Anaemia: what low haemoglobin means, especially in pregnancy
In this article
Anaemia is when your blood has fewer red blood cells than normal, or too little haemoglobin inside them, so it carries less oxygen around your body. The WHO says this can leave you tired, weak, dizzy and short of breath. In pregnancy, KKH says the most common cause is low iron, and a routine blood test picks it up.
| What it is | Too few red blood cells or too little haemoglobin |
|---|---|
| Usual cause in pregnancy | Iron deficiency (KKH) |
| When KKH tests | Early in pregnancy, again at 24 to 28 weeks, and when you come in to deliver |
| First treatment | Iron tablets, then a repeat blood test after 4 weeks (KKH) |
| How common | 37% of pregnant women worldwide, the WHO estimates |
Why anaemia shows up in pregnancy
KKH says iron deficiency is the most common cause of anaemia in pregnancy. Some women are short of vitamin B12 or folate instead, and thalassaemia, an inherited blood condition, can also cause it. The NHS adds that in pregnancy, iron deficiency anaemia most often comes from not getting enough iron in your diet.
KKH lists the women more likely to become anaemic:
- vegetarians, because their diet is lower in iron
- women who were anaemic before
- twin or triplet pregnancies
- pregnancies less than a year apart
- bleeding during pregnancy, or heavy periods before it
- long-term illness such as diabetes, kidney disease or inflammatory bowel disease
It is not rare. The WHO estimates that 37% of pregnant women worldwide are anaemic, and 40% of children aged 6 to 59 months.
Signs of anaemia worth mentioning to your gynae
KKH lists tiredness, giddiness, headaches, a fast or irregular heartbeat, shortness of breath, chest pain, cold hands and feet, and pale skin. The WHO calls these symptoms non-specific. Plenty of other things cause them, pregnancy included, so the blood test is how you find out for sure.
Tell your gynae or polyclinic if you notice them between check-ups rather than putting them down to a long week.
How KKH tests for and treats anaemia
At KKH you have a full blood count at about 10 to 12 weeks, a repeat at 24 to 28 weeks, and another when you are admitted to deliver. Some women are also offered thalassaemia screening.
If the test shows anaemia, KKH says you start iron tablets, often on top of your pregnancy vitamins, and have the blood test again four weeks later to check they are working. If your haemoglobin stays below 10 despite the tablets, an iron infusion through a drip may be considered. If you are anaemic or lose a lot of blood at delivery, KKH says a blood transfusion may be needed.
Iron tablets can upset your stomach, cause constipation and turn your stools dark. KKH says the dark stools are common and harmless, and suggests taking the tablets with a meal or snack if they upset your stomach. Store them out of reach: the NHS warns that an iron overdose in a young child can be fatal.
Eating for iron, Singapore style
KKH points to red meat, poultry and fish, and to tofu, beans, lentils and leafy greens such as spinach, kai lan, chye sim and bok choy. Dates, raisins, figs, prunes and longans make easy snacks.
Two habits change how much iron you absorb. KKH says fruit rich in vitamin C helps when eaten with iron. Coffee, black tea, milk and other calcium-rich foods block it, so keep them about 2 hours apart from your iron. Our guide to iron-rich foods for pregnancy in Singapore turns this into hawker orders and meals.
What untreated anaemia can mean for you and your baby
KKH says anaemia in pregnancy can leave you weak and foggy, and raises your chances of infection, heavier blood loss at delivery, preterm birth and postnatal depression. Your baby may have a low birth weight. That is why KKH checks your blood twice in pregnancy instead of waiting for symptoms.
Frequently asked questions
What is anaemia in pregnancy?
It is anaemia that develops while you are pregnant. KKH says iron deficiency is the usual cause, and the full blood count early in pregnancy and at 24 to 28 weeks is how it is found.
What is the meaning of anaemia on a blood test?
It means your red blood cell count or haemoglobin level is lower than normal. The WHO says the healthy level depends on age, sex and whether you are pregnant, so your doctor reads the number against the range for you.
How long do I need to take iron tablets?
The NHS says a course for iron deficiency anaemia usually lasts about 6 months, with blood tests along the way. In pregnancy, KKH repeats the blood test four weeks after you start to see how you are responding.
Can babies and children get anaemia?
Yes. The WHO says young children are among the groups most affected, and that iron deficiency anaemia can affect a child's cognitive and physical development. If your child seems unusually pale or tired, ask your doctor whether a blood test is needed.
Related terms
- Preterm (Premature) Birth: A baby born alive before 37 completed weeks of pregnancy. In Singapore, about 8.5% of babies arrive this early.
- Low Birth Weight: A birth weight under 2.5 kg, from being born early, growing slowly in the womb, or both.
- Postnatal Depression: A common, treatable depression after birth that lasts beyond two weeks and gets in the way of daily life.
- Antenatal (also Prenatal): Antenatal means before birth. Antenatal care is the check-ups, scans and tests you get while you are pregnant.
- Trimester: One of the three stages of pregnancy, each about three months long.
