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Anemia in Pregnancy

What you need to know — and what we can do together

Patient Education ACOG Guideline-Based MFM Specialist Care
ACOG Practice Bulletin · SMFM Guidelines · FIGO 2025

Understanding the Basics

What is Anemia?

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Red Blood Cells

Carry oxygen from your lungs to your body and baby

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Anemia

Too few red blood cells, or too little hemoglobin to carry enough oxygen

Diagnosed when hemoglobin < 11.0 g/dL
A routine blood test at your prenatal visit

ACOG Practice Bulletin No. 233

Prevalence

You Are Not Alone

32M

pregnant women affected
globally each year

~50%

of pregnant women
worldwide

40%

of cases caused by
iron deficiency

Anemia is very common in pregnancy — and very treatable.

WHO Global Nutrition Report · SMFM Consult Series

Pathophysiology

Why Pregnancy Increases Risk

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Blood Volume ↑
Plasma expands faster than red cells
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Baby's Needs ↑
Fetus draws iron for growth and development
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Dietary Demands ↑
Diet alone often cannot meet increased needs
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Iron Stores ↓
Ferritin levels fall as stores are depleted
ACOG Practice Bulletin No. 233 · FIGO 2025

Classification

Types of Anemia in Pregnancy

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Iron Deficiency

Most common type
~40% of cases

Most Common
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Folate / B₁₂ Deficiency

Megaloblastic anemia
Prevented by prenatal vitamins

Preventable
🧪

Hemoglobinopathies

Sickle cell disease
Thalassemia syndromes

Specialist Care
ACOG Practice Bulletin No. 233 · SMFM Consult Series

Recognizing Anemia

How Anemia May Feel

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Fatigue & Weakness

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Dizziness

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Shortness of Breath

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Rapid Heartbeat

Many women have no symptoms at all — which is why routine screening matters.

ACOG Practice Bulletin No. 233

Clinical Significance

Why Treatment Matters

For Mother

  • Increased risk of postpartum hemorrhage
  • Greater fatigue during labor and recovery
  • Higher chance of needing a blood transfusion
  • Increased risk of cesarean delivery

For Baby

  • Preterm birth (before 37 weeks)
  • Low birth weight (< 2,500 g)
  • Reduced oxygen during labor
  • Premature rupture of membranes

✓ With early treatment, most of these risks can be significantly reduced.

Meta-analysis 2025 · ACOG Practice Bulletin No. 233

Monitoring

When Will I Be Screened?

1st
First Visit
CBC + Ferritin
Baseline hemoglobin
24–28
Weeks 24–28
Repeat CBC
Routine re-screening
Rx
If Treated
Follow-up CBC
~4 weeks after starting treatment
PP
Postpartum
Continue iron
6 weeks after delivery

Ferritin < 30 µg/L indicates depleted iron stores — even before hemoglobin falls.

ACOG Practice Bulletin No. 233 · FIGO 2025

First-Line Treatment

Oral Iron Therapy

How to Take It

  • Take in the morning on an empty stomach
  • Take with vitamin C (e.g., orange juice) to boost absorption
  • 60–120 mg elemental iron daily
  • Every-other-day dosing may reduce side effects

What to Avoid

  • Calcium supplements at the same time
  • Coffee, tea, or milk within 1–2 hours
  • Antacids taken together with iron

Dark or black stools are normal when taking iron.

FIGO 2025 · ACOG Practice Bulletin No. 233

When Oral Iron Is Not Enough

Intravenous (IV) Iron

When IV Iron Is Recommended

  • Oral iron not tolerated (nausea, constipation)
  • No hemoglobin rise after 2–4 weeks of oral therapy
  • Severe anemia requiring rapid correction
  • Within 4–6 weeks of your due date
  • Preferred in the 3rd trimester (after 32 weeks)

What to Expect

  • Given as a short infusion in a clinical setting
  • Bypasses the stomach — no GI side effects
  • Safe and effective after the first trimester
  • Corrects anemia more quickly than oral iron
FIGO 2025 · ACOG Practice Bulletin No. 233

Treatment Comparison

Oral vs. IV Iron at a Glance

💊 Oral Iron 💉 IV Iron
Best For Mild to moderate anemia Severe anemia or oral intolerance
Dose 60–120 mg elemental iron/day Calculated by your doctor (Ganzoni formula)
Side Effects Nausea, constipation, dark stools Minimal; infusion site reactions (rare)
Speed Gradual (weeks) Faster correction
Timing Any trimester through postpartum Preferred after 32 weeks
FIGO 2025 · ACOG Practice Bulletin No. 233

Other Types of Anemia

Folate & Vitamin B₁₂

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Folate (Folic Acid)

Essential for red cell production and baby's neural tube development.

  • At least 400 mcg daily in prenatal vitamin
  • Start before conception if possible
  • Leafy greens, citrus, beans, fortified cereals
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Vitamin B₁₂

Needed for healthy red blood cells. More common in vegetarian/vegan diets or after weight-loss surgery.

  • Included in most prenatal vitamins
  • Meat, fish, eggs, dairy — or fortified foods
  • Injections available if absorption is impaired
ACOG Practice Bulletin No. 233 · SMFM Consult Series

Nutritional Support

Iron-Rich Foods

Heme Iron (Best Absorbed)

From animal sources — absorbed 2–3× more efficiently

  • Lean beef, chicken, turkey
  • Fish and shellfish (cooked)
  • Organ meats (liver — in moderation)

Non-Heme Iron

From plant sources — pair with vitamin C to boost absorption

  • Lentils, beans, chickpeas
  • Fortified cereals and breads
  • Spinach, tofu, pumpkin seeds

Diet alone cannot fully meet pregnancy's iron demands — supplements remain essential.

ACOG Practice Bulletin No. 233 · FIGO 2025

When to Seek Care

Call Your Care Team If You Have…

  • Severe fatigue or weakness
  • Dizziness or fainting
  • Rapid or irregular heartbeat
  • Severe shortness of breath
  • Chest pain or pressure
  • Intolerable side effects from supplements

Do not wait for your next appointment — contact us right away.

ACOG Practice Bulletin No. 233

Prevention

Staying Ahead of Anemia

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Take Your Prenatal Vitamin

Every day — it contains iron, folate, and B₁₂

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Eat a Balanced Diet

Include iron-rich, folate-rich, and B₁₂-rich foods

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Attend All Prenatal Visits

Routine screening catches anemia early

Tell your doctor about any dietary restrictions, surgeries, or conditions that may affect absorption.

ACOG Practice Bulletin No. 233 · SMFM Consult Series
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We Are in This Together

Anemia is common, detectable, and treatable.
Most women see improvement within a few weeks of starting treatment.

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Regular monitoring

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Consistent treatment

❤️

Healthy outcomes

Always follow your doctor's recommendations about supplements and follow-up testing.

MFM Patient Education · ACOG · SMFM