because a possible harm cannot be ruled out, suitability is assessed with its benefits and risks.
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