When you’re pregnant, it can be tricky to pinpoint why, exactly, you feel so sluggish all the time. Maybe you’ve chalked up the fatigue to hormones or a burgeoning belly, or perhaps you suspect that pregnancy insomnia is contributing to your exhaustion.
But while all of the above can indeed cause fatigue — which is usually a very normal pregnancy symptom — it’s also possible for exhaustion to be a sign of anemia.[1]
This condition occurs when the body isn’t able to make enough healthy red blood cells to carry oxygen. Pregnant women have a higher risk of developing anemia, especially during the second and third trimesters.
The good news: With a few minor nutritional adjustments and possibly a supplement to address low iron levels, anemia can be easily treated during pregnancy.
Read on for more about this condition, including the different types of anemia and signs to look out for during pregnancy.
What is anemia during pregnancy?
Anemia is a condition that can occur when the body isn’t able to make enough healthy red blood cells. Without these red blood cells, it’s more difficult to distribute oxygen throughout your body, which can result in symptoms like excessive fatigue, shortness of breath and headaches.[2]
There are more than 400 different types of anemia, but a few are more likely to affect moms-to-be:[3]
- Iron-deficiency anemia: Iron deficiency is the most common cause of anemia worldwide, and pregnant women are particularly susceptible to developing low iron stores.[4]
- Folate-deficiency anemia: Moms-to-be who don’t have enough folic acid in their blood may develop folate-deficiency anemia. This B vitamin is crucial for your baby’s development, so it’s important to get enough of it during pregnancy.[5]
- Vitamin-B12-deficiency anemia: Less commonly, pregnant women may develop anemia caused by a vitamin B12 deficiency.[6]
Whatever the cause, it’s important to treat anemia during pregnancy. Not only will doing so help you feel better, but severe, untreated anemia can increase the risk of pregnancy complications, including preterm birth and the need for a blood transfusion during delivery.[7]
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Many doctors will check for anemia during your first prenatal appointment and again in the second or third trimesters.[8]
Symptoms of anemia during pregnancy
Early on, you may mistake signs of anemia for normal pregnancy symptoms. In fact, some pregnant women are completely unaware that they're anemic until it's revealed in a blood test.
As the condition progresses, signs of anemia in pregnancy may include:[9]
- Excessive tiredness or weakness
- Headaches
- Dizziness
- Shortness of breath
- A rapid or irregular heartbeat
- Numbness or a cold feeling in your hands and feet
- A low body temperature
- Pale skin, especially a loss of color in the face, lips or nails
- Chest pain
- Trouble concentrating
- Irritability (most common with a vitamin B12 deficiency)
If you’re experiencing any of these symptoms, be sure to let your doctor know.
What causes anemia during pregnancy?
The vast majority — about 75% — of anemia cases during pregnancy are iron-deficiency anemia, meaning they’re caused by low levels of iron.
Iron is an essential mineral that helps your body make hemoglobin, a protein found in red blood cells that helps shuttle oxygen from your lungs to the rest of your body.[10]
When you’re pregnant, the amount of blood in your body increases to support both you and your growing baby — by some counts, by up to 45% by the time you reach the 24-week mark.
That means you need about twice as much iron during pregnancy as you did before you were expecting — an amount that’s hard for many pregnant women to get from food alone.
Without sufficient iron stores, red blood cell production slows, supplying the body with less oxygen. The result? One tired mama.
Less often, anemia can be caused by a vitamin deficiency, such as insufficient levels of vitamin B12, folate or vitamin C — one more reason why it’s so important to take your prenatal vitamin.
An underlying condition, such as thyroid disorder, can also cause anemia in moms-to-be.
Who is at risk of anemia during pregnancy?
Some women are more likely to develop anemia than others. You might have a higher risk if you:
- Are pregnant with more than one baby
- Have a decreased appetite due to severe morning sickness
- Are pregnant soon after a previous pregnancy
- Have a history of anemia or a heavy menstrual flow
- Aren’t consuming enough iron in your diet
How anemia is diagnosed during pregnancy
Your practitioner will perform a complete blood count (CBC), which tabulates the number of various cells that make up your blood.[11]
If your red blood cell count is low, your doctor will diagnose you with anemia and may give you other blood tests to figure out the type of anemia you have.
The CBC test is a standard part of care early on in your pregnancy — usually at your first prenatal appointment as part of your initial pregnancy bloodwork — and again later in your pregnancy.
Risks of anemia during pregnancy
If anemia isn’t treated, it can become severe. Untreated severe anemia, especially during the first two trimesters, has been linked to an increased risk of:
- Poor fetal growth
- Infections
- Preterm birth
- A low birth weight baby
- Needing a blood transfusion during delivery
- Postpartum depression
The good news: Even if you've been anemic throughout your pregnancy, it's extremely rare for a baby to have an iron deficiency too. Why? Your baby will take all the iron that she needs to thrive first.
Can anemia cause miscarriage?
No, anemia itself doesn’t directly cause miscarriage. It may, however, cause pregnancy complications like low birth weight.[12]
How to treat anemia during pregnancy
In most cases, the treatment for iron-deficiency anemia in pregnancy is simple: more iron. Your health care provider may prescribe a daily iron supplement to take in addition to your prenatal vitamin.[13]
Take both, only with your doc’s okay, at different times of the day to ensure that you're getting all your daily nutrients. For maximum results, take your iron one hour before — or two hours after — eating food.[14]
You can also take it with a glass of orange juice, but avoid the calcium-fortified kind (vitamin C helps boost iron absorption, but calcium can decrease it). Or, you can also take your iron supplement with prune juice to help counter the inevitable constipation that extra iron brings with it.
Be aware, too, that iron supplements can make nausea worse. If this is the case for you, try the standard strategies for managing morning sickness, including eating smaller, more frequent meals (six snack-size meals instead of three big ones) and drinking plenty of water.
You may also want to try taking your iron supplement right before bed, since you may be less likely to notice nausea when you're asleep. Your practitioner may also suggest slow-release iron tablets or a different form of iron (like iron bisglycinate) that's easier on the stomach.
If you can’t tolerate iron supplements or they haven’t helped raise your hemoglobin levels after about three weeks, or if you have severe iron-deficiency anemia (especially later in your pregnancy), your doctor may suggest you receive iron intravenously, or through an IV, though this is rare.
And in addition to taking your supplements, be sure your diet includes plenty of iron-rich foods, including lean red meat, poultry, leafy greens, lentils, beans and chickpeas.
Since treatment depends on the cause, it’s important to talk with your doctor about your particular needs. If you have a different type of anemia, such as one due to another vitamin deficiency or illness, you may require folic acid supplements or other treatments to address the underlying disease.
How to prevent anemia during pregnancy
While not all cases of anemia in pregnancy are preventable, getting enough iron in your diet goes a long way in helping you to avoid iron-deficiency anemia, the most common type.
Before you’re pregnant, that means consuming 18 milligrams of iron per day; once you conceive, you should aim for 27 milligrams.
Some healthy foods that are high in iron include:
- Iron-fortified cereal (18 milligrams per serving)
- Lean beef (2 milligrams in 3 ounces)
- Liver (5 milligrams in 3 ounces of beef liver)
- Beans and legumes (4 milligrams in 1/2 cup of white beans; 3 milligrams in 1/2 cup of lentils)
- Green, leafy vegetables (6 milligrams in 1 cup cooked spinach)
- Seeds and nuts (2 milligrams in 1 ounce or 18 cashews)
- Dark chocolate (7 milligrams in 3 ounces)
- Baked potatoes (2 milligrams for a medium spud)
Cooking in cast-iron pans may also help give your iron intake a little boost, since foods absorb some of the iron from the skillet. Also note that animal-based iron (from meat) is absorbed by the body better than plant-based iron.
Anemia during pregnancy is quite common, and it’s also usually very easy to diagnose and treat.
Just be sure to eat plenty of fresh and healthy iron-rich foods, take an iron supplement if your doctor suggests it, and let your care team know if you’re experiencing any unusual symptoms.
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