Anaemia in Pregnancy - Causes, Complications and Treatment

Iron deficiencies are the primary contributors to anaemia in pregnancy. [1] According to the National Family Health Survey (NFHS) of 2022, anaemia affects 52.2% of pregnant women in India. Pregnancy is probably one of the most memorable and emotional phases in a woman's life. However, when it comes to how her body changes throughout pregnancy, there are several things to consider. The higher need for iron to the growing baby is one such shift.

One of the contributing factors to a number of maternal and foetal issues is anaemia during pregnancy. It lessens the woman's ability to cope with bleeding during or after delivery and makes her more susceptible to infections. Premature delivery, low birth weight (LBW), mother and child death rates, and intrauterine growth retardation have all been correlated to anaemia during pregnancy.

Anaemia in pregnancy is a condition characterised by a low level of haemoglobin or red blood cells in the blood during pregnancy which lowers the oxygen level in the body.

Many organs and bodily mechanisms are impacted when the cells do not receive enough oxygen. Due to the additional blood that the body produces to help the growing baby (the nutrition it needs), pregnant women are more likely to suffer anaemia.

Anaemia has over 400 types. Pregnancy makes some of them more prevalent, including:

1. Iron-deficiency anaemia (due to low iron): This is the most common form of anaemia during pregnancy. Between 15% and 25% of pregnant women are iron deficient.Red blood cells contain the element iron, which helps in the storage and use of oxygen by the muscles and the transport of oxygen from the lungs to the body. With low iron in the body, the woman may experience fatigue and lowered infection defence. 
2. Folate-deficiency anaemia (due to lack of folic acid): Folate or folic acid is a water-soluble vitamin that helps prevent neural tube defects in growing babies.Pregnant women frequently take folic acid supplements, which are also present in fortified foods like cereals, leafy veggies, bananas, legumes, and melons. Due to the lack of folic acid in the food, the body produces fewer red blood cells, resulting in a deficiency.
3. Vitamin B12 deficiency anaemia (caused by a lack of vitamin B12): The body needs vitamin B-12  to help synthesise red blood cells.Even though some women get enough B-12 in their diets, it's possible that their inability to properly absorb the vitamin results in a deficiency.

Classification of Anaemia in Pregnancy

The blood volume increases by 20% to 30% during pregnancy. Thus, to meet the iron needs, the body produces more red blood cells. Hence mild anaemia is normal in pregnancy.

However, to differentiate the severity, prevent complications, and treat anaemia in pregnancy, it has been classified.

Symptoms of anaemia during pregnancy can initially be mild and often go undiagnosed. However, with the progressing pregnancy, the symptoms can get worse.

A doctor visit is essential since some symptoms may not be caused by anaemia alone but rather by other underlying conditions. If a woman is pregnant and experiencing the following symptoms, she could be anaemic.

1. Pale skin, lips, hands, nails, or underside of the eyelid
2. Easy fatigue
3. Rapid heartbeat
4. Dizziness
5. Breathlessness
6. Concentration difficulty
7. Weakness and easy fatigue
8. Headache 
9. Unintended movement in the lower leg
10. Sore tongue

Anaemia during pregnancy is a common condition affecting women worldwide. It is estimated that up to 50% of pregnant women suffer from anaemia.

It is important to understand the causes of anaemia during pregnancy to prevent and manage the condition effectively, ensuring a healthy pregnancy and birth outcome for both mother and baby. Some of the causes of anaemia during pregnancy include.

1. Being vegan could be the prime cause of anaemia.
2. Had a past history of anaemia, pregnancy could add to iron deficiency.
3. Heavy menstrual flow before pregnancy is the culprit in rare cases.
4. Multiple pregnancies where there is more need is another factor.
5. If the mother’s age is less than 20, she is at increased risk of developing anaemia.
6. Getting pregnant within a year of giving birth to a baby can put the woman at risk of iron deficiency.
7. Iron deficiency anaemia during pregnancy develops when the body doesn't have enough iron from diet or prenatal vitamins. 
8. Severe morning sickness with excess vomiting can contribute to anaemia in pregnancy.
9. Intestinal ulcers, Crohn's disease, or ulcerative colitis leading to internal bleeding can cause anaemia in some expectant moms.
10. Not consuming enough iron, folic acid, or vitamin B-12 in the diet or prenatal supplements.
11. Conditions like sickle cell anaemia and thalassemia can add to anaemia during pregnancy.
12. Donating blood before pregnancy or during pregnancy can be an additional cause of anaemia.

Anaemia in pregnancy can affect the baby's growth and risk the mother's health during and after labour. The baby could be born too early or preterm (when delivery occurs before 37 weeks of pregnancy) or have a low birth weight if the woman has anaemia during pregnancy.

Having a lot of exhaustion may also prevent the pregnant woman from recovering after childbirth.

Low birth weight and postpartum depression are also linked to iron deficiency anaemia during pregnancy. Also, some studies indicate a higher risk of newborn death right after birth due to anaemia.

Some other complications of anaemia in pregnancy due to severe or untreated iron deficiency anaemia are:

1. Placental abruption
2. Stillbirth
3. Developmental delay in the baby 
4. Low birthweight
5. Significant amount of blood loss during delivery
6. Increased risk of infection due to anaemia

Anaemia is typically diagnosed through a blood test that measures the haemoglobin level. The World Health Organization defines anaemia in pregnancy as a haemoglobin level below 11 g/dL in the first and third trimesters and below 10.5 g/dL in the second trimester.

Treatment of anaemia in pregnancy varies depending on the pregnant woman’s age, general health, symptoms and on how serious the problem is. 

1. Iron supplementation: The most common cause of anaemia during pregnancy is iron deficiency. Therefore, iron supplementation is the first-line treatment for anaemia in pregnant women.
   The American College of Obstetricians and Gynecologists (ACOG) recommends a daily iron supplement of 30 mg to 60 mg for pregnant women with anaemia. Women who cannot tolerate oral iron supplements may need intravenous iron therapy.
2. Folate and vitamin B12 supplementation: Folate and vitamin B12 are also important for the production of red blood cells. Pregnant women with anaemia may benefit from supplementation with these vitamins, particularly if they have a deficiency.
3. Blood transfusion: In severe cases of anaemia, a blood transfusion may be necessary to quickly increase the haemoglobin level and improve oxygen delivery to the foetus.
   However, blood transfusions carry risks and are only used when other treatments are ineffective or when the mother's life is in danger.

Anaemia is a common condition during pregnancy, but it can be prevented with the right strategies. Here are some details for the prevention of anaemia during pregnancy:

1. Iron-rich diet: Eating a diet that is rich in iron is one of the best ways to prevent anaemia during pregnancy. Iron-rich foods include red meat, poultry, fish, beans, lentils, tofu, fortified cereals, and dark leafy greens.Pairing these foods with vitamin C-rich foods, such as citrus fruits and tomatoes, can enhance the absorption of iron.
2. Regular check-ups: Regular prenatal check-ups can help to identify and monitor anaemia during pregnancy. A healthcare provider can perform blood tests to measure the haemoglobin level and recommend appropriate treatment if necessary.
3. Treat underlying conditions: Anaemia during pregnancy can be caused by underlying conditions, such as bleeding disorders or infections. Treating these conditions promptly can help to prevent anaemia.
4. Manage morning sickness: Severe morning sickness can lead to dehydration and a loss of nutrients, including iron. Managing morning sickness through small, frequent meals and staying hydrated can help to prevent anaemia.
5. Avoid tea and coffee with meals: Tea and coffee contain compounds that can interfere with iron absorption. Drinking tea or coffee with meals can reduce the absorption of iron from food.
6. Know your risk factors: Some women are at a higher risk of developing anaemia during pregnancy, including those with a history of anaemia, multiple pregnancies, or a diet that is low in iron. Knowing your risk factors can help you to take proactive steps to prevent anaemia.

Sources of Iron

Normally during antenatal screening in pregnant women, haemoglobin is checked to prevent and treat anaemia. Consult the doctor if a pregnant woman notice any of these symptoms:

1. Dizziness
2. Severe headache 
3. Rapid pulse rate
4. Pale skin, lips
5. Soreness in the tongue
6. Restlessness in the limbs

If a pregnant woman is concerned about these symptoms, talk to the doctor about getting tested for anaemia and finding out how to keep the red blood cell count in check throughout the pregnancy.

Pregnancy comes with several physical, mental, and emotional changes. Anaemia in pregnancy is one of the most common conditions seen in expecting moms. Anaemia can be treated and prevented by eating a diet high in iron, folate, and vitamin C. Furthermore, daily prenatal vitamin use can help overcome the deficiency. Discuss your risk of anaemia during pregnancy with your healthcare provider and any worries you may have.