'Pink of health' in pregnancy
FAQs on improving hemoglobin, preventing anemia during Pregnancy
We cannot build a blood bank in every nook and corner of our vast country. But we certainly can build one in every woman carrying a baby within. The importance of a good hemoglobin in pregnancy cannot be overstated. Aiming to help every expectant mother be in the pink of health, Dr Parul Chopra Buttan answers the Frequently Asked Questions regarding improving hemoglobin and preventing anemia in pregnancy.
Q1. What is a normal level of hemoglobin in pregnancy? What is anemia?
A hemoglobin (Hb) of 11g/dL and more is considered normal in pregnancy.
A hemoglobin of <11g% in pregnancy is defined as anemia.
Mild anemia Hb = 9-11g%
Moderate anemia Hb = 7-9g%
Severe anemia Hb <7g%
Q2. What are the nutrients required to build hemoglobin?
Iron, folic acid, vitamin B12 (methylcobalamin) and proteins are the major nutrients required to build hemoglobin.
Other micronutrients like vitamin A, zinc, calcium, riboflavin, ascorbic acid, molybdenum, cobalt, selenium are also needed in small quantities. Their deficiency may impact the severity of anemia.
Q3. Why does hemoglobin fall in pregnancy?
Pregnancy is a special state when the demands for nutrients are increased in the body. The expectant mother’s blood volume expands and red blood cells increase. The growing baby and placenta also need more nutrients. If the iron stores were borderline or poor before conceiving, anemia can quickly develop in pregnancy.
Q4. What are the common causes of anemia (low hemoglobin) in pregnancy?
The most common type of anemia in pregnancy, seen in India and globally, is nutritional anemia. Deficiency of iron is the most common cause. Other nutritional deficiencies include folic acid, vitamin B12, proteins and micronutrients.
Other cause of anemia are genetic factors, such as thalassemia (beta thalassemia minor being the most common in India), sickle cell trait, G6PD deficiency. Chronic blood loss due to worm infestations (like hookworm, amoebiasis etc), hemolytic anemia (due to increased blood breakdown) are other common causes.
Q5. What are the symptoms of anemia?
The common symptoms of anemia are weakness, easy fatiguability, tiredness, reduced exercise capacity, loss of appetite, shortness of breath on exertion (or even on rest in severe cases), dizziness, light headedness etc. A lot of these symptoms overlap with normal early pregnancy too. If the symptoms are persistent or unusually severe, discuss these with your doctor. You may also notice a pale looking skin instead of the usual pinkish, brittle nails, lustreless hair and experience a fast, bounding heartbeat (palpitations).
Q6. How can I improve my diet in pregnancy to improve my hemoglobin?
The following foods are a rich source of iron, folic acid and other nutrients that help in building a good hemoglobin-
Green leafy vegetables (saag, paalak, methi, bathua, peas, broccoli etc) – consume as subzi, soups, salads, paalak ki puris, bathua rotis etc. Rich in iron, folic acid and fibre, they are a delight to eat in winters in India.
Beetroot – consume raw in salads or boiled. Make beetroot stuffed rotis or interesting beetroot and pomegranate curds.
Fruits like pomegranate – it is better to consume the fruit, rather than drink the juice in pregnancy. Eat a few spoonfuls of pomegranate or sprinkle it over homemade bhels and chaats. Sour fruits like oranges, lemons are rich in vitamin C and help in increasing absorption of iron from the diet.
Nuts & dry fruits – overnight soaked walnuts and almonds are a great way to start your day. Anjeer (figs) and mota kishmish (munakka) are excellent sources of iron, to be consumed in small quantities only.
Jaggery (gur) is one of the richest sources of iron. A snack of bhuna chana (protein-rich) and gur once a day is both filling and packed with nutrients.
Cereals like whole wheat (dalia), brown rice, poha (rice flakes) are a good source of iron besides other nutrients and fibre. Ensure variety in diet.
Non vegetarian sources include lean meats (chicken, fish, pork, beef, eggs). They contain haeme iron which is more efficiently absorbed and used by the body. Ensure hygienic source and proper cooking of non veg foods.
Q7. Besides diet, how can I improve my hemoglobin?
Iron and folic acid supplements are advised by your doctor at the appropriate time in pregnancy.
Only folic acid supplements are recommended in the first trimester (the first 3 months of pregnancy) and starting from the 4th month (or 2nd trimester or >13 weeks), iron supplements are recommended. The dose and specific iron preparation suitable for you will be decided by your doctor based on her consultation with you.
Taking your iron tablet with a lemonade, before a meal helps in improving its absorption. If you notice side effects like gas, acidity, diarrhoea, constipation, vomiting, nausea etc, consult your doctor for a dose adjustment. If an expectant mother is unable to take iron supplements by mouth, then injections can be planned.
Q8. What are the effects of anemia on the expecting mother and the developing baby inside?
In India, severe anemia is an important cause of maternal deaths. It puts a strain on all the organs and may lead to heart failure, infections, low brain function, inability to tolerate blood loss at delivery. It also increases the risk of abortions, premature births, growth restriction of babies within the womb and predisposes to poorer health of the child later in life.
Q9. What are the tests that can detect anemia in pregnancy?
Simple blood tests can detect anemia and help in finding out its cause in a majority of expecting mothers.
CBC (complete blood count) – it is done once every trimester routinely. It has many parameters like hemoglobin, hematocrit, MCV, MCH etc which point to the presence and type of anemia
HPLC or Hb electrophoresis – it is a study of the hemoglobin patterns in the blood. It is done once, either in the pre-pregnancy visit or in early pregnancy. It helps detect thalassemia minor, a genetic condition in which the red blood cells have a shorter life span.
Iron studies – serum ferritin, total iron binding capacity, serum iron, free erythrocyte protoporphyrin are some special tests to detect iron deficiency anemia. They are recommended by your doctor in special cases.
Liver and kidney function tests may be needed if anemia of chronic disease is suspected.
Other tests that help diagnose cause of anemia are-
Urine routine and microscopic examination and culture is done once every trimester routinely. It gives evidence of hemolytic anemia, if present.
Stool examination for ova, cysts, occult blood is done in some cases