Anaemia in pregnancy
Also called: anemia in pregnancy, low haemoglobin in pregnancy, iron deficiency anaemia in pregnancy, low blood in pregnancy
Anaemia in pregnancy means the blood has too little haemoglobin to carry oxygen well. It is very common and is usually caused by low iron. A routine blood test finds it, and diet changes and iron tablets treat most women.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Anaemia (a low level of healthy red blood cells) happens when the blood does not have enough haemoglobin. Haemoglobin is the protein in red cells that carries oxygen to you and your baby. During pregnancy your body needs much more iron, because the growing baby takes iron from your stores. If you started pregnancy with low stores, or your diet does not supply enough, your haemoglobin can fall.
The World Health Organization says more than 40 in every 100 pregnant women worldwide are anaemic, and at least half of this is due to lack of iron. Low folate (a B vitamin), low vitamin B12, blood loss and inherited haemoglobin disorders such as thalassaemia can also cause it.
Many women have no clear symptoms, so anaemia is usually picked up on routine antenatal blood tests. Others feel very tired, dizzy or short of breath. Untreated anaemia can raise the risk of an early birth, a small baby and heavier bleeding at delivery, and can leave you exhausted after the birth. The good news is that most women get better with iron-rich food and iron tablets. Your doctor or midwife decides which treatment and dose is right for you.
In Pakistan: what studies show
Pakistan's 2018 National Nutrition Survey found anaemia in 35.5% of pregnant women, and 46.9% had low iron. Smaller hospital studies find much more: a 2024 review of 16 studies put it at 70.4%.
- In the 2018 National Nutrition Survey, 35.5% of pregnant women had anaemia, compared with 43.0% of women who were not pregnant.[1] (national survey, data April 2018 - January 2019)
- The same national survey found that 21.2% of pregnant women had anaemia caused by low iron (iron deficiency anaemia), compared with 18.0% of women who were not pregnant.[1] (national survey, data April 2018 - January 2019)
- In the 2018 national survey, nearly half of pregnant women (46.9%) had low iron stores, even though not all of them were yet anaemic.[1] (national survey, data April 2018 - January 2019)
- A 2024 review that pooled 16 Pakistani studies with 9,263 pregnant women found that 70.4% had anaemia.[3] (systematic review/meta-analysis, data studies published Jan 2007 - Dec 2021)
- One hospital study in Gwadar, Balochistan found that 146 of 200 pregnant women (73%) coming for routine check-ups had anaemia.[2] (cross-sectional, data Sep 2017 - Feb 2018)
- In the same Gwadar hospital study, 40% of the pregnant women (80 women) had moderate anaemia, the most common level.[2] (cross-sectional, data Sep 2017 - Feb 2018)
What we do not know yet: The national survey (35.5%) and the pooled review of mostly hospital studies (70.4%) disagree widely, likely because of different settings and haemoglobin cut-offs; the review also gives two different study counts in different sections. The national survey reports anaemia in pregnant women only as one national figure, with no provincial or urban/rural split, and no Pakistan DHS figure or Pakistan-specific anaemia-in-pregnancy guideline was found.
Pakistan studies cited
- Ministry of National Health Services, Regulations and Coordination (Nutrition Wing); technical support UNICEF Pakistan National Nutrition Survey 2018: Key Findings Report. Government of Pakistan, Ministry of National Health Services, Regulations and Coordination / UNICEF Pakistan 2018 (survey year; publication year not stated on the report). Open source
- Latif M, Ayaz SB, Munir MU, et al. Frequency and Severity of Anemia in Pregnant Women at Gwadar Development Authority Hospital, Gwadar, Balochistan. Pakistan Armed Forces Medical Journal 2022;72(Suppl-2):S204-07. Open source
- Mahar B, Shah T, Shaikh K, et al. Uncovering the hidden health burden: a systematic review and meta-analysis of iron deficiency anemia among adolescents, and pregnant women in Pakistan. Journal of Health, Population and Nutrition 2024;43:149. doi:10.1186/s41043-024-00643-y. Open source
Symptoms
- Often no symptoms at all; many cases are found only on a routine blood test
- Tiredness and weakness that feel worse than usual
- Dizziness or light-headedness
- Pale skin
- Shortness of breath
- Palpitations (feeling your heart pounding or racing)
- Headaches
- Poor concentration or low mood
- Chest pain
Causes and risk factors
Causes
- Low iron, the most common cause, because the baby takes iron from the mother and the body needs more of it in pregnancy
- Not getting enough iron from food, or poor absorption of iron from the gut
- Low folate (vitamin B9) or low vitamin B12
- Blood loss, for example heavy periods before pregnancy or bleeding during pregnancy
- Gut conditions that reduce absorption, such as coeliac disease or Crohn's disease
- Inherited haemoglobin disorders such as thalassaemia and sickle cell disease
What makes it more likely
- Low iron stores before pregnancy
- A diet low in iron, including a vegetarian or vegan diet that is not well planned
- A short gap between pregnancies, or many previous births
- Expecting twins or triplets
- Being under 20 years old
- Anaemia in a previous pregnancy
- Heavy periods before pregnancy
- Not taking prescribed iron supplements, or booking late for antenatal care
- Poverty and little access to education
Complications
Mild anaemia often causes few problems, but more severe or untreated anaemia can affect both mother and baby. For the baby it is linked with growing less well, being born early or small, and having low iron stores in the first months of life, which may affect brain development. Rarely, severe anaemia can lead to stillbirth. For the mother there is a higher risk of infection, of the placenta separating early (placental abruption) and of heavier bleeding at delivery. After the birth, anaemia can cause marked tiredness, slow recovery and a higher risk of postnatal depression.
When to see a doctor
- Chest pain, severe breathlessness or fainting (seek emergency care straight away)
- Any heavy vaginal bleeding in pregnancy or after the birth (go to hospital urgently)
- A fast or pounding heartbeat that does not settle, or feeling very unwell
- Symptoms of anaemia that are getting worse even though you are taking iron
- Being told your haemoglobin is very low, especially late in pregnancy
- Being unable to keep iron tablets down because of side effects
Are you a PMDC-registered doctor who treats Anaemia in pregnancy? List your profile free.
Diagnosis
Anaemia is checked with a simple blood test (full blood count). In the UK this is offered at the booking visit, again at about 28 weeks, and at any time symptoms appear. Your haemoglobin result is compared with the normal level for your stage of pregnancy; the cut-off is slightly lower in the second and third trimesters than in the first.
If anaemia is found, iron deficiency is the usual cause, so iron tablets are often started and the blood test is repeated after 2 to 4 weeks to see if haemoglobin is rising. If it does not improve, further tests may check your iron stores (ferritin), folate and vitamin B12 to look for another cause. Very low haemoglobin, troublesome symptoms, late pregnancy (after about 34 weeks) or no response to tablets are reasons for referral to the hospital maternity team.
Treatment
- Confirm anaemia with a blood test and let your doctor or midwife look for the likely cause
- Eat more iron-rich foods and foods with vitamin C, which helps the body absorb iron
- Take oral iron tablets or syrup as prescribed; this is the first choice for most women, and the blood test is repeated after 2 to 4 weeks
- If haemoglobin does not rise, have further blood tests for other causes such as low folate or vitamin B12
- Intravenous iron (iron given by drip in hospital) may be offered if tablets do not work, cannot be tolerated, levels are very low, or the pregnancy is beyond about 34 weeks
- A blood transfusion is kept for very low haemoglobin, severe symptoms or heavy bleeding
- Keep taking iron for as long as advised once levels are normal, often for about three months, and have your blood checked again after the birth
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Oral iron | first choice to treat iron-deficiency anaemia in pregnancy; your doctor or midwife decides which product, dose and how long to take it | Ferrous sulfate (9 brands), Elemental Iron (26 brands), Iron (40 brands), Iron polymaltose complex (108 brands), Polysaccharide iron complex (23 brands), Iron protein succinylate (28 brands) |
| Oral iron with folic acid | WHO recommends daily iron and folic acid for pregnant women as part of antenatal care to help prevent anaemia, early birth and low birth weight | Ferrous sulfate + Folic acid (21 brands), Elemental iron + Folic acid (12 brands), Iron + Folic acid (11 brands), Iron polymaltose complex + Folic acid (79 brands), Iron protein succinylate + Folic acid (5 brands) |
| Folic acid | best started before conception or as early as possible in pregnancy to protect the baby's developing brain and spine (neural tube) | Folic acid (32 brands) |
| Intravenous iron | given by drip in hospital when tablets fail or are not tolerated, iron levels are very low, or there is not enough time for tablets to work late in pregnancy | Iron sucrose (8 brands), Ferric carboxymaltose (2 brands) |
| Stool softeners (laxatives) | may help if iron tablets cause constipation, alongside more fibre and fluids; ask your doctor, midwife or pharmacist first | Lactulose (74 brands) |
Self-care and prevention
Self-care
- Take iron exactly as your doctor or midwife advises; do not start, stop or change any medicine or supplement in pregnancy without asking them
- Take iron with water or a glass of orange juice, as vitamin C helps absorption
- Avoid tea, coffee and milk or other dairy foods for about an hour around your iron dose, as they reduce absorption
- Keep calcium supplements and antacids apart from your iron, and ask your pharmacist how to time them
- Eat iron-rich foods such as lentils, chickpeas, beans, lean meat, fish, leafy greens like spinach, nuts, seeds and dried fruit
- Add vitamin C foods such as oranges, kiwi or broccoli to meals
- If iron causes constipation, eat more fibre and drink plenty of fluids; dark stools are a common, harmless side effect
- If you miss a dose, take the next one as normal; do not double up
Prevention
- Take the daily iron and folic acid supplements offered as part of antenatal care
- Start folic acid before you try to get pregnant, or as soon as you know you are pregnant
- Build up iron through a varied, iron-rich diet before and during pregnancy
- Book antenatal care early and attend blood tests at booking and around 28 weeks
- Allow time between pregnancies, since a short gap raises the risk of anaemia
Common questions
Are iron tablets safe in pregnancy and breastfeeding?
Yes. Oral iron tablets are usually effective and safe in pregnancy, and they are considered safe while breastfeeding. Your doctor or midwife will choose the product and dose. Do not take extra iron on your own without advice.
Can anaemia in pregnancy harm my baby?
Mild anaemia usually does not, but more severe anaemia is linked with early birth, low birth weight and low iron stores in the baby. Rarely it can lead to stillbirth. This is why anaemia is checked routinely and treated early.
Why are my stools dark and why am I constipated on iron?
Dark stools are a common and harmless effect of iron tablets. Constipation, stomach upset and nausea can also happen. More fibre and fluids often help; if side effects are hard to cope with, tell your midwife, who may change the supplement.
What should I eat if I have anaemia in pregnancy?
Choose iron-rich foods such as lentils, chickpeas, beans, lean meat, fish, spinach, nuts, seeds and dried fruit. Eat vitamin C foods like oranges with meals to help absorb iron. Avoid tea, coffee and dairy at the same time as iron-rich meals or iron tablets.
How long will I need to take iron?
Usually until your haemoglobin is back to normal and then for a few more months to refill your stores, often about three months. Some women continue iron after the birth. Your blood will be checked again after delivery.
Sources
- WHO e-Library of Evidence for Nutrition Actions (eLENA). Daily iron and folic acid supplementation during pregnancy (2024).
- World Health Organization. Daily iron and folic acid supplementation in pregnant women (WHO guideline summary) (n.d.).
- East Kent Hospitals University NHS Foundation Trust (patient leaflet). Iron deficiency anaemia in pregnancy (n.d.).
- University Hospitals of Leicester NHS Trust (patient leaflet). Anaemia in pregnancy (2024).
- NHS BNSSG REMEDY referral pathways (draft pathway). Anaemia in Pregnancy _ Draft (2024).
- Journal of Health, Population and Nutrition (peer-reviewed). Uncovering the hidden health burden: a systematic review and meta-analysis of iron deficiency anemia among adolescents, and pregnant women in Pakistan (2024).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.