Anaemia and pregnancy

What is anaemia?

Anaemia is a blood condition that develops when you don’t have enough red blood cells. Red blood cells contain haemoglobin, a protein that carries oxygen around your body and to your baby.

Signs and symptoms of anaemia in pregnancy

Symptoms of anaemia can include:

• tiredness and lack of energy
• shortness of breath
• feelings of having a fast-beating, fluttering or pounding heart (heart palpitations)
• pale skin.

There are different types of anaemia and each has a different cause. The most common type for pregnant women is iron-deficiency anaemia.

What causes iron deficiency anaemia?

Pregnancy is often the cause of iron-deficiency anaemia. You and your baby need a lot more iron to make red blood cells while you’re pregnant. Iron-deficiency anaemia can happen when you are not eating enough food with iron.

You are also more likely to have anaemia if you:

• are a vegetarian or vegan
• have had anaemia before
• have a history of heavy periods
• are carrying more than one baby
• were younger than 20 when you got pregnant
• you are pregnant again after having a baby within the last year.

You’ll be asked about your health, your and your family’s medical history, any medical conditions and your lifestyle at your booking appointment. Tell your midwife if anything in the list above applies to you.

Will I be checked for anaemia during my pregnancy?

Yes. You should have a blood test to check for any conditions that may affect your baby, including anaemia, at your booking appointment and when you are 28 weeks pregnant.

If you’re carrying more than one baby you should have an extra blood test at 20-24 weeks.

This will give you enough time to get treatment if you need it.

You can call your midwife at any time if you think you have anaemia symptoms and you can be tested for anaemia at any point in your pregnancy. You don’t have to wait for your antenatal appointments or for routine tests

“I had anaemia before I was pregnant with my son, which was treated. I’m pregnant again and have been feeling the same... tired and run down. I’ve told my midwife and am waiting for the results of my blood test.”

Lauren

Will iron deficiency anaemia harm me or the baby?

Most people with anaemia in pregnancy go on to have a healthy pregnancy and baby. However, anaemia has been linked to pregnancy complications before and after birth if it isn’t treated. These can include:

• premature birth
• low birthweight
• placental abruption
• stillbirth
• your body being less able to cope with blood loss during labour
• iron deficiency in your baby in their first 3 months of life
• problems with the baby’s mental development.

This can be difficult to read, but try not to worry too much as the risk is low. If you are diagnosed with anaemia and it is treated properly it is very likely that you will still have a healthy pregnancy and baby.

How is iron deficiency anaemia treated?

If you have anaemia you’ll probably be prescribed iron supplements (tablets) or as a liquid to take every day. Vitamin C can help the body absorb iron, so you could try taking the tablets with a drink containing vitamin C such as orange juice.

The supplements may also give you some stomach pain, constipation and your poo may be black. This is normal but call your midwife if you’re worried.

You may find it easier to cope with side effects if you take the supplements with or soon after food.

Your symptoms should get better after taking iron supplements. If it doesn’t, or if your anaemia is severe, you’ll probably be referred to a haematologist (a doctor expert in blood disorders).

You may be given iron through intravenous therapy (IV). This means giving you iron in liquid form through a needle directly into the vein (usually in your arm). You may also be offered a blood transfusion.

Best foods to treat anaemia

Most people should be able to get all the iron they need by eating a healthy, balanced diet. Eating well will help you either prevent anaemia or manage your symptoms if you have it.

Some food has more iron than others. For example, animal-based foods are particularly rich in iron and are most easily absorbed.

Iron-rich food list

Most people should be able to get all the iron they need by eating a healthy, balanced diet. Eating well will help you either prevent anaemia or manage your symptoms if you have it.

Good sources of iron include:

• meat (red meat such as beef, lamb and pork is best, just make sure it is cooked thoroughly)
• pulses (beans, peas and lentils)
• fresh green leafy vegetables, such as cabbage, spinach, watercress, parsley, spring onions
• seeds, such as sunflower or sesame seeds
• dried prunes, raisins, figs and unsulphured apricots (dried apricots without sulfur dioxide)
• fish such as grilled mackerel and canned tuna (no more than 4 medium-sized cans a week)
• wholegrains, such as brown rice
• nuts, such as almonds, hazelnuts and brazil nuts.

To make sure you get an iron-rich diet you can:

• add green leafy vegetables to main meals, such as cabbage, spinach, watercress, parsley, spring onions or chives
• add dried fruit to desserts and have fruit (or nuts) as snacks between meals
• try iron-fortified foods, such as breakfast cereals or wholemeal toast.

Foods to help the body absorb iron

Some fruits and vegetables containing vitamin C can help the body absorb iron. These include:

• kiwi fruit
• oranges
• potatoes
• cauliflower
• broccoli
• brussels sprouts
• parsley.

Try to avoid drinking tea and coffee (including decaf versions), especially with a meal, because this can stop iron being absorbed into your body. It will be helpful to cut down on your caffeine intake in pregnancy anyway.

"Anaemia in pregnancy can be completely draining, but don't be afraid to ask for help. Feeling tired and worn out is part of pregnancy but if you feel like it's more than it should be, get checked out."

Jackie

Vitamin B12 or folate deficiency anaemia

Vitamin B12 and folate (B9) keep the nervous system healthy. You will develop Vitamin B12 or folate deficiency anaemia if you don’t have enough of these vitamins. These types of anaemia are less common than iron-deficiency anaemia.

You won’t be tested for these types of anaemia as part of your antenatal care. You will only be tested if you have low iron levels or have any symptoms.

Signs and symptoms of Vitamin B12 anaemia

As well as the symptoms listed at the top of the page you may also have:

• a pale yellow tinge to your skin
• a sore and red tongue (glossitis)
• mouth ulcers
• pins and needles (paraesthesia)
• changes in the way that you walk and move around
• disturbed vision
• irritability
• depression
• changes in the way you think, feel and behave
• a decline in your mental abilities, such as memory, understanding and judgement (dementia).

Some of these symptoms can also occur in people who have a vitamin B12 deficiency but have not developed anaemia.

Folate deficiency anaemia

As well as the symptoms listed at the top of the page you may also have:

• reduced sense of taste
• diarrhoea
• numbness and tingling in the feet and hands
• muscle weakness
• depression.

Both deficiencies are treated with supplements and some women will need vitamin B12 injections.

B12 and folate helps your baby grow and develop. They protect the baby from developing problems with the neural tube, such as spina bifida.

You can find vitamin B12 in food such as:

• meat
• fish
• eggs
• dairy products
• yeast extract (such as marmite)
• fortified foods (foods that have nutrients added to them).

Make sure that any meat is cooked thoroughly, and any dairy products are pasteurised.

Find out more about foods to avoid in pregnancy.

You can find folate in:

• broccoli
• brussels sprouts
• spinach
• asparagus
• peas
• chickpeas.
• fortified breakfast cereals.

Folic acid in pregnancy

A healthy diet on its own will not give you enough folate for pregnancy so it’s very important to take folic acid supplements.

You should always take folic acid supplements in pregnancy, even if you do not have folate deficiency anaemia.

This is because folic acid tablets drastically cut the risk of having a baby with spina bifida or other problems affecting the baby’s spine and neural tube. You should take folic acid for the first 12 weeks of pregnancy as that’s when the spine and neural tube are developing.

Folic acid and vitamin D supplements are the only supplements you need to take during pregnancy, unless your GP, midwife or doctor has prescribed anything else. 

After you have the baby

If you had anaemia during pregnancy talk to your midwife, doctor or health visitor about how this will be treated after you have your baby.

You may need to carry on taking vitamin supplements or having injections.

Anaemia and breastfeeding

You can breastfeed safely with anaemia. You can also take vitamin supplements safely while breastfeeding, as long as you don’t take more than the recommended or prescribed dose. You can check this with your GP, midwife or health visitor.

Anaemia can affect the milk supply so you may not produce a lot of milk. This can make breastfeeding difficult for some women, but not everyone. If you want to breastfeed your midwife or health visitor can support you. They will also be able to give you details of local services such as breastfeeding café’s, centres and drop ins.