Pregnancy and Anaemia

What is Anaemia?

Anaemia is decrease in the number of red blood cells in blood, which can lead to a lack of oxygen-carrying ability and causing unusual tiredness. The deficiency occurs either because of the reduced production or an increased loss of red blood cells. Red blood cells are produced in the bone marrow, and their average life expectancy is about 120 days.

To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anaemia will develop.


  • Poor intake of iron in diet. Iron is needed to make red blood cells. When women loose blood, they also loose iron. This happens in pregnancy due to the fact that the woman must supply iron to both herself and her baby. Iron can be replenished by vitamin supplements or in the diet.
  • Folic acid deficiency. Folic acid is vitamin B, which is needed to produce red blood cells.
  • Blood loss from haemorrhoids or gastrointestinal bleeding
  • Even if iron and folic acid intake are sufficient, a pregnant woman may become anaemic because pregnancy alters the digestive process. The unborn child consumes some of the iron or folic acid normally available to the mother’s body

Signs & Symptoms

The symptoms, such as tiredness and general weakness, will be similar to any other person with anaemia. In severe cases, the woman will be short of breath even at rest.

If the anaemia is prolonged, other signs may develop, such as a smooth shiny tongue and tenderness of the skin at the corners of the mouth. However, these advanced signs are rare.


Routine blood tests during antenatal care show low haemoglobin concentration as well as the characteristic small, pale red blood cells under the microscope (in the case of iron deficiency anaemia).

The diagnosis of iron deficiency anaemia can be confirmed by measuring the amount of stored iron as well as the levels of iron binding proteins in the blood. The diagnosis of folate deficiency is confirmed by estimating red blood cell folate levels.

Course of Anaemia

Patients with severe anaemia are more likely to deliver early and have small babies. Women with severe anaemia may have symptoms such as weakness, fatigue, shortness of breath and headaches.

Birth is also associated with blood loss. Therefore, if a woman is anaemic, she should take iron for several months after delivery in order to help the body replace the lost blood cells and iron stores. Breast feeding women may also need to take iron because iron is lost in breast milk.

As long as the anaemia is treated and corrected, there should be no problems.


A well balanced diet is always recommended. Iron and folate supplementation is indicated in pregnancy.

When the anaemia is caused by lack of iron, it is treated with iron supplements, preferably ferrous sulphate tablets. These supplements should not be taken more than twice daily, since the side effects of iron are increased in doses higher than this. The side effects are stomach upsets and constipation which are problematic in pregnancy.

If the anaemia is due to folic acid deficiency, it is treated with folic acid supplements.