What causes Iron Deficiency Anaemia during Pregnancy?

During pregnancy, your body goes through several significant changes and all sorts of challenges can arise — one of which is the increase in blood production to provide nutrients for your baby. While this is essential for your young one's growth, this also means that pregnant women have a higher risk of developing anaemia.

Fortunately, anaemia can be treatable when caught early and easily monitored throughout pregnancy. Iron-deficient anaemia, in particular, can have serious health consequences for the mother and child if left untreated. That said, it’s vital to educate yourself and understand what you need to do to keep yourself and your baby safe from harm.

What is Iron Deficiency Anaemia?

Iron deficiency anaemia is the result of low body stores of iron, which are essential for the production of red blood cells (RBCs). Having too few of these red blood cells limits the ability your blood's ability to carry oxygen or iron around to different parts of your body.

During pregnancy, the growing baby is highly dependent on the mother's blood for nutrition, oxygen and life support. The increased blood volume in a mother's body can dilute the amount of iron carried in the same amount of blood. Additionally, the increased metabolic demands, growth of many organs, and the addition of another life can put more pressure on the health of both. If left untreated, these symptoms can be risky for both mother and baby, before and after birth.

Causes

Iron deficiency anaemia in pregnancy is most often caused by a lack of iron in your diet. The amount of additional iron needed in pregnancy is 800-1000 mg (300 mg of that for the foetus and placenta). Very few women have enough stores of iron to meet the increased demand. Even in non-anaemic mothers, iron supplementation is recommended in pregnancy.

However, you are also more likely to have anaemia if you:

• Are vegetarian/vegan
• Had anaemia before you were pregnant
• Have a history of heavy periods
• Are carrying more than one child
• Have had two pregnancies close together

During the second and third trimesters, iron deficiency anaemia is a risk factor for preterm birth, low birth weight babies and even infant death. For anaemic mothers, even a small amount of blood loss at delivery will have more significant consequences and discomforts after delivery compared to non-anaemic mothers. In the most severe cases, it can increase a mother's chance of dying in labour.

Your healthcare professional will likely conduct blood tests to screen for iron-deficiency during your first prenatal visit. The results should show how well your body has processed iron in the past, and if you are at risk during your pregnancy.

Signs and Symptoms

Some pregnant women may not have apparent symptoms unless their red blood cell count is dangerously low. Each may experience symptoms differently, however, here are the most common that include:

• Fatigue and exercise intolerance
• Shortness of breath
• Fast/increased heart palpitations (fluttering, pounding, fast-beating)
• Pale appearance on skin, lips, nails.
• Lack of energy
• Trouble concentrating
• Cold hands and feet.

Again, you may not have apparent symptoms. So be sure to get routine blood tests to check for anaemia at your prenatal appointments.

Preventing Anaemia

Proper nutrition and diet is the best way to prevent anaemia if you are pregnant or trying to become pregnant. Eating balanced during pregnancy helps maintain the levels of iron and other essential nutrients needed for the health of the mother and baby. 

It's estimated that each woman must acquire an additional 2-5 mg of iron each day. It's recommended for all women who are pregnant to take vitamin supplements with at least 400 micrograms of folic acid. Further, you can also improve your intake of iron-rich foods or find foods that are supplemented or fortified with iron. Good sources of these include liver, meat, poultry, fish, nuts, dried fruits, and green leafy vegetables².

Testing and Treatment

Anaemia can be tested for during your prenatal examinations through a routine blood test for haemoglobin or hematocrits levels.

• Haemoglobin: measures the amount of haemoglobin in your blood. It is the part of the blood that carries oxygen from your lungs to the rest of your body.
• Hematocrits: measures the percentages of red blood cells found in the blood.

If you have lower than normal levels (Hb less than 13.5)^1, you may have iron-deficiency anaemia and require further tests. It is recommended to continue to get blood tests throughout your pregnancy to check for anaemia, especially in your second or third trimester where you may be more at risk.  

Treatment will depend on your situation, such as your age, general health, symptoms and severity of anaemia. Treatment includes typically adding iron or vitamin supplements to your daily routine. Most prenatal vitamins contain some amount of iron. 

Conclusion

Pregnancy is a 40-week process that causes dramatic changes in a woman's body physically, psychologically, and emotionally. Proper nutrition is paramount to a healthy pregnancy and a safe delivery of your baby.

Iron deficiency anaemia, although scary, can be preventable by regular screenings at your prenatal appointments. The midwives and doctors at OT&P provide compassionate care from the early stages of your pregnancy, throughout your birth and beyond. By consulting with the specialists at OT&P, you will be able to make the best health choices for you and your growing family.

References

1. Mukherji J. Iron deficiency anaemia in pregnancy. Rational Drug Bull. 2002;12:2-5.

2. FAO/WHO. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. WHO technical report series: 916. Geneva, Switzerland: WHO; 2003.