Anemia in pregnancy

Authors:
Michael Auerbach, MD, FACP
Helain J Landy, MD
Section Editors:
Lynn L Simpson, MD
Stanley L Schrier, MD
Deputy Editors:
Jennifer S Tirnauer, MD
Vanessa A Barss, MD, FACOG

Contributor Disclosures

 An estimated 30 percent of reproductive-age women and 40 percent of

pregnant women are anemic, with the overwhelming majority due to low or
absent iron stores. In addition, a large number of women have iron deficiency
without anemia that may lead to iron deficiency anemia during pregnancy. (See
'Prevalence and epidemiology' above.)

 The World Health Organization (WHO) defines anemia in the first trimester
of pregnancy as a hemoglobin level <11 g/dL (approximately equivalent to a
hematocrit <33 percent) and/or a hemoglobin <10.5 g/dL in the second
trimester. (See 'Definition of anemia' above.)

 Physiologic anemia of pregnancy (caused by expansion of the blood volume

to a greater degree than the red blood cell [RBC] mass) and iron deficiency
are the two most common causes of anemia in pregnant women. However,
other inherited and acquired causes of anemia should not be overlooked. (See
'Causes of anemia' above.)

 Prenatal vitamins with iron are used to prevent iron deficiency that may
occur due to the increased iron demands of pregnancy. (See 'Prevention of
iron deficiency' above.)

 There are no specific clinical characteristics that can be used to

distinguish between physiologic anemia and iron deficiency anemia.
Physiologic anemia is a diagnosis of exclusion, and iron deficiency without
anemia is common. Thus, one author (MA) screens all pregnant women for iron
deficiency at the first prenatal visit (algorithm 1), along with routine prenatal
laboratory testing (complete blood count [CBC] and other prenatal testing),
regardless of hemoglobin level. For most women, this can be done with a ferritin
level; selected individuals may require more extensive testing. A ferritin level
<30 ng/mL (<30 mcg/L) is sufficient for diagnosis of iron deficiency, and a level
≥30 ng/mL is sufficient to exclude iron deficiency if there are no comorbidities.
The other author (HL) screens all pregnant women for anemia with a CBC and
tests those with anemia for iron deficiency. Anemia with atypical findings (eg,
macrocytosis, abnormalities in white blood cells [WBCs] or platelets) should
prompt evaluation for other causes of anemia. (See 'Screening during
pregnancy' above.)