Pregnancy anemia, why and how to avoid it?

As you probably know, during pregnancy, your body undergoes many changes and needs a lot of nutrients, which we don't always have in stock. Sometimes, this nutritional deficiency can lead to anemia in pregnancy, a common condition in pregnant women. But what exactly is it? Where does it come from, and how can it be avoided? In this article, we explain how to recognize, diagnose, and treat anemia... and, most importantly, how to prevent it with a varied diet.

 

What is anemia in pregnancy?

Anemia in pregnancy is a condition that often becomes more visible towards the end of the 2nd trimester or the beginning of the 3rd trimester of pregnancy, a period when maternal blood volume increases the most (up to 40-50%), which mechanically dilutes the hemoglobin level. According to the WHO, it affects approximately 37% of pregnant women worldwide.

In cases of anemia, the hemoglobin level in the blood is insufficient to transport the oxygen needed by the pregnant woman's body and her baby's body. Red blood cells, which contain hemoglobin, play an important role in transporting oxygen from the lungs to the organs. Hemoglobin, made of iron, is essential for this process. When you are pregnant, your needs for iron, vitamin B12, and vitamin B9 (folate) increase significantly to meet the high demands of your body and your child's.

However, if your diet does not provide these nutrients in sufficient quantities, or if your body cannot absorb them properly, you can develop an iron deficiency, and consequently, anemia.

More rarely (but it happens), anemia can also occur following heavy blood loss, such as after childbirth with a risk of hemorrhage.

 

Symptoms of anemia during pregnancy

The symptoms of anemia in pregnant women can be subtle, and they are often mistaken for normal changes due to pregnancy. However, if you suffer from anemia and it remains untreated, it can lead to complications for you and your baby. Here are the most common signs:

• persistent fatigue;
• general weakness;
• frequent dizziness or lightheadedness;
• noticeable paleness of the skin (especially face and hands);
• headaches;
• ringing in the ears;
• accelerated heart rate.

You might also experience shortness of breath, even during light activities. Anemia can also cause significant irritability and difficulty concentrating. In short, a whole host of signals to listen to!

Wondering if you suffer from iron deficiency? Our article Iron deficiency: symptoms, effects and treatment may interest you.

 

Diagnosis of anemia during pregnancy

Anemia in pregnancy can be detected in pregnant women through a blood test, specifically a complete blood count (CBC), which is part of the routine check-up offered in the 6th month of pregnancy. This measures the hemoglobin level in red blood cells. If it remains:

• below 11 g/dL in the 1st and 3rd trimester;
• below 10.5 g/dL in the 2nd trimester…

… anemia is confirmed. If this is your case, additional blood tests may be prescribed to identify the precise cause, such as:

• ferritin levels (to assess iron stores);
• a test to assess for vitamin B12 deficiency;
• another to detect vitamin B9 (folate, also known as folic acid in its synthetic form) deficiency.

In any case, the earlier anemia is diagnosed in a pregnant woman, the sooner she can receive appropriate treatment.

 

How to treat anemia in pregnant women?

What medicine says in France

An important point to know: in France, the Haute Autorité de Santé and the CNGOF are clear on this point: there is no justification for systematic iron supplementation in all pregnant women. Unjustified supplementation can even pose risks to the mother. This is why screening by blood test remains the essential step before any treatment decision.

When anemia is confirmed, the reference treatment is based on pharmaceutical-grade iron (generally 80 to 100 mg of elemental iron per day), prescribed by your doctor or midwife and combined with a daily intake of folic acid. The effectiveness of the treatment is checked by monitoring the hemoglobin level approximately one month after initiation, and the treatment is generally continued for three months after correction of the anemia, to replenish reserves.

To learn more about the different forms of vitamin B9 (folate, folic acid, 5-MTHF), consult our article Vitamin B9, folic acid or folate.

There are different forms of iron that can be used in supplementation, such as iron bisglycinate: a randomized study conducted on 80 Danish pregnant women (Milman et al., 2014) showed that at half dose (25 mg versus 50 mg of elemental iron), bisglycinate maintained equivalent iron status, with good reported digestive tolerance. If you have questions about the most suitable form of iron for your situation, do not hesitate to discuss it with your doctor or pharmacist.

If oral supplements are not sufficient, the healthcare professional may offer iron injections. In cases of severe anemia, blood transfusions may even be considered to rapidly stabilize hemoglobin levels.

Prevention through diet

Rest assured, iron deficiency is not systematic in pregnant women! And apart from any diagnosed deficiency, a good diet remains the best prevention lever on a daily basis.

To cover your needs for iron and vitamin B9 (folate), you can prioritize a diet rich in heme iron (present in animal products, much better absorbed than plant-based iron), such as:

• red meat;
• fish;
• poultry.

Are you vegetarian? Don't panic! You can also cover part of your iron needs with foods like:

• lentils;
• spinach;
• egg yolk;
• dried fruits;
• whole grains.

Plant-based iron (non-heme) is, however, significantly less well absorbed by the body than heme iron, which is all the more reason to systematically combine it with a source of vitamin C, which significantly improves its absorption. Conversely, avoid consuming tea and coffee during meals: the tannins they contain inhibit iron absorption.

As you can see, anemia in pregnancy remains a common condition in pregnant women, but it is not inevitable: early screening and, if necessary, appropriate treatment and follow-up by your doctor can correct it effectively.

This article is for informational purposes only and does not constitute medical advice. Only a healthcare professional can diagnose anemia and prescribe treatment appropriate for your situation. Never start iron supplementation without a prior blood test, as an excess of iron can also be harmful.