Feeling tired, weak or short of breath?
This could be normal symptoms of pregnancy or it could be anemia.
Let’s review this very common issue of anemia during pregnancy.
What is Anemia?
Anemia is when you have a lack of sufficient red blood cells.
This is measured by a blood test called the complete blood count (CBC) that
looks at your hemoglobin and hematocrit level (among other things).
The CBC test is standard early in your pregnancy-- usually at your first
prenatal visit and then again later on in your pregnancy (usually at the
time of your glucose test).
FALSE! Your body goes through substantial changes when
you become pregnant. So, there is no surprise that your hemoglobin levels
decrease. The definition of what anemia is during pregnancy is different
from the numbers used when you are not pregnant.
Here is what the American College of Obstetrics and Gynecology (ACOG)
define as anemia in pregnancy:
1st trimester – Hemoglobin <11 g/dL (approximate hematocrit
2nd trimester – Hemoglobin <10.5 g/dL (approximate hematocrit
<31 or 32 percent)
3rd trimester – Hemoglobin level <10.5 to 11 g/dL (approximate
hematocrit <33 percent)
Your blood volume increases by 20-30 percent!
This is why it is normal in pregnancy to have a lower hemoglobin level then
before you were pregnant. Your blood cells get “diluted” by the increase in
This is termed “physiologic anemia of pregnancy”.
Translation: normal low blood count expected in pregnancy.
Deficiencies of all of the above can lead to anemia during pregnancy.
The most common cause of anemia in pregnancy is due to
Your body's iron needs increase throughout pregnancy due to your expanding
blood volume and to help with baby’s growth and red blood cell production.
Your body’s need for Vitamin B12 and folate increases too.
Usually, your prenatal vitamin has enough of these micronutrients for your
However, for some women, they may need more.
True! Having two pregnancies close together could place you at
risk due to already depleted iron stores!
You are at a greater risk of becoming anemic during your pregnancy if you:
Are pregnant with twins
Do not consume sufficient iron
Have had a heavy pre-pregnancy menstrual flow
Have two closely spaced pregnancies
Have a history of anemia before your pregnancy
Basically, anything that increases your chances of starting pregnancy
already with depleted stores of micronutrients or a pregnancy with higher
Many of the symptoms of anemia during pregnancy are symptoms you might
experience even if you are not anemic. You may feel :
Paleness of the skin
Short of breath
Loss of focus
If you are concerned, speak to your healthcare provider who can order a
blood test to check.
While mild anemia may not have a big impact on your baby, it can still
impact your delivery and postpartum recovery. You are at higher risk of
needing blood transfusion after delivery and getting
postpartum depression. Moderate and severe anemia has
higher risks and more impact on your baby such as preterm birth ,
low birth weight and developmental delays.
The treatment for iron deficiency is simple: More iron!
An iron supplement in addition to your prenatal vitamin will help. Take
them with a glass of orange juice because vitamin C increases absorption of
iron! If you have a different micronutrient deficiency such as B12 or
folate you may be advised to take those as well.
Besides taking your supplements, make certain your diet includes lots of
iron-rich foods, including poultry, leafy greens, lentils, beans, and beef.
Great nutrition is the very best way to prevent anemia.
Anemia is super common in pregnancy. You may not have symptoms, but it is
important to maintain a normal level of hemoglobin to best support you
during pregnancy, delivery and postpartum!
MaternalWell text support for any general questions or reach out to our
pregnancy nutritionist for a personalized plan.