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Anemia in Pregnancy — Comprehensive

Diagnosis and Management of Maternal Anemia

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Anemia in Pregnancy — Comprehensive?

WHO definition: hemoglobin under 11 g/dL in pregnancy (under 10.5 g/dL in second trimester due to physiologic hemodilution).

Severity classification: mild (10-10.9 g/dL), moderate (7-9.9 g/dL), severe (under 7 g/dL).

Prevalence: 30-50% globally; 17% in developed countries; up to 50% in developing regions.

Physiologic changes in pregnancy: 50% plasma volume increase but only 25% red cell mass increase, causing dilutional anemia and increased iron demand (2-fold increase).

Etiologies: iron deficiency (50%, most common), folate deficiency, B12 deficiency, hemoglobinopathies (thalassemia, sickle cell), chronic disease, hemolysis, blood loss.

Trimester-specific demands: third trimester has highest iron requirements (placental, fetal, expanded blood volume).

Symptoms

Often asymptomatic in mild anemia.
Fatigue, weakness, dizziness, lightheadedness.
Pallor of conjunctiva, mucous membranes, palms.
Tachycardia, palpitations, dyspnea on exertion.
Headaches, irritability, poor concentration.
Pica (craving for ice, dirt, starch — pagophagia, geophagia, amylophagia).
Restless legs syndrome.
Brittle nails, hair loss, glossitis, angular cheilitis (chronic iron deficiency).
Severe anemia: chest pain, syncope, heart failure (rare).

Risk Factors

Multiparity, multiple gestation, short interval between pregnancies.
Inadequate prenatal care or supplementation.
Poor diet (vegetarian/vegan without supplementation).
Heavy menstrual bleeding pre-pregnancy.
Hyperemesis gravidarum.
Adolescent pregnancy.
History of bariatric surgery, malabsorption, IBD, celiac disease.
Prior anemia or chronic disease.
Hemoglobinopathy carrier status (thalassemia, sickle cell).
Helminthic infection in endemic areas (hookworm).

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pre-pregnancy hemoglobin under 12 g/dL.
  • Symptoms of fatigue, dyspnea, palpitations during pregnancy.
  • First trimester hemoglobin under 11 g/dL on routine screening.
  • Mid-pregnancy hemoglobin under 10.5 g/dL.
  • Failure to respond to oral iron supplementation.
  • Pre-conception counseling for women with chronic anemia or hemoglobinopathy.
  • Severe symptoms (palpitations, syncope, chest pain) at any pregnancy stage.

Treatment Methods

01
Universal screening: complete blood count at first prenatal visit and at 28 weeks (some recommend 24-28 and 32-36 weeks).
02
Iron deficiency workup: ferritin (most sensitive in pregnancy, level under 30 ng/mL diagnostic), serum iron, TIBC, transferrin saturation.
03
B12 and folate levels for macrocytic anemia.
04
Hemoglobin electrophoresis for suspected hemoglobinopathy (essential in high-prevalence regions).
05
Reticulocyte count to assess marrow response.
06
Oral iron supplementation: 60-200 mg elemental iron daily (ferrous sulfate, ferrous fumarate, ferrous gluconate); take with vitamin C, avoid with calcium/coffee/tea.
07
Side effects management: nausea (start low, increase gradually), constipation (stool softener, hydration), GI upset (take with food).
08
Intravenous iron (iron sucrose, ferric carboxymaltose, iron isomaltoside): for severe anemia, oral intolerance, second/third trimester time pressure, malabsorption.
09
Avoid iv iron in first trimester unless absolutely necessary.
10
Folate supplementation: 400-800 mcg/day routinely; 5 mg/day in folate deficiency or hemoglobinopathy.
11
B12 supplementation: oral or intramuscular based on cause.
12
Severe anemia (under 7 g/dL near term): consider transfusion to optimize for delivery.
13
Postpartum management: continue iron 3-6 months, address ongoing blood loss, screen for postpartum hemorrhage risk.
14
Long-term: assess for celiac disease, IBD, gynecologic causes if persistent or recurrent.
15
Patient education: dietary iron sources (red meat, liver, beans, fortified cereals), supplementation timing, follow-up testing.

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.