Why does hemoglobin decrease?
During pregnancy, the volume of blood plasma grows faster than the number of red blood cells, so a slight decrease in hemoglobin is physiological. It is for this reason that the normal thresholds in pregnant women are lower than outside pregnancy. However, the majority of anemia is associated with true iron deficiency. Iron is spent on the mother’s hematopoiesis, the development of the placenta and the formation of the child’s reserves, and during childbirth it is lost in the blood. Therefore, towards the end of pregnancy, the deficiency increases.
- Iron deficiency anemia is the most common
- Folate deficiency anemia
- B12 deficiency anemia
- Anemia in chronic inflammatory diseases
- Hereditary hemoglobinopathies, such as thalassemia
- Anemia after bleeding
Risk factors
Some women begin pregnancy with low iron reserves. They can be identified in advance by ferritin and the deficiency can be corrected at the planning stage. During pregnancy, the risk is increased by frequent vomiting, the inability to eat properly, and chronic diseases of the stomach and intestines that impair absorption. In families where hereditary blood diseases occur, the doctor may prescribe additional tests.
- Heavy menstruation before pregnancy
- The interval between births is less than two years
- Multiple pregnancy
- Poor diet, abstaining from meat
- Severe toxicosis
- Gastrointestinal diseases that impair absorption
Symptoms
Many signs of anemia are similar to common pregnancy complaints and can be easily overlooked. Iron deficiency affects not only the blood, but also the skin, hair, and nails. Sometimes there is a desire to eat chalk, ice, earth or raw cereals - this is a characteristic sign of iron deficiency. With severe anemia, weakness interferes with everyday activities, shortness of breath appears with little exertion.
- Weakness, fatigue
- Pale skin and mucous membranes
- Shortness of breath and palpitations on exertion
- Dizziness, tinnitus
- Brittle nails, hair loss, cracks in the corners of the mouth
- Craving for chalk, ice, unusual smells
Diagnostics
A general blood test is taken upon registration and again in the second and third trimesters. In addition to hemoglobin, the doctor evaluates the size and saturation of red blood cells, which suggests the cause. The main indicator of iron reserves is ferritin: a value below 30 µg/l indicates a deficiency. Ferritin may falsely increase during inflammation, so it is assessed along with other indicators. For large red blood cells, folic acid and vitamin B12 are checked; if hereditary anemia is suspected, additional hemoglobin tests are performed.
- Complete blood count with erythrocyte indices
- Ferritin
- Serum iron, transferrin
- Folic acid and vitamin B12
- Reticulocytes
- Hemoglobin testing for suspected thalassemia
Treatment and prevention
Iron deficiency anemia is treated with oral iron supplements. Diet alone is not enough for treatment, but eating meat, poultry, fish, legumes and foods with vitamin C helps better. It is better not to take iron tablets with tea, coffee or milk. If oral medications are poorly tolerated, do not help, or anemia is detected late, the doctor may prescribe iron intravenously from the second trimester. Blood transfusions are only needed for severe anemia. Folic acid is recommended for all pregnant women, and the dose and duration of iron intake is determined by the doctor.
- Iron supplements - as prescribed by a doctor
- Blood test monitoring after 2–4 weeks of treatment
- Meat, liver, fish, legumes, greens in the diet
- Folic acid during the planning stage and in the first trimester
- Checking ferritin before pregnancy
- Continuation of treatment after hemoglobin normalization
