Anaemia in Pregnancy: Iron and Folic Acid

Anaemia is one of the most common health problems in pregnancy. The World Health Organization (WHO) defines it as having fewer red blood cells than normal, or less haemoglobin inside them, so the blood carries less oxygen around the body. WHO reports that 37% of pregnant women worldwide, about 32 million women, have anaemia, and 30% of all women aged 15 to 49.

Why does anaemia matter in pregnancy?

WHO says anaemia in pregnancy has been linked with poor outcomes for mother and baby, including premature birth, low birth weight and maternal death. It also leaves you exhausted at a time when you need energy. The good news is that it is easy to test for and usually straightforward to treat.

What are the signs of anaemia?

WHO lists these common symptoms:

• Tiredness
• Dizziness or feeling light-headed
• Cold hands and feet
• Headache
• Shortness of breath

In severe cases there may be pale skin, fast breathing, a fast heartbeat and easy bruising. The NHS adds that iron deficiency anaemia can also cause a pounding heartbeat, ringing in the ears, a sore tongue, hair loss, an altered sense of taste, and unusual cravings for things that are not food, such as ice or paper.

Many of these feel like ordinary pregnancy tiredness, which is exactly why you should not try to judge it yourself. Only a blood test can tell.

How is anaemia found and treated?

A full blood count is the standard test. In the NHS antenatal schedule, blood is taken early in pregnancy and again at around 28 weeks to check your iron level. If the level is low, the NHS says a doctor or midwife will advise you to take iron supplements.

WHO recommends daily oral iron and folic acid supplementation as part of routine antenatal care. Do not choose your own dose. The right amount depends on your blood results and your history, so follow exactly what your clinic prescribes, and go back for the repeat blood test so they can check it is working.

What about folic acid?

Folic acid is a different thing from iron and it works earliest. The NHS advises taking a folic acid supplement every day from before you become pregnant until you are 12 weeks pregnant, because it lowers the risk of neural tube defects such as spina bifida in the baby. Some women are advised a higher amount, for example if they have diabetes, a family history of neural tube defects or take certain medicines. Your doctor decides that, so tell the clinic about every medicine and condition you have.

One important warning from the NHS: do not take cod liver oil or any supplement containing vitamin A (retinol) during pregnancy, because too much vitamin A could harm the baby. Check multivitamin labels, and show any supplement you have bought to your midwife or doctor before taking it.

Which foods help build iron?

Food alone may not correct anaemia, but it supports treatment. The NHS lists these iron-rich foods:

• Dark green leafy vegetables
• Meat
• Pulses such as beans, peas and lentils
• Dried fruit such as apricots, prunes and raisins
• Fortified breakfast cereals and bread

The NHS also advises cutting down on tea, coffee, milk and dairy around iron-rich meals, because these make it harder for the body to absorb iron. A cup of tea an hour or two after the meal is better than one with it.

When to see a doctor

See your doctor or midwife if you feel unusually tired, breathless on light activity, dizzy, or your heart races when you climb stairs. Also go if you were told your iron is low and you have not had a repeat blood test.

Get emergency help if you have chest pain, fainting, or severe breathlessness at rest: call Rescue 1122 where available, or go to the nearest hospital emergency department. Never stop or change prescribed iron because of stomach upset without telling your clinic first, as they can adjust it for you.