Anaemia in Pregnancy

Anaemia can develop at anytime during the average lifespan, though it is more common during pregnancy. This is why routine testing is done at regular intervals throughout a woman’s pregnancy, in particular within the first trimester and at around 20 weeks. Anaemia is essentially a decrease in the number of red blood cells, known as haemoglobin, in the blood. The bone marrow is responsible for constantly producing and replenishing these highly specialised cells every 120 days. Because they are responsible for carrying oxygen to all the cells of the body, two of the first signs of iron deficiency anaemia are breathlessness and tiredness.

Many women have low iron levels early in their pregnancy because of blood loss through their monthly periods. In fact, iron deficiency is common among young women who may not even be aware they have it, especially those who experience very heavy periods. Though during pregnancy when there is a span of amenorrhoea (no periods), iron stores have a chance to replenish.

How Anaemia Occurs

It is far easier to prevent anaemia from occurring in the first place than to treat it once it has been diagnosed. Even when dietary intake is sufficient, pregnant women can still become anaemic. This is why it is important to have every pregnancy monitored by a midwife, GP or obstetrician.

• Because of the demands of the growing baby a mother’s haemoglobin level can drop incidentally.
• An overall increase in a mother’s circulating blood volume means the haemoglobin level can become diluted from its normal level.
• A poor dietary intake of iron. Very restrictive diets, elimination diets or low kilojoule intake can all lead to anaemia related issues.
• Mothers who were underweight at the start of their pregnancy or who have experienced severe morning sickness are more at risk.
• Through blood loss where there is a decrease in overall blood volume as well as haemoglobin levels. Threatened miscarriage, ante-partum haemorrhage or other bleeding can all contribute.
• During a multiple pregnancy e.g. with twins/triplets/ quadruplets or more, the risks of becoming anaemic are higher.
• In women who have had a previous miscarriage, pregnancies in close succession and insufficient time for their iron stores to replenish following an earlier pregnancy before they conceive again.
• Chronic illness where there is already a compromise to normal blood levels and functioning.

Signs and Symptoms of Anaemia

• Paleness and looking “washed out”. Feeling weak and not having as much strength as usual.
• Feeling unusually tired, fatiguing easily and not having the same degree of stamina and energy levels as usual.
• Feeling irritable, easily exasperated and just not as tolerant.
• Feeling “run down” and being more prone to catching infectious illnesses.
• Easily becoming breathless, such as being unable to climb a flight of stairs or go for a brisk walk. without needing to pause and catch your breath.
• Fainting and feeling light headed. Headaches are not uncommon in women who are anaemic.
• When the mucosa of the inner, lower eyelid appears pale with little redness. When there is a normal level of haemoglobin, the mucousa appears red/pink.
• In extreme cases of anaemia, some women are compelled to eat non-edible food stuffs such as clay, sand, dirt or chalk. This is because their body is craving iron when, in fact, these substances interfere with normal iron absorption and contribute to the problem.

Treatment for Anaemia

• Iron supplements in the form of tablets or liquid. Ferrous Sulphate is commonly prescribed for pregnant women who are at risk of anaemia.
• Folic acid supplements are also often prescribed. These can be in combination with iron (ferrous) supplements.
• Vitamin B12 is sometimes prescribed via supplements or through a dietary increase. Rich sources are animal products such as egg, meat and milk.
• Vitamin C supplements are also necessary to help with iron absorption. Dietary sources are also ideal, though need to be eaten each day as Vitamin C is water soluable and not stored in the body.
• Boosting dietary iron intake. Haem iron is viewed as “first class” iron and comes from animal/meat sources. Red meat is ideal, with white meat providing a sound alternative. Non haem iron is found in green leafy vegetables, such as broccoli, silver beet, Chinese greens and beans.
• If a mother’s iron level is seriously low, injections of iron are prescribed or a transfusion of blood becomes necessary.

With treatment, a mother’s iron level should return to within a normal range in a few weeks. If this does not occur, then additional screening tests are ordered to rule out any underlying cause for her anaemia. Even after delivery, iron supplementation is often recommended to compensate for extra blood loss at the time of birth. Follow-up blood tests are commonly ordered at the six week post natal check.

N.B. Iron tablets can cause constipation, stomach upsets and a change in the colour of bowel motions so that they become a very dark green or even black. You may need to increase the fibre and fluid intake in your diet or take a stool softening agent to manage this side effect.

But I’m Scared of Needles

Unfortunately, the only way to diagnose iron deficiency is by testing a sample of blood. This is usually accessed through one of the veins in the inner aspect of the elbow. If you are anxious about your blood being collected, then speak with your midwife or doctor. Numbing gels and heat packs as well as drinking plenty of fluids beforehand can all make a difference with ease of blood collection. You can request a phlebotomist (blood collector) who is very experienced and who will take into account your anxiety. You may like to take your partner or a good friend with your for support.

Will My Anaemia Affect My Baby?

Mild anaemia does not pose a risk to a baby, only to a mother. Babies are designed, by nature, to ensure they have adequate iron to grow and fuel their brain growth. This combined with the changes in a mother’s digestion processes can lead to iron deficiency anaemia even if a mother’s dietary intake is sufficient. Babies store iron for the first few months of their life so that they do not have a deficit in their own needs. When solid food e.g. iron fortified rice cereal, is introduced at around six months of age, this boosts their iron intake to fuel their body’s requirements.

It is uncommon for babies to be iron deficient at birth. In fact, the opposite is often true which is why newborns frequently become jaundiced as result of adjusting their iron stores to a normal range after they are born. One of the by products of red cell breakdown is bile, which can cause a temporary yellow staining of the skin and eyes. Babies need a high haemoglobin count to “grab” onto as much oxygen as they can as it is coming via the placental blood flow.

Untreated anaemia can lead to premature delivery. Babies of anaemic mothers tend to be lighter than they would otherwise be. Because of these factors, there is an increase in other associated risks of prematurity and being small for gestation age.

If you are diagnosed with anaemia, don’t become alarmed. With treatment and regular monitoring, a return to normal iron levels almost always occurs. If your iron count is particularly low, you may need to make some lifestyle changes until it returns to normal. Modifying your working hours, having more rest and sleep and focusing on having an excellent diet can make all the difference.