Anaemia in pregnancy: Risk factors, symptoms, diagnosis, treatment

Anaemia in pregnancy is a condition in which a pregnant woman has low levels of haemoglobin in her blood. Haemoglobin is an iron-rich protein in red blood cells that carries oxygen to tissues throughout the body, including the developing foetus.

What are the types of anaemia in pregnancy?

Several types of anaemia can occur during pregnancy.

• Iron-deficiency anaemia: This is the most common type of anaemia that occurs during pregnancy when the body does not have enough iron to produce haemoglobin, which carries oxygen to the body's tissues. In pregnancy, iron requirements increase due to the expansion of blood volume and the needs of the developing foetus.
• Folic acid deficiency anaemia: Folic acid (vitamin B9) is essential for the production of red blood cells. Inadequate intake of folate can lead to folate-deficiency anaemia. Pregnant women require increased amounts of folate to support foetal growth and development.
• Vitamin B12 deficiency anaemia: Vitamin B12 is necessary for the production of healthy red blood cells. A deficiency in vitamin B12 can lead to a type of anaemia called megaloblastic anaemia. This type of anaemia is relatively rare but can occur in pregnant women with a diet lacking vitamin B12 or have absorption issues.
• Haemolytic anaemia: This type of anaemia occurs when red blood cells are destroyed faster than they are produced. Haemolytic anaemia can be caused by autoimmune disorders, infections, or inherited conditions.
• Aplastic anaemia: Aplastic anaemia is a rare condition where the bone marrow does not produce enough red blood cells, white blood cells, and platelets. It can occur during pregnancy but is highly uncommon.

What are the risk factors for anaemia in pregnancy?

Several risk factors can contribute to the development of anaemia during pregnancy. These include:

• Insufficient dietary intake of iron-rich foods
• History of anaemia in a previous pregnancy
• Pre-existing medical conditioning such as chronic kidney disease, autoimmune disease
• Short interpregnancy intervals
• Heavy menstrual bleeding
• Multiple pregnancies (having twins or triplets)

What are the symptoms of anaemia during pregnancy?

Symptoms of anaemia include:

• Fatigue or feeling more tired and weaker than usual despite adequate rest
• Weakness
• Shortness of breath
• Pale skin, lips, and nails
• Rapid or irregular heartbeat
• Dizziness or light-headedness
• Headaches
• Cold hands and feet

How is anaemia in pregnancy diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

• Complete blood count (CBC): A CBC is a blood test that provides valuable information about various components of your blood, including haemoglobin levels, red blood cell count, haematocrit (the percentage of blood volume occupied by red blood cells), and other indices. Abnormalities in these parameters can indicate the presence and severity of anaemia.
• Iron studies: Additional blood tests may be ordered to assess iron levels and iron storage in the body. These tests include serum iron, total iron-binding capacity (TIBC), transferrin saturation, and ferritin levels. They help determine if the anaemia is due to iron deficiency.

Depending on the suspected cause of anaemia, other tests may be ordered, such as tests for folate and vitamin B12 levels, as well as tests for underlying conditions like autoimmune disorders or chronic kidney disease.

How is anaemia in pregnancy treated?

The treatment of anaemia in pregnancy aims to restore and maintain adequate levels of haemoglobin and iron in the body.

• Iron supplementation.
• Vitamin B12 or folic acid supplementation.
• Increase consumption of iron-rich foods such as lean red meat, chicken, fish, green leafy vegetables, beans, and lentils. Combining iron-rich foods with sources of vitamin C like citrus fruits, strawberries, and tomatoes can enhance iron absorption.

In severe cases of anaemia requiring immediate intervention, a blood transfusion may be performed. This involves receiving blood from a compatible donor to rapidly increase the haemoglobin and red blood cell count.

Anaemia in pregnancy FAQs

1. Does anaemia in pregnancy cause infection?

   Anaemia does not directly cause an infection but can weaken the immune system and increase the risk of developing infections.

2. Does anaemia in pregnancy cause low birth weight?

   Compared to women who do not have anaemia during pregnancy, pregnant women with low haemoglobin levels are more likely to deliver a low-birth-weight baby (less than 2.5kg at birth).

   Anaemia during pregnancy can impact foetal growth and development, potentially leading to lower birth weight due to a reduction in oxygen supply to the foetus, premature birth and complications during pregnancy.

3. When should I worry about anaemia in pregnancy?

   If you are pregnant and concerned about anaemia, it is important to discuss your concerns with your healthcare provider. While mild anaemia is relatively common in pregnancy, certain signs and symptoms may indicate a more severe condition.

   • Significant weakness
   • Chest pain
   • Difficulty performing daily activities
   • Extreme fatigue

   If you experience ongoing symptoms of anaemia, such as excessive fatigue, shortness of breath, dizziness, or rapid heartbeat, it is vital to consult your doctor. Persistent or worsening symptoms may indicate more significant underlying anaemia or other health issues that require evaluation and management.

Book an appointment at Pantai Hospitals

Each pregnancy is unique, and the severity and management of anaemia can vary. Regular prenatal appointments and open communication with your doctor are crucial for monitoring your health and addressing any concerns throughout pregnancy.

A dedicated and expert team of obstetricians and gynaecologists at Pantai Hospital is available for consultation to provide patients with the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions about anaemia in pregnancy.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.