Low red blood cell count hemoglobin and hematocrit pregnancy

Your body goes through significant changes when you become pregnant. The amount of blood in your body increases by about 20-30 percent, which increases the supply of iron and vitamins that the body needs to make hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen to other cells in your body.

Many women lack the sufficient amount of iron needed for the second and third trimesters. When your body needs more iron than it has available, you can become anemic.

Mild anemia is normal during pregnancy due to an increase in blood volume. More severe anemia, however, can put your baby at higher risk for anemia later in infancy. In addition, if you are significantly anemic during your first two trimesters, you are at greater risk for having a pre-term delivery or low-birth-weight baby. Being anemic also burdens the mother by increasing the risk of blood loss during labor and making it more difficult to fight infections. 

Am I at Risk?

You are at higher risk for becoming anemic during your pregnancy if you:

• Have two pregnancies close together
• Are pregnant with more than one child
• Are vomiting frequently due to morning sickness
• Do not consume enough iron
• Have a heavy pre-pregnancy menstrual flow

Many of the symptoms of anemia during pregnancy are also symptoms you may experience even if you are not anemic; these include:

• Feeling tired or weak
• Progressive paleness of the skin
• Rapid heartbeat
• Shortness of breath
• Trouble concentrating

Doctors typically perform several tests to check the percentage of red blood cells in your plasma and the amount of hemoglobin in your blood. These are indicators of whether you are at risk for becoming anemic.

Is Pregnancy-Related Anemia Preventable?

Good nutrition is the best way to prevent anemia if you are pregnant or trying to become pregnant. Eating foods high in iron content (such as dark green leafy vegetables, red meat, fortified cereals, eggs, and peanuts) can help ensure that you maintain the supply of iron your body needs to function properly. Your obstetrician will also prescribe vitamins to ensure that you have enough iron and folic acid. Make sure you get at least 27 mg of iron each day. If you do become anemic during your pregnancy, it can usually be treated by taking iron supplements.

Ask your doctor about your risk for anemia and make sure you are tested at your first prenatal visit. You also may want to get tested four to six weeks after delivery. Depending on your condition, your doctor may refer you to a hematologist, a doctor who specializes in blood conditions.

Where Can I Find More Information?

If you find that you are interested in learning more about blood diseases and disorders, here are a few other resources that may be of some help:

Results of Clinical Studies Published in Blood

Search Blood, the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, patients interested in viewing an access-controlled article in Blood may obtain a copy by e-mailing a request to the Blood Publishing Office.

Patient Groups

A list of Web links to patient groups and other organizations that provide information.

Feeling sluggish and weak? If you’re so drained that you often have trouble tending to your daily life, anemia may be to blame. 

The good news is, anemia in pregnancy is easy to treat and quite common, especially in the second and third trimesters. With a few minor nutritional adjustments (and potentially a supplement) to address low iron levels, you can have a healthy pregnancy.

What is anemia in pregnancy?

Anemia is a condition when the body can’t make enough red blood cells. A low red blood cell count makes it harder to send oxygen throughout your body, which can result in symptoms like excessive fatigue. 

Severe, untreated anemia during pregnancy can increase the risk for complications, including preterm birth. That’s why it’s so important to go to all of your prenatal appointments and let your doctor know if you’re experiencing unusual symptoms.

What causes anemia during pregnancy?

Low iron levels cause about 75 percent of anemia cases, usually because you’re not getting enough of this essential mineral in your diet. 

Here's the rundown on why anemia makes you feel run-down: By week 24 of pregnancy, the amount of blood in your body increases by up to 45 percent to support both you and your growing baby. 

Red blood cells contain hemoglobin, an iron-rich protein that carries oxygen from your lungs to the rest of your body. Your body needs iron to make hemoglobin — about twice as much as you needed before you were expecting to account for the increased blood volume. 

Without sufficient iron stores, red blood cell production slows, supplying the body with less oxygen. The result? One tired mama.

Risk factors for anemia during pregnancy include:

• Being pregnant with more than one baby
• Vomiting frequently due to severe morning sickness
• Getting pregnant soon after your last pregnancy
• Having a history of anemia or a heavy menstrual flow
• Not consuming enough iron in your diet

Less commonly, anemia could be caused by:

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More on Your Pregnancy Health

• A vitamin deficiency (vitamin B12, vitamin C or vitamin B9, which is folate), one more reason it’s so important to take your prenatal vitamin
• An underlying condition, such as thyroid disease

Symptoms of anemia during pregnancy

Early on, you may mistake anemia symptoms for normal symptoms of pregnancy. In fact, some pregnant women are completely unaware they're anemic until it's revealed in a blood test.

As the condition progresses, signs of anemia in pregnancy may include:

• Excessive tiredness or weakness
• Headaches
• Dizziness
• Shortness of breath
• A rapid or irregular heartbeat
• Numbness or a cold feeling in your hands and feet
• A low body temperature
• Pale skin, especially a loss of color in the face, lips or nails
• Chest pain
• Irritability (due specifically to a B12 deficiency)
• Trouble concentrating

If you’re experiencing any of these symptoms and are concerned it might be anemia, be sure to let your doctor know.

How anemia is diagnosed

Your practitioner will perform a complete blood count (CBC), which tabulates the number of various cells that make up your blood. If your red blood cell count is low, your doctor will diagnose you with anemia and may give you other blood tests to figure out the type of anemia you have. 

The CBC test is a standard part of care early on in your pregnancy — usually at your first prenatal appointment as part of your initial pregnancy bloodwork — and again later in your pregnancy.

Risks of anemia during pregnancy

If anemia is left untreated, it can become severe. Untreated severe anemia, especially during the first two trimesters, can increase the risk of:

• Poor fetal growth
• Infections
• Preterm birth 
• A low birth weight baby
• Needing a blood transfusion during delivery 
• Postpartum depression

The good news: Even if you've been anemic throughout your pregnancy, it's extremely rare for a baby to have an iron deficiency too. Why? A Your baby will take all the iron that she needs to thrive first. 

Can anemia cause miscarriage?

Anemia itself doesn’t directly cause miscarriage. But it could be a sign of a thyroid condition that may slightly increase the risk of pregnancy loss.

Very rarely, hypothyroidism can cause anemia during pregnancy. This type of thyroid disorder (often caused by Hashimoto’s disease) spurs antibodies to attack the thyroid gland. Some research suggests that hypothyroidism is linked to a slightly elevated risk of pregnancy complications.

Try not to stress. Let your doctor know if you have a family or personal history of thyroid disease, and report any symptoms of thyroid conditions that you notice.

Your practitioner can detect and effectively treat anemia and thyroid problems before either can cause a bigger problem.

How to treat anemia

In most cases, the treatment for pregnancy-induced anemia is simple: more iron. Your health care provider may prescribe a daily iron supplement to take in addition to your prenatal vitamin. 

Take both, only with your doc’s okay, at different times of the day to ensure that you're getting all your daily nutrients. For maximum results, take them with a glass of orange juice, but avoid the calcium-fortified kind (vitamin C helps boost iron absorption, but calcium can decrease it) or prune juice (which also helps with the inevitable constipation that extra iron brings with it).

Keep in mind that timing is important. For one hour before you take your iron supplement and two hours after, avoid milk, cheese, yogurt, eggs, spinach, whole grains, coffee and tea, since they can hinder iron absorption. 

And in addition to taking your supplements, be sure your diet includes plenty of iron-rich foods, including poultry, leafy greens, lentils, beans and beef.

Be aware, too, that iron supplements can make nausea worse. If this is the case for you, try the standard treatments for morning sickness, including eating smaller, more frequent meals (six snack-size meals instead of three big ones) and drinking plenty of water. 

You may also want to try taking your iron supplement right before bed, since you may be less likely to notice nausea when you're asleep.

Since treatment depends on the cause, it’s important to talk with your doctor about your particular needs. In the rare case your anemia is due to a vitamin deficiency or illness, you may require folic acid supplements or other treatments to address the underlying disease.

How to prevent anemia when you're expecting

While not all cases of anemia in pregnancy are preventable, getting enough iron in your diet goes a long way in helping you to avoid the condition. Before you’re pregnant, that means consuming 18 milligrams (mg) of iron per day; once you do conceive, you should aim for 27 mg. 

While a prenatal vitamin covers your bases — along with your requirements for other important nutrients like folic acid and vitamin B12 — you should also try to eat a variety of healthy foods that are high in iron. These include:

• Iron-fortified cereal (18 mg per serving)
• Lean beef (2 mg in 3 ounces)
• Liver (5 mg in 3 oz of beef liver)
• Beans and legumes (4 mg in 1/2 cup of white beans; 3 mg in 1/2 cup of lentils)
• Green, leafy vegetables (6 mg in 1 cup cooked spinach)
• Seeds and nuts (2 mg in 1 oz or 18 cashews)
• Dark chocolate (7 mg in 3 oz)
• Baked potatoes (2 mg for a medium spud)

Cooking in cast iron pans may also help give your iron intake a little boost, since foods absorb some of the iron from the skillet. Also note that animal-based iron (from meat) is absorbed by the body better than plant-based iron.

Anemia during pregnancy is quite common, but it’s also easily diagnosed and treated. Just be sure to eat plenty of fresh and healthy iron-rich foods, go to your scheduled prenatal appointments and let your doctor know if you’re experiencing any unusual symptoms.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

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