Anemia in pregnancy: how to recognize it and how to prevent it

Anemia is frequently diagnosed during pregnancy. The incidence rate of anemia in pregnancy is estimated to be 22% in developed countries and 56% in developing countries, making this complication a global health problem.

The decrease in the hemoglobin value in pregnancy is physiological , as there is necessarily an increase in the plasma volume of the blood, and, consequently, the erythrocyte volume decreases.

What are the blood values ​​that indicate anemia in pregnancy?

According to the World Health Organization we speak of anemia when the hemoglobin value falls below 11 g/dl or the hematocrit value falls below 33% .

If the hemoglobin falls below 7 g/dl anemia is defined as severe and if it falls below 4 g/dl it is defined as very severe.

The Center for Disease Control and Prevention, however, adds a slightly different range to the WHO values ​​for the second quarter. In this gestational age, it lowers the level of anemia to 10.5 g/dl of hemoglobin and 32% of hematocrit.

During pregnancy, the need for iron increases starting from the second trimester and up to the 30th week of gestation. The reasons why, on the other hand, one can go into deficiency, are different and range from the fetal request, greater if the pregnancy is twins, to an incorrect dietary intake up to pathological conditions that predispose to anemia, such as placenta previa , thyroiditis and hypothyroidism.

How to prevent anemia in pregnancy

The Istituto Superiore di Sanità has drawn up guidelines for the prevention of anemia in pregnancy, giving a list of 6 recommendations:

• It is recommended that pregnant women be offered screening for anemia;
• Investigate cases of lower than normal hemoglobin levels (11 g/dl in the first trimester and 10.5 g/dl starting at week 28);
• Offer all women the necessary information, starting with correct nutrition;
• Offer preconceptional screening and counseling for women who may have hemoglobinopathies (sickle cell disease and thalassemia) if they have never had them;
• Offer information and screening for hemoglobinopathies for women within 10 weeks of pregnancy, if they have never had it;
• If the woman is identified as a carrier of hemoglobinopathies, counsel and screen tests the partners as well

In terms of prevention, of course, the first thing necessary to do is to have a correct and balanced diet, which does not cause nutrient deficiencies.

Iron in food

In our diet we take iron both from plant foods (vegetables, cereals, legumes) and from animal foods (meat, fish).

It is estimated that we take 40% from vegetables and legumes, 30% from cereals and derivatives and 30% from meat and fish.

Unfortunately, however, in foods of vegetable origin, iron is mostly present in the so-called “non-heme” form, i.e. it does not bind to hemoglobin and myoglobin, so it is only 2-13% assimilable, while in meat and fish is found in the heme form, 25% bioavailable.

Furthermore, the presence of fibers and calcium in vegetables and legumes and phytates especially in legumes limits the absorption of the iron contained in them.

This means that the majority of the iron we take in with the diet, we don’t actually assimilate.

There are some strategies to increase the bioavailability of iron from vegetables or, in any case, to optimize the assimilation of iron in a meal.

For example, folic acid and ascorbic acid improve the assimilation of iron. It can therefore be useful to season our dishes with lemon or with citrus fruits in general . Aromatic herbs also help the absorption of iron, because they keep the acidity of the gastric juices high.