What causes anemia during pregnancy?

Complications during pregnancy can be scary. Even relatively common, non-life-threatening illnesses, like anemia, can cause complications.
Anemia occurs when you don't have enough red blood cells to transport adequate oxygen or iron. In people who aren't pregnant, this can cause:
Pregnant people can also experience labored breathing, rapid heartbeat, and loss of concentration. These symptoms are most pronounced in the first trimester when your body is still adjusting to being pregnant.
There are hundreds of types of anemia, but only a few that usually develop during pregnancy.
Iron-deficiency anemia
Iron deficiency is the leading cause of anemia in the United States, and as such, is the leading cause of anemia during pregnancy. Between 15% and 25% of pregnant people experience an iron deficiency, which causes fatigue and can make you more susceptible to infection.
Folate-deficiency anemia
Folic acid is a water-soluble vitamin found in fortified foods like leafy vegetables, legumes, cereals, and bananas. It can help prevent neural tube defects during pregnancy, so it's a vital part of the diet. Not getting enough folic acid can lead to a reduced number of red blood cells and folate deficiency.
Vitamin B-12 deficiency anemia
Another vitamin that aids in producing red blood cells is vitamin B-12. Some women's bodies can't process B-12, leading to a deficiency and fewer red blood cells.
Who's at risk for anemia?
As with other types of complications, some women are at higher risk of anemia, including those who:
- Are strict vegetarians or vegans, who are more likely to have vitamin B-12 deficiencies
- Have celiac or Crohn's disease, or another type of disorder that impacts nutrient absorption
- Have heavy periods
- Have had two pregnancies in quick succession
- Are pregnant with multiple babies
- Are not getting sufficient iron from their diets and supplements they may be taking
How is anemia diagnosed?
If you suspect you may be developing symptoms of anemia, you should contact your doctor immediately. They'll order blood tests to check your red blood cell count and hemoglobin levels. These will tell them if there's any reason to be concerned. These tests may also be part of your normal prenatal care plan. In addition to routine blood tests, your doctor may also want a hematocrit test, which measures the portion of red blood cells found in a certain amount of blood.
What are the effects on the baby?
If you develop anemia during pregnancy, the baby can:
- Arrive early
- Fail to grow to a healthy weight
Additionally, there can be post-partum effects for the birth parent. Anemia causes fatigue, which makes recovery longer and more difficult. It can also reduce the amount of milk new mothers produce, especially first-time mothers. If you're not producing enough milk, or there isn't enough iron in your milk, your baby may also develop anemia.
How is anemia in pregnancy treated?
One of the most common treatments for anemia during pregnancy is to take iron supplements or prenatal vitamins high in iron. These can be found at your local drugstore or grocery store. Your doctor may also recommend adding the following iron-rich foods to your diet:
- Meat, including beef and pork. Organ meats like liver are exceptionally high in iron
- Poultry, especially dark meat
- Fish, especially shellfish like clams and oysters
- Dark, leafy vegetables
- Legumes
- Yeast-leavened bread
- Iron enriched bread, pasta and cereals
You can also increase the amount of folic acid with:
- Citrus fruit, like oranges and grapefruits
- Fortified breakfast cereals
- Enriched grain products
Anemia is a common and easy to treat illness. If you're anemic prior to becoming pregnant, or you're worried that you may have developed anemia during pregnancy, note your symptoms and discuss your concerns with your doctors. They can recommend a treatment plan to keep you and your baby healthy for the duration of your pregnancy.

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American Pregnancy Association: "Anemia During Pregnancy."
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National Library of Medicine: "Anemia and insufficient milk in first-time mothers."
Penn Medicine: "What is Anemia?"
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