What is anaemia?

Anaemia is a lack of red blood cells, which can lead to a lack of oxygen-carrying ability,
causing unusual tiredness.
The deficiency occurs either through the reduced production or an increased loss of red
blood cells.
These cells are manufactured in the bone marrow and have a life expectancy of
approximately four months.
To produce red blood cells, the body needs (among other things) iron, vitamin B12 and
folic acid. If there is a lack of one or more of these ingredients, anaemia will develop.

What are red blood cells?

Red blood cells are the cells that circulate in the blood plasma (fluid) and give blood its
red colour.
Through its pumping action, the heart propels the blood around the body through the
arteries.
The red blood cells obtain oxygen in the lungs and carry it to all the body's cells.
The cells use the oxygen to fuel the combustion (burning) of sugar and fat, which
produces the body's energy.
During this process, called oxidation, carbon dioxide is created as a waste product.
It binds itself to the red blood cells that have delivered their load of oxygen.
The carbon dioxide is then transported via the blood in the veins back to the lungs where
it is exchanged for fresh oxygen by breathing.

Causes of anaemia during pregnancy

Women often become anaemic during pregnancy because the demand for iron and
other vitamins is increased.
The mother must increase her production of red blood cells and, in addition, the foetus
and placenta need their own supply of iron, which can only be obtained from the mother.
In order to have enough red blood cells for the foetus, the body starts to produce more
red blood cells and plasma.
It has been calculated that the blood volume increases approximately 50 per cent during
the pregnancy, although the plasma amount is disproportionately greater.
This causes a dilution of the blood, making the haemoglobin concentration fall.
This is a normal process, with the haemoglobin concentration at its lowest between
weeks 25 and 30.
The pregnant woman may need additional iron supplementation, and a blood test called
serum ferritin is the best way of monitoring this.
Other causes include:

a diet low in iron. Vegetarians, and dieters in particular, should make sure their
diet provides them with enough iron

lack of folic acid in the diet, or more rarely, a lack of vitamin B12

loss of blood due to bleeding from haemorrhoids (piles) or stomach ulcers

anaemia is more common in women who have pregnancies close together and

also in women carrying twins or triplets.

What are the symptoms of anaemia during pregnancy?

If the woman is otherwise healthy, she will rarely have any symptoms of anaemia unless
her haemoglobin (red pigment) is below 8g/dl.

The first symptoms will be tiredness and paleness.

Palpitations the awareness of the heartbeat, breathlessness and dizziness can

occur, though they are unusual.

If the anaemia is severe (less than 6g of haemoglobin per decilitre of blood), it

may cause chest pain (angina) or headaches.
What can be done to avoid anaemia during pregnancy?

Be sure to get a varied diet.

If planning a pregnancy, talk to a doctor or midwife about food and supplements

if possible, before becoming pregnant.

Good sources of iron are beef, wholemeal bread and cereals, eggs, spinach and
dried fruit.

Supplementing the diet with iron, vitamins and especially folic acid. Taking 400
micrograms folic acid when pregnant is important to reduce the risk of having child with
spina bifida. A doctor may advise taking combined iron and folic acid supplements
before becoming pregnant.

To absorb the maximum amount of iron from the diet, it will help to also eat a diet
rich in vitamin C. Raw vegetables, potatoes, lemon, lime and oranges are all good
sources of vitamin C.

Foods rich in folic acid include beans, muesli, broccoli, beef, Brussels sprouts
and asparagus.

A pregnant woman should take notice of her body's signals and consult a doctor
if any symptoms occur.

It is now routine to recommend to women planning a pregnancy to take a folic

acid supplement for the first 12 weeks of pregnancy and preferably starting before
conception. This reduces the risk of spinal cord defects (spina bifida) developing in the
foetus.
How does a doctor diagnose anaemia during pregnancy?
Apart from the clinical symptoms, anaemia is usually detected during antenatal
screening. Blood tests are usually done at the first consultation, and again in the second
half of pregnancy.
A description of the red blood cells their different form and colour will be included in the
result of the blood test.
In women of Afro-Caribbean or Mediterranean origin, additional tests are performed to
screen for genetic causes of anaemia, namely sickle cell anaemia and thalassaemia.
Possible complications of anaemia


Difficulty in breathing, palpitations and angina.

Severe anaemia due to loss of blood after the delivery. If this occurs, then a
woman may be advised to have a blood transfusion.
How will a doctor treat anaemia during pregnancy?
A doctor will examine the expectant mother and prescribe any necessary treatment for
anaemia, such as vitamins or minerals.
Iron tablets can often cause constipation or diarrhoea and some women simply cannot
take them.
Side-effects on the gut can be resolved by taking the iron with or after food or by starting
with a low dose and increasing gradually talk to your doctor about this.
Iron supplements for non-anaemic pregnant women
Anaemia in women is often associated with low birth weight and preterm births, but that
does not mean that women should be taking iron pills, or any vitamin pills
indiscriminately, to prevent poor pregnancy outcomes.
Women who are not suffering from anaemia should ensure that they receive proper
advice on diet and nutrition from their doctors and midwives.
Iron supplements may have a harmful effect on women who do not need them in the first
place.
Conclusion
This study has shown that anaemia in pregnancy is still a major health problem in
Malaysia identifying primigravidae as being more at risk than multigravidae. So also are
women using TBH for antenatal care, pregnant teenagers and women that book late for
antenatal care. The use of TBHs being a common practice in Malaysia indicates that the
traditional health providers need to be enlightened on the need to include the use of iron
and folate supplements in the management of their pregnant patients. Educating women
on early ANC booking and compliance with the use of prescribed medications should
also be emphasized.

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