Anemia During Pregnancy: Symptoms, Testing & Treatment

Understanding anemia during pregnancy

Anemia means your blood has less hemoglobin than it should. Hemoglobin is the protein in red blood cells that carries oxygen through your body. Your body needs iron to make it.

Iron deficiency and anemia are related but not the same. Iron deficiency means your iron stores are low. Anemia means hemoglobin has already dropped. You can be low in iron before you become anemic.

Why iron needs go up

During pregnancy your blood volume grows by about 40 to 50 percent. Your body also sends iron to the placenta and your baby, especially in the third trimester. Many people start pregnancy with low stores from heavy periods, a recent pregnancy or diet.

Normal blood dilution

The liquid part of your blood expands faster than red blood cells. This dilutes hemoglobin a little, which is a normal part of pregnancy. That is why pregnancy uses its own ranges for each trimester.

Not every anemia is from low iron

Iron deficiency is the most common cause, but anemia can also come from low folate or vitamin B12, inherited conditions such as thalassemia or sickle cell trait, or other health conditions. Finding the cause comes first.

Signs and symptoms

• Fatigue
• Weakness
• Dizziness
• Headaches
• Less energy for exercise
• Shortness of breath with activity
• Heart palpitations

Some people have no symptoms at all. Many of these feelings also overlap with normal pregnancy, so blood work is the reliable way to know.

How is anemia diagnosed during pregnancy?

Screening is part of routine prenatal care. ACOG recommends a complete blood count (CBC) in the first trimester and again around 24 to 28 weeks. Your provider may look at:

• Hemoglobin and hematocrit
• MCV and other red blood cell measures
• Ferritin, which reflects iron stores
• Serum iron and TIBC
• Transferrin saturation
• Other tests when needed, such as B12, folate or hemoglobin evaluation

Anemia thresholds differ by trimester, and results are always read together with your symptoms and history. Low ferritin can point to depleted iron stores. Other causes, such as vitamin deficiencies or inherited blood conditions, may need more testing. A lab number alone does not decide treatment.

Why treating anemia matters

Iron-deficiency anemia can leave you feeling drained. When it goes untreated, it is associated with postpartum anemia, preterm birth and low birth weight. These are not inevitable. Finding the cause and treating it supports your health during pregnancy and your recovery after birth.

Treatment options

Dietary iron

Iron-rich foods include lean red meat, poultry, fish, beans, lentils, tofu, spinach and iron-fortified cereals. Pairing them with vitamin C foods like citrus, strawberries or peppers helps absorption. Tea, coffee and calcium can reduce absorption when taken at the same time. Food alone is often not enough once iron is low.

Oral iron supplements

Iron tablets are commonly the first-line treatment for iron-deficiency anemia in pregnancy. Side effects can include nausea, constipation, stomach upset and dark stools. Your provider may adjust the dose or schedule, such as every-other-day dosing, and recheck labs after a few weeks.

Intravenous (IV) iron

IV iron may be considered when oral iron is not tolerated, does not work, is not absorbed well, or when your situation calls for a different approach, such as anemia found later in pregnancy. It is generally considered in the second or third trimester, not the first. IV iron is not routinely needed and is not better for every pregnant patient.

Iron infusions available at Lakeland Birth & Gynecology

Iron Sucrose 100 mg

$294

Iron Sucrose 200 mg

$394

Iron Deficiency Consultation With Standard Labs

$150

• Your clinician prescribes the dose. Patients do not choose a dose online.
• Some patients need a series of infusions.
• Infusion pricing includes administration and required monitoring.
• The $150 consultation includes standard labs: CBC, Ferritin, Serum iron, TIBC and transferrin saturation.
• Infusions are billed separately from consultations.
• Baseline labs are generally required within 30 days of starting a new treatment course.
• Outside provider orders can be reviewed and accepted when clinically appropriate.

Can I receive an iron infusion if I see another OB or midwife?

Yes. You do not need to transfer your prenatal care to us. If you have recent blood work and a valid infusion order from your OB/GYN or midwife, you can request a review. We may need additional assessment before treatment, and we can keep your provider updated with your permission. If you would like midwifery-led care, learn about our pregnancy and prenatal care.

Postpartum anemia

After birth, anemia can come from blood loss during delivery or from low iron that carried over from pregnancy. Common signs include deep tiredness, dizziness, a racing heartbeat, shortness of breath and trouble keeping up with recovery or feeding.

Oral iron is often the first option. IV iron may be considered when anemia is more significant, oral iron is not tolerated, or faster replacement is needed. Follow-up labs help make sure your levels recover.

When to seek urgent care

Call 911 or go to the nearest emergency room for fainting, chest pain, severe shortness of breath, a very fast heartbeat at rest, or heavy bleeding (soaking a pad an hour or passing large clots). Severe or unstable anemia needs emergency care, not an outpatient infusion. In pregnancy, also seek urgent care for decreased fetal movement, vaginal bleeding or leaking fluid.