Risk Factors for Anemia in Pregnancy

All pregnant women are at risk for becoming anemic. That's because they need more iron and folic acid than usual. But the risk is higher in these situations:

• Pregnant with more than one child
• Two pregnancies close together
• Vomiting a lot because of morning sickness
• Teenager who is pregnant
• Don't eat enough foods that are rich in iron
• Heavy periods before you became pregnant

Symptoms of Anemia During Pregnancy

The most common symptoms of anemia during pregnancy are:

• Pale skin, lips, and nails
• Feeling tired or weak
• Dizziness
• Shortness of breath
• Rapid heartbeat
• Trouble concentrating

In the early stages of anemia, you may not have obvious symptoms. And many of the symptoms are ones that you might have while pregnant even if you're not anemic. So be sure to get routine blood tests to check for anemia at your prenatal appointments
Severe or untreated iron-deficiency anemia during pregnancy can increase your risk of:

• Preterm or low-birth-weight baby 
• Blood transfusion (if you lose a significant amount of blood during delivery)
• Postpartum depression

Untreated folate deficiency can increase your risk of having a:

• Preterm or low-birth-weight baby
• Baby with a serious birth defect of the spine or brain (neural tube defects)

Untreated vitamin B12 deficiency can also raise your risk of having a baby with neural tube defects.

Tests for Anemia

During your first prenatal appointment, you'll get a blood test so your doctor can check whether you have anemia. Blood tests typically include:

• Hemoglobin test. It measures the amount of hemoglobin -- an iron-rich protein in red blood cells that carries oxygen from the lungs to tissues in the body.
• Hematocrit test. It measures the percentage of red blood cells in a sample of blood.

If you have lower than normal levels of hemoglobin or hematocrit, you may have iron-deficiency anemia. Your doctor may check other blood tests to determine if you have iron deficiency or another cause for your anemia.
Even if you don't have anemia at the beginning of your pregnancy, your doctor will most likely recommend that you get another blood test to check for anemia in your second or third trimester.

Treatment for Anemia

If you are anemic during your pregnancy, you may need to start taking an iron supplement and/or folic acid supplement in addition to your prenatal vitamins. Your doctor may also suggest that you add more foods that are high in iron and folic acid to your diet.
In addition, you'll be asked to return for another blood test after a specific period of time so your doctor can check that your hemoglobin and hematocrit levels are improving.
To treat vitamin B12 deficiency, your doctor may recommend that you take a vitamin B12 supplement.
The doctor may also recommend that you include more animal foods in your diet, such as:

• meat
• eggs
• dairy products

Preventing Anemia

To prevent anemia during pregnancy, make sure you get enough iron. Eat well-balanced meals and add more foods that are high in iron to your diet.
Aim for at least three servings a day of iron-rich foods, such as:

• lean red meat, poultry, and fish
• leafy, dark green vegetables (such as spinach, broccoli, and kale)
• iron-enriched cereals and grains
• beans, lentils, and tofu
• nuts and seeds
• eggs

Foods that are high in vitamin C can help your body absorb more iron. These include:

• citrus fruits and juices
• strawberries
• kiwis
• tomatoes
• bell peppers

Try eating those foods at the same time that you eat iron-rich foods.  For example, you could drink a glass of orange juice and eat an iron-fortified cereal for breakfast.
Also, choose foods that are high in folic acid to help prevent folate deficiency. These include:

• leafy green vegetables
• citrus fruits and juices
• fortified breads and cereals
• dried beans

Follow your doctor's instructions for taking a prenatal vitamin that contains a sufficient amount of iron and folic acid.
Vegetarians and vegans should talk with their doctor about whether they should take a vitamin B12 supplement when they're pregnant and breastfeeding. 

Types of Anemia During Pregnancy

Several types of anemia can develop during pregnancy. These include:

• Iron-deficiency anemia
• Folate-deficiency anemia
• Vitamin B12 deficiency

Here's why these types of anemia may develop:
Iron-deficiency anemia. This type of anemia occurs when the body doesn't have enough iron to produce adequate amounts of hemoglobin. That's a protein in red blood cells. It carries oxygen from the lungs to the rest of the body.
In iron-deficiency anemia, the blood cannot carry enough oxygen to tissues throughout the body.
Iron deficiency is the most common cause of anemia in pregnancy.
Folate-deficiency anemia. Folate, also called folic acid, is a type of B vitamin. The body needs folate to produce new cells, including healthy red blood cells.   
During pregnancy, women need extra folate. But sometimes they don't get enough from their diet. When that happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the body.
Folate deficiency can directly contribute to certain types of birth defects.
Vitamin B12 deficiency. The body needs vitamin B12 to form healthy red blood cells. When a pregnant woman doesn't get enough vitamin B12 from her diet, her body can't produce enough healthy red blood cells. Women who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin B12 deficiency, which may contribute to birth defects. 
Blood loss during and after delivery can also cause anemia.

see also Risk Factors for Anemia in Pregnancy

Anemia in Pregnancy

When you're pregnant, you may develop anemia. When you have anemia, your blood doesn't have enough healthy red blood cells to carry oxygen to your tissues.
During pregnancy, your body produces more blood to support the growth of your baby. If you're not getting enough iron or certain other nutrients, your body might not be able to produce the amount of red blood cells it needs to make this additional blood.
It's normal to have mild anemia when you are pregnant. But you may have more severe anemia from low iron or vitamin levels or from other reasons.
Anemia can leave you feeling tired and weak. If significant and untreated, it can increase your risk of serious complications like preterm delivery.
Here's what you need to know about the causes, symptoms, and treatment of anemia during pregnancy.

see also Types of Anemia During Pregnancy

10 medical reasons for feeling tired

Any serious illness, especially painful ones, can make you tired. But some quite minor illnesses can also leave you feeling washed out. Here are 10 health conditions that are known to cause fatigue

1. Coeliac disease

Is a type of food intolerance where your body reacts badly when you eat gluten, a substance found in bread, cakes and cereals. There are 250,000 diagnosed cases in the UK, but research suggests that up to 90% of sufferers don’t know they have it. Other symptoms of coeliac disease, apart from tiredness, are diarrhoea, anaemia and weight loss. Your GP can check if you have coeliac disease through a blood test.

2. Anaemia

One of the most common medical reasons for feeling constantly run down is iron deficiency anaemia. It affects around one in 20 men and post-menopausal women, but may be even more common in women who are still having periods. Typically, you’ll feel you can’t be bothered to do anything, your muscles will feel heavy and you’ll get tired very quickly. Women with heavy periods and pregnant women are especially prone to anaemia.

3. Chronic fatigue syndrome

Chronic fatigue syndrome (also called myalgic encephalomyelitis or ME) is a severe and disabling tiredness that goes on for at least six months. There are usually other symptoms, such as a sore throat, muscle or joint pain and headache.

4. Sleep apnoea

Sleep apnoea is a condition where your throat narrows or closes during sleep and repeatedly interrupts your breathing. This results in bad snoring and a drop in your blood's oxygen levels. The difficulty in breathing means that you wake up often in the night, and feel exhausted the next day.
It’s most common in overweight, middle-aged men. Drinking alcohol and smoking makes it worse.

5. Underactive thyroid

An underactive thyroid gland means that you have too little thyroid hormone (thyroxine) in your body. This makes you feel tired. You’re also likely to put on weight and have aching muscles. It’s most common in women, and it happens more often as you get older.
Your GP can diagnose underactive thyroid by taking a simple blood test.

6. Diabetes

One of the main symptoms of diabetes, a long-term condition caused by too much sugar in the blood, is feeling very tired. The other key symptoms are feeling very thirsty, going to the toilet a lot, and weight loss. Your GP can diagnose diabetes with a blood test.

7. Glandular fever

Glandular fever is a common viral infection that causes fatigue along with fever, sore throat and swollen glands. Most cases happen in teenagers and young adults. Usually, glandular fever symptoms clear up within four to six weeks, but the fatigue can linger for several more months.
8. Depression
As well as making you feel very sad, depression can also make you feel drained of energy. And it can stop you dropping off to sleep or cause you to wake you up early in the morning, which makes you feel more tired during the day.

9. Restless legs

This is when you get uncomfortable sensations in your legs, which keep you awake at night. You might have an overwhelming urge to keep moving your legs, or a deep ache in your legs, or your legs might jerk spontaneously through the night. Whatever your symptoms, your sleep will be disrupted and of poor quality, so you’ll feel very tired through the day.

10. Anxiety

Feeling anxious is sometimes perfectly normal. However, some people have constant, uncontrollable feelings of anxiety, which are so strong that they affect their daily life. Doctors call this generalised anxiety disorder (GAD). It affects around around one in 20 people in the UK. As well as feeling worried and irritable, people with GAD often feel tired.