NHS Forth Valley – Iron Deficiency Anaemia in Pregnancy

Iron is vital for making haemoglobin in red blood cells. Haemoglobin traps oxygen from the lungs and carries it around the body to your organs and baby. Anaemia is when the level of haemoglobin in your blood is lower than normal; when this happens, less oxygen can be carried around the body.

During pregnancy, you are more likely to have low levels of iron and become anaemic. This page offers advice about how to improve your iron levels and why it is important.

Why is it Important to Maintain a Normal Haemoglobin (Hb) Level During Pregnancy?

Good iron levels help to:

Maintain a healthy immune system.
Reduce risk of small babies or preterm births.
Decrease the impact of blood loss at delivery and reduce the risk of blood transfusion.
Improve postnatal recovery, especially if you need surgery or have a perineal tear.
Avoid a decreased breast milk supply associated with severe anaemia.

How Do I Know if I Have Anaemia?

The most common symptoms of anaemia are:

Excessive tiredness.
Weakness.
Dizziness.
Irritability.
Shortness of breath / chest pain.
Heart palpitations (awareness of a faster heartbeat).

If you have any of these symptoms, talk to your midwife and a blood test can be performed. Routine blood tests are offered when you book for your pregnancy and again at 28 and 34 weeks pregnant.

Why Would I Have Iron Deficiency Anaemia?

There might not be enough iron in your diet.
Your gut is not absorbing iron despite having an iron-rich diet.
Due to increased demands of pregnancy, you are unable to take in enough iron through your diet.

Who is More Likely to Have Iron Deficiency Anaemia?

You may lose iron because of bleeding if you have heavy periods before pregnancy or other medical conditions. You are at risk if you:

Have low iron stores prior to pregnancy (Ferritin <50).
Have blood conditions like sickle cell anaemia or thalassaemia.
Have inflammatory conditions affecting your gut (e.g., inflammatory bowel disease, coeliac disease, previous gut surgeries).
Have higher demands (e.g., multiple pregnancy).
Are under 20 years of age.
Had anaemia in a previous pregnancy.
Have a child less than 1 year of age.
Are at high risk of bleeding during pregnancy or at birth (e.g., placenta praevia, previous or planned caesarean section).
Follow a vegan/vegetarian diet or have poor dietary intake of iron.

What Can I Do to Maintain a Good Supply of Iron?

You will be offered iron tablets three times a week from your booking visit (Mon-Wed-Fri) unless you have a medical problem, are not allowed to take iron, or your ferritin level is >50.

Eating plenty of iron-rich foods as part of a healthy diet helps maintain iron and haemoglobin levels:

Animal sources: Red meat, fish, poultry (these contain a form of iron easily absorbed).
- Do not eat liver products in pregnancy (high in iron but also high in vitamin A, which is dangerous for your baby).
Vegetarian sources: Fortified cereals, dried fruit, green vegetables (peas, broccoli, dark leafy cabbage, spinach), beans and pulses (lentils, soybeans, kidney beans, chickpeas), nuts and seeds, dark chocolate, tofu.

Some fruits and vegetables containing vitamin C help the body absorb iron:

Kiwi fruit, oranges, potatoes, cauliflower, Brussels sprouts, parsley.

Iron absorption can be delayed by:

Coffee, tea, food containing calcium (milk and other dairy).

For further information on diet advice, check bda.uk.com/foodfacts.

What Treatment Can I Take if I Develop Anaemia?

If you are found to be anaemic or have low iron stores, your GP or midwife will prescribe iron tablets and inform you of the correct dose.
Pregnant women with low iron stores benefit from taking iron to prevent anaemia due to increased demands.
Take iron tablets on an empty stomach; vitamin C/orange juice helps absorption. Avoid milk products for 1 hour before and after taking iron tablets (e.g., milk in coffee, cereal with milk).
Do not take other vitamins, medications, or antacids at the same time.
A repeat blood test will be offered in 6 weeks to evaluate if the tablets are working.

Side Effects and Additional Advice

Some side effects include nausea, bloating, and constipation. Sometimes the type of iron can be changed (e.g., liquid iron) to reduce side effects.
Do not take an extra iron tablet if you forget; just take one when you remember. It’s best to take iron no more than on alternate days to improve absorption.
Occasionally, if oral iron is not tolerated or effective, intravenous iron (through a drip) may be offered.
Keep iron tablets out of reach of children due to risk of iron poisoning.