Anemia in Pregnancy

Kari M. Horowitz, MDa,*, Charles J. Ingardia, MD

b
,
Adam F. Borgida, MDb

KEYWORDS
 Anemia  Pregnancy  Hemoglobin  Iron  Folate

KEY POINTS
 Physiologic anemia occurs in pregnancy because plasma volume increases more quickly
than red cell mass.
 Anemia in pregnancy is defined as hemoglobin and hematocrit lower than 11% and 33%
in the first trimester, 10.5% and 32% in the second trimester, and 11% and 33% in the
third trimester.
 An increase of 60 mg of elemental iron daily is recommended in the second and third tri-
mesters because an average diet cannot meet the increased iron demand in pregnancy.
 Iron deficiency anemia accounts for 75% of all anemia in pregnancy.
 It is recommended to screen for and treat iron deficiency anemia in pregnancy because
treatment to maintain maternal iron stores may be beneficial to neonatal iron stores.

INTRODUCTION

Numerous adaptations occur in women to accommodate pregnancy. One of the most

profound changes is a complex interaction among the renal, hematologic, and endo-
crine systems to prepare for the expected blood loss that occurs at the time of deliv-
ery. Fluid retention begins early in pregnancy with a lag in the production of red blood
cells (RBCs) causing a “physiologic anemia” of pregnancy in most women. With a
focus on singleton gestations this article discusses the physiologic changes in the
hematologic system. Also discussed are this physiologic anemia and other common
causes of anemia in pregnancy.

HEMODYNAMIC PHYSIOLOGY OF PREGNANCY

Plasma Volume Changes
In response to early renal homeostatic changes, maternal blood volume begins to
increase by 6 weeks of gestation. As a result of free body water retention, the maternal

a
Department of Maternal Fetal Medicine, University of Connecticut Health Center, 263
Farmington Avenue, Farmington, CT 06030, USA; b Department of Maternal Fetal Medicine,
Hartford Hospital, 85 Jefferson Street, Suite 625, Hartford, CT 06102, USA
* Corresponding author.
E-mail address: khorowitz@resident.uchc.edu

Clin Lab Med 33 (2013) 281–291

http://dx.doi.org/10.1016/j.cll.2013.03.016 labmed.theclinics.com
0272-2712/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.