Anaemia and pregnancy

What is anaemia? 

Anaemia is a blood condition that develops when you do not have enough healthy red blood cells. Red blood cells contain haemoglobin, a protein that carries oxygen around your body and to your baby.  

Signs and symptoms of anaemia in pregnancy 

You will be checked for anaemia during your routine antenatal appointments. But it helps to know what the symptoms are so you can let your GP or your midwife know if you think you have it.  

Symptoms of anaemia include: 

• tiredness and lack of energy 
• shortness of breath 
• a noticeably fast-beating, fluttering or pounding heart (heart palpitations) 
• paler than normal skin, which can happen in a person with any skin tone.

The most common type of anaemia in pregnancy is iron-deficiency anaemia. It affects at least 4 in 10 pregnant people in the UK. 

“I was diagnosed as anaemic at my booking appointment. It wasn't until I had been taking iron supplements for a few weeks that I realised how better I felt. I hadn't realised that I was short of breath and had a real lack of energy.” 

Lucy 

What causes iron deficiency anaemia? 

Iron-deficiency anaemia is common in pregnancy because the amount of blood in your body increases, but the amount of red blood cells stays the same. It’s also hard to get enough iron from the food you eat.

You are more likely to develop iron-deficiency anaemia in pregnancy if you: 

• are vegetarian or vegan 
• have had anaemia before 
• are carrying more than one baby 
• were younger than 20 when you got pregnant 
• have had 3 or more babies  
• you are pregnant again after having a baby within the last year. 

At your booking appointment your midwife will ask you about: 

• your health 
• your medical history 
• any medical conditions you have 
• your lifestyle.

This will help them understand if you are at risk of iron-deficiency anaemia during your pregnancy.  

Will I be checked for anaemia during my pregnancy? 

Yes. Your midwife will offer you a blood test to check for any conditions that may affect your baby, including anaemia, at your booking appointment and again when you are 28 weeks pregnant. 

You will be offered an extra blood test at 20-24 weeks if you are carrying more than one baby. 

Call your midwife at any time if you think you have anaemia symptoms. They can test you for anaemia at any point in your pregnancy. You do not have to wait for your antenatal appointments or for routine tests. 

Will iron deficiency anaemia harm me or my baby? 

It is unlikely. Most people with anaemia in pregnancy go on to have a healthy pregnancy and baby. However, anaemia has been linked to pregnancy complications before and after birth if it is not treated. These can include:  

• low birthweight 
• premature labour and birth 
• stillbirth
• higher risk of needing a blood transfusion in labour 
• reduced breastmilk or chest milk supply 
• iron deficiency in the first 3 months of your baby’s life 
• fatigue (extreme tiredness) in the few months after birth 
• postnatal depression.

You can reduce the risk of anaemia in pregnancy by: 

• going to all your antenatal appointments 
• having any blood tests that you are offered 
• telling your GP or midwife about symptoms you are worried about 
• following a healthy, balanced diet 
• following the advice of your midwife or GP. 

How is iron deficiency anaemia treated? 

If you have anaemia your doctor may prescribe iron tablets (or a liquid version).   

Take your iron tablets on an empty stomach (ideally 1 hour before a meal). Vitamin C can help the body to absorb iron), so you could try taking the tablets with a drink that contains vitamin C, such as orange juice. 

Take any other multivitamins or medication such as antacids at a separate time.

Some people have stomach pain, nausea, constipation and dark or black poo when they first take iron supplements. This is normal but call your midwife if you are worried.  

Any side effects should get better over time. If they don’t, your doctor may advise you to take the supplements every second day instead, or they may prescribe a lower dose.

Your GP may refer you to a haematologist (a doctor who specialises in blood disorders) if your haemoglobin levels do not rise after supplements, or if you can tolerate (cope with) any side effects. 

You may be given iron through intravenous therapy (IV). This means giving you iron, in liquid form, through a needle directly into the vein (usually in your arm). 

You may be offered this if: 

• taking supplements is not working 
• you cannot tolerate the supplements 
• you need fast-working treatment.

You also may be offered a blood transfusion if you are very anaemic just before your baby is due. This is because there is a risk that you may become severely anaemic if you bleed even a small amount during birth. 

Which foods are a good source of iron?  

Most people should get all the iron they need by eating a healthy, balanced diet. But it can get harder as your pregnancy progresses and you need more iron.  Eating well will help to either prevent anaemia or manage your symptoms if you have it.  

Good sources of iron include: 

• red meat, such as beef, lamb and pork (cooked thoroughly) 
• fish, such as canned sardines and canned tuna (no more than 4 medium-sized cans a week) 
• poultry, such as chicken or turkey 
• pulses and legumes, such as beans, peas and lentils 
• dark green leafy vegetables, such as spinach, kale and broccoli 
• dried fruit, such as apricots 
• fortified breakfast cereals 
• nuts and seeds.

Which foods and drinks help the body to absorb iron? 

Some fruits and vegetables containing vitamin C can help the body absorb iron. Try having these with your iron-rich meals. They include: 

• kiwi fruit 
• oranges or orange juice 
• potatoes 
• cauliflower 
• broccoli 
• brussels sprouts 
• parsley. 

Try to avoid drinking tea and coffee (including decaf versions), especially with a meal. These contain compounds called tannins, which can stop iron being absorbed into your body. High levels of caffeine can cause pregnancy complications, so it is a good idea to cut down on your caffeine intake as much as possible in pregnancy anyway. Use our calculator to find out your daily caffeine intake. 

“Feeling tired and worn out is part of pregnancy, but if you feel like it is more than it should be, get checked out. Don’t be afraid to ask for help.”

Jackie 

What about vitamin B12 or folate deficiency anaemia? 

Vitamin B12 and folate deficiency anaemia are less common in pregnancy. 

Vitamin B12 and folate keep the nervous system healthy and protect your baby from developing problems with the neural tube, such as spina bifida. 

When you do not have enough vitamin B12 or folate (B9) your body produces abnormally large red blood cells that do not work properly.  

You will not be tested for these types of anaemia as part of your antenatal care. You will only be tested if you have low iron levels or have any symptoms that suggest you have B12 or folate anaemia.  

Signs and symptoms of Vitamin B12 anaemia 

As well as the symptoms of iron-deficiency anaemia, such as fatigue or pale skin, you may also have: 

• a pale-yellow tinge to your skin 
• a sore and red tongue (glossitis) 
• mouth ulcers 
• pins and needles (paraesthesia) 
• changes in the way that you walk and move around 
• disturbed vision 
• irritability 
• depression 
• changes in the way you think, feel and behave 
• problems with your memory, understanding and judgement. 

It is also possible to experience some of these symptoms if you are deficient in vitamin B12 but have not yet developed anaemia. 

Folate deficiency anaemia 

As well as the symptoms of iron-deficiency anaemia you may also have: 

• reduced sense of taste 
• diarrhoea 
• numbness and tingling in the feet and hands 
• muscle weakness 
• depression.

It is important to see your GP if you have symptoms of vitamin B12 or folate deficiency anaemia. Your GP can diagnose you with a blood test and treat you with supplements or injections to replace the missing vitamins.  

Foods that are also good sources of vitamin B12 include: 

• meat 
• fish, such as salmon and cod 
• eggs  
• milk and other dairy products  
• yeast extract (such as Marmite) 
• fortified breakfast cereals 
• soy products.

Make sure that any meat is cooked thoroughly and that any dairy products are pasteurised to avoid food related infections like Listeria.  

Find out more about foods to avoid in pregnancy.  

Folic acid in pregnancy 

You should always take folic acid supplements in pregnancy, even if you do not have folate deficiency anaemia. 

This is because folic acid tablets bring the risk of having a baby with spina bifida or other problems that affect the baby’s spine and neural tube down to almost none. Ideally you should start taking folic acid 2 months before you start trying to get pregnant as this means the folic acid has a chance to build up in your body to give most protection. trying for a baby Take it until 12 weeks of pregnancy. This helps your baby’s brain and spine to develop.

Some people need to take a higher dose of folic acid if there is an increased risk of neural tube defects in their developing baby. Folic acid and vitamin D supplements are the only supplements you need to take during pregnancy unless your GP, midwife or doctor has prescribed something else.   

After you have the baby  

Talk to your midwife, doctor or health visitor about how anaemia will be treated after you have your baby. 

You may need to carry on taking supplements or having injections. In some cases your doctor may recommend having a blood transfusion to boost your red blood cells.

Anaemia and breastfeeding 

You can breast or chest feed safely with anaemia. You can also take any supplements safely while breastfeeding if you do not take more than the recommended or prescribed dose. You can check this with your GP, midwife or health visitor.  

Anaemia can affect the milk supply, so you may not produce a lot of milk. This can make breastfeeding harder for some people, but not everyone.

If you want to breastfeed your baby, your midwife or health visitor can offer advice and support. They will also be able to give you details of local services such as breastfeeding cafés, centres and drop-ins, where you can talk to other parents and breastfeeding counsellors. 

Find out more about feeding your baby.