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Extracted from Mayes Midwifery (2011) 14th Edition, Sue Macdonald & Julia Magill-Cuerden (Eds). Courtesy Elsevier

Anaemia is a deficiency in the quality or quantity of red blood cells, resulting in the reduced oxygen-carrying capacity of the blood. In the UK, the National Institute for Health and Clinical Excellence (NICE) recommends that routine iron supplementation in pregnancy is NOT necessary but that it is warranted when haemoglobin levels are lower than 11g/dL at first contact or 10.5 g/dL at 28 weeks. The World Health Organization (WHO) has warned of the risks of anaemia to pregnant women, and estimates that 42 per cent of pregnant women worldwide are anaemic. At least half of this burden is assumed to be due to iron deficiency with the rest due to conditions such as folate, vitamin B12 or vitamin A deficiency, chronic inflammation, parasitic infections and inherited disorders. The highest rates of anaemia occur in Africa and the Indian sub-continent.

Types of anaemia

  • Iron deficiency anaemia
  • Folic acid deficiency anaemia
  • Haemoglobinopathies, including sickle cell and thalassaemia
  • Anaemia as a result of blood loss or secondary to infection
  • Aplastic anaemia (rare in pregnancy)

Effects on pregnancy and childbirth

  • Undermines the woman's general health
  • Lowers resistance to infection
  • Exacerbates minor disorders of pregnancy, e.g. digestive problems
  • In severe cases, may cause intrauterine hypoxia
  • Increases severity of antepartum and postpartum haemorrhage
  • Increases risk of
  • thromboembolic disorders
  • postnatal depression
  • maternal mortality

Signs and symptoms

  • Pallor of mucous membranes
  • Tiredness, dizziness, fainting
  • Dyspnoea on exertion
  • Palpitation
  • Oedema
  • Digestive upsets, loss of appetite

Iron deficiency anaemia

Investigations include haemoglobin level, mean corpuscular volume (MCV), packed cell volume (PCV), total iron binding capacity and serum ferritin.


Where iron deficiency anaemia has been confirmed, oral iron 120 - 140 mg daily may be given as

  • ferrous sulphate 200 mg twice daily
  • ferrous gluconate 600 mg twice daily

In severe anaemia, iron by intramuscular (IM) injection may be required.

Folic acid deficiency anaemia

Folic acid is necessary for the formation of nuclei in all body cells. In pregnancy, when cells proliferate, deficiency may occur unless intake is increased.


All pregnant women and those intending to become pregnant are recommended to take 0.4 - 5 mg folic acid daily until term.

The Practising Midwife featured article

Treatment for women with postpartum iron deficiency anaemia. Smith V. TPM 2015;18(10):54 - 58 



Knott L (2013). Folate deficiency (Professional reference).

National Institute for Health and Clinical Excellence. (2008) Maternal and child nutrition. Public health guideline PH11.

Centers for Disease Control and Prevention (2015). Folic Acid - Recommendations.

World Health Organization (2012). Guideline: Daily iron and folic acid supplementation in pregnant women.


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