Iron deficiency anemia during in pregnancy: Doctor explains why the first 28 weeks are important for mother and unborn baby

Iron deficiency-induced anemia during pregnancy: What care should every expecting mother take during the first 28 weeks after conceiving? Read on to find out from a doctor.

Anemia in Pregnancy: Anemia during pregnancy remains a major public health concern in India, often going unnoticed until complications arise. Despite ongoing awareness and supplementation programs, its prevalence continues to stay alarmingly high, impacting both maternal and fetal health. According to the National Family Health Survey (NFHS-5), anemia affects 52.2% of pregnant women, and this rate has remained unchanged for over two decades. As per WHO, anemia in pregnancy is defined as hemoglobin <11 g/dL and classified as mild (10-10.9 g/dL), moderate (7-9.9 g/dL), and severe (<7 g/dL).

Why Does Iron Deficiency Anemia Occur?

Dr. Onkar Swami, Senior Vice-President Medical Services at Alembic Pharmaceuticals, explains - Iron deficiency anemia (IDA), the most common type of anemia, develops from poor dietary intake, reduced iron absorption, and blood loss from vomiting or underlying conditions. Increased iron requirements during pregnancy further make it difficult to maintain adequate iron stores without supplementation.

How is IDA Diagnosed?

All pregnant women are screened for anemia by a full blood count at the first prenatal visit and again around 28 weeks of pregnancy. Evaluation is warranted if hemoglobin levels fall below 11 g/dL at any stage of pregnancy and post-pregnancy. However, measuring hemoglobin alone is insufficient; serum ferritin is the key marker, with levels <30 g/L indicating iron deficiency. Measurement of serum ferritin is recommended at least once early in pregnancy.

What are the common risk factors? In mothers, it can result in fatigue, reduced immunity, and increased risk of infections, and may lead to serious complications such as postpartum hemorrhage (excessive bleeding after childbirth).

In babies, it is linked to poor growth in the womb, premature birth, and low birth weight, leading to developmental delays.

How To Prevent Anemia During Pregnancy

Diet and nutrition play an important role in preventing anemia during pregnancy.9 Including iron-rich foods like leafy greens, red meat, cereals, eggs, and seeds in the daily diet helps maintain healthy iron levels. However, diet alone is often insufficient, and supplementation is widely recommended.

The WHO recommends daily supplementation with 60 mg elemental iron and 400 g folic acid for six months during pregnancy and continuing for three months after childbirth in high-prevalence settings. In India, the Ministry of Health advises 60 mg iron with 500 g folic acid from the second trimester for 100 days.12

Iron supplements should be taken on an empty stomach, either 1 h before eating or 2 h after. Furthermore, supplements should not be taken along with products that reduce absorption (e.g., milk, tea, coffee, antacids). Vitamin C may be added to improve iron absorption.

Treatment of IDA in Pregnancy

Treatment includes oral or parenteral, and, depending on the underlying cause, severity of symptoms, prior response, patient preference, and cost.

Oral iron (60-120 mg daily) is the first-line treatment and should continue until hemoglobin normalizes, followed by a lower maintenance dose to restore iron stores. Parenteral preparations are indicated when oral therapy fails, is not tolerated, or in moderate to severe cases, but are avoided in the first trimester.14,5 Blood transfusion is reserved for severe anemia, especially near delivery or with significant symptoms or bleeding.

Thus, early screening, adequate supplementation, and timely treatment are essential to reduce the risks of anemia for both mother and baby.