What is iron-deficiency anemia?
Iron-deficiency anemia (IDA) is a type of blood disorder. The red blood cells in your body contain hemoglobin, which is responsible for carrying oxygen throughout your body. Your body needs iron to build enough healthy red blood cells and keep your hemoglobin at the right level. If your body lacks the right amount of iron, you could become anemic.
As a woman, it's not unusual to have anemia, especially when you're of childbearing age. Iron deficiency is by far the most common cause of anemia in pregnancy and accounts for 75 to 95 percent of all cases.
But it's not the only cause: You could also develop anemia from not getting enough folic acid or vitamin B12, by losing a lot of blood, or from having certain diseases or inherited blood disorders, such as sickle cell disease or thalassemia.
Am I at risk of becoming anemic?
Yes. Pregnancy increases your likelihood of becoming anemic.
During pregnancy, the recommended amount of iron increases from 18 milligrams (mg) per day to 27 mg per day. You need extra iron to support additional red blood cells, the placenta, and your growing baby. Plus, the extra iron prepares your body for any blood loss that may occur when you give birth.
But there are other factors outside pregnancy that increase your risk further, including:
- Heavy menstrual periods
- A diet low in iron-rich foods
- A diet low in vitamin-C-rich foods (which help with iron absorption)
- Eating too many foods or drinks that reduce iron absorption (like dairy products, foods containing soy, coffee and tea)
- A short gap between pregnancies
- Being younger than 20 when you become pregnant
- Having a stomach or intestinal disease that affects how your body absorbs nutrients
- Having certain types of gastric bypass surgery, which alters the gut and absorption of nutrients
- Taking medication that affects the way your body absorbs iron from food
- Losing more blood than normal when giving birth previously
What are the symptoms of iron-deficiency anemia?
You might not have any symptoms, especially if your anemia is mild. Sometimes tiredness is the only symptom you notice. And it's common to feel tired during pregnancy, so many women don't realize that a lack of iron is making them feel more tired than normal.
Fatigue and weakness are the most common symptoms of severe anemia. Other symptoms include:
- Shortness of breath
- Pale complexion
- Chest pain
- Irritability or poor concentration
- An unpleasant urge to move your legs during periods of inactivity (restless legs syndrome)
- Leg cramps
- Craving nonfood items (pica) or ice to suck or chew on
- Pale lips, inner eyelids, and the inside of your mouth
- Spoon-shaped nails
- Glossy tongue
- Cracks in the corners of your mouth
How is anemia diagnosed?
At your first prenatal appointment, your provider will evaluate your medical history, give you a physical exam, and test your blood for anemia.
One of the blood tests you'll have is a complete blood count (CBC). Among other things, the CBC measures:
- The percentage of red blood cells in your bloodstream (hematocrit or Hct)
- The amount of hemoglobin (Hgb or Hb) in those red blood cells
Blood test results
The American College of Obstetricians and Gynecologists and the U.S. Centers for Disease Control give guidelines for diagnosing anemia. In the first and third trimesters, an Hct less than 33 percent and an Hgb level less than 11 grams (g) of hemoglobin per deciliter (dL) of blood suggest anemia. In the second trimester, the levels are a little lower: 32 percent Hct and 10.5 g/dL Hgb.
Your provider may follow up your CBC with more tests to determine if iron deficiency is the cause of your anemia.
Even if you're not anemic at the start of your pregnancy, it's not unusual to develop anemia as your pregnancy progresses, so you may be tested again later on.
How will anemia affect my pregnancy?
It's normal to feel worried about being diagnosed with anemia, but mild anemia that's diagnosed and treated early shouldn't pose a problem during your pregnancy. Most experts agree that anemia in pregnancy is more of a concern if it's severe, untreated, or lasts a long time.
If your provider advises you take iron supplements, and you take them as prescribed, your condition should improve. If you have a more severe case of anemia, you may be treated with IV iron supplements, or possibly even a blood transfusion if your hemoglobin falls to 6 g/dL or less.
If you have severe anemia, and it doesn't get better with initial treatment, your healthcare provider may refer you to a specialist for care. You may need to see a hematologist or a maternal-fetal medicine (MFM) specialist to figure out if another condition is causing your anemia.
When you have a low level of iron, you may find yourself getting more tired or fatigued more easily during your pregnancy. Pregnancy can be exhausting anyway, so take extra care of yourself if you're feeling the added strain of having low iron.
Will my baby be affected?
A mild iron deficiency shouldn't affect your baby while you're pregnant. But research also suggests that mild iron-deficiency anemia that goes untreated and becomes more severe during pregnancy – especially in the first two trimesters – is linked to an increased risk of a baby being born with a low birth weight.
Having severe iron-deficiency anemia may even increase the risk of stillbirth and newborn death.
What can I do to have a healthy pregnancy?
Let your provider know if you were diagnosed with iron-deficiency anemia before you became pregnant. That way, she can manage your condition and treat you effectively during preconception and throughout your pregnancy.
As with any pregnancy, go to all your appointments, take your prenatal vitamins, and follow the advice of your healthcare provider. She may suggest that you take iron supplements or modify the foods you eat.
You can improve your anemia by eating iron-rich foods, such as shrimp, beef, turkey, enriched breakfast cereals, beans, and lentils. Foods that enhance iron absorption are also beneficial to include, such as orange juice, strawberries, broccoli, grapefruit, and peppers.
Avoid consuming too many foods or drinks that prevent your body from absorbing iron properly, such as dairy products, soy products, coffee, and tea. If you do consume these foods or drinks, it may be best to have them an hour before or two hours after an iron-rich meal.
Also, when you take an iron supplement, have it with a small snack. Eating a large amount of food hinders iron absorption.
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.