Could you be at risk for anemia? Redfearn, Suz. Baby Talk 69. 4 (May 2004): 77.

Anemia, a deficiency of red blood cells, affects up to half of pregnant women due to the increase of a fluid in a woman's blood by as much as 50 percent during pregnancy, diluting the concentrations of red blood cells and hemoglobin, a critical protein in these cells. If left untreated, a severe case can cause poor fetal growth, preterm birth, and low birth weight. Here, Redfearn presents some information about anemia, its causes, symptoms, diagnosis, treatment, and prevention.

For many women, pregnancy can be as tiring as it is exciting. While some fatigue is normal for moms-to-be, excessive tiredness may be a sign of anemia, a deficiency of red blood cells (which carry oxygen in the blood) that affects up to half of pregnant women.

Why is this condition so common? During a normal pregnancy, the volume of fluid in a woman's blood increases by as much as 50 percent, diluting the concentrations of red blood cells and hemoglobin, a critical protein in these cells. If levels drop too low, the body's ability to carry oxygen to the lungs, tissues, and the baby can be compromised.

Untreated, a severe case of anemia can cause poor fetal growth, preterm birth, and low birth weight. But since women are routinely tested for the condition at their first prenatal visit and then again during their second trimester, doctors usually catch the condition before it becomes serious. "In the majority of cases, when the condition is diagnosed and treated, it's not going to harm you or your baby," says Laura Riley, M.D., a maternal-fetal medicine specialist at Massachusetts General Hospital, in Boston. Here's what you need to know:

*CAUSES: The most common cause is just pregnancy itself, says Dr. Riley. When anemia is the result of increasing blood fluid volume (the most common cause), it's called "physiologic" anemia of pregnancy. The second most common type, irondeficiency anemia, comes from decreased iron stores in the body. (Iron is needed in pregnancy to make hemoglobin and red blood cells for both mom and her baby-to-be.) Less commonly, anemia in pregnancy can also be caused by a folic acid or vitamin B12 deficiency. A more serious and rare form is caused by an inherited predisposition to anemia called thalassemia, which is mainly seen among people from the Mediterranean and the Middle East. Even more rare, anemia in pregnancy can be the result of sicklecell anemia, which is most commonly seen in African-Americans.

*SYMPTOMS: Most women won't have any symptoms. If they do occur, symptoms can be identical to those of pregnancy: fatigue, a drop in exercise tolerance, and shortness of breath. In more acute cases, a woman may also notice pale skin, lips, and nails; dizziness; and a rapid heartbeat.

* DIAGNOSIS: Most cases of anemia are detected during the complete blood count (CBC) done on every woman when she comes in for her first prenatal visit and again at 28 weeks, says Dr. Riley. If anemia is found, your doctor may order more tests to target the cause.