Anemia is a condition that develops when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin (what the midwives check throughout your pregnancy) is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen. Symptoms of anemia — like fatigue — occur because organs are not getting what they need to function properly.

Supporting the nutritional needs of a developing fetus, building a significantly greater blood volume, and other changes make pregnancy a common time for women to experience anemia.

Effects and Potential Complications of Anemia in Pregnancy

Without treatment, anemia can cause a number of problems for mom and baby.

For mom:

  • Greater fatigue in labor
  • Increased problems with even modest blood loss at birth
  • More difficult, slower postpartum recovery
  • Increased risk of postpartum hemorrhage
  • Greater risk of postpartum infection
  • Trouble establishing a milk supply

For baby:

  • Growth retardation
  • Lack of sufficient iron in their own bodies, which can potentially lead to anemia
  • Neural tube defects (with folic acid deficiency)

Symptoms of Anemia

  • Dizziness
  • Constant significant fatigue
  • Shortness of breath
  • Paleness of the fingernail beds, skin, and mucous membranes
  • General weakness
  • Loss of appetite
  • Constipation
  • Abdominal pain
  • Heart palpitations
  • Frequent colds or infections
  • Other symptoms depending on the type of nutritional deficiency

Causes of Anemia

During pregnancy, nutritional deficiency is a common cause of anemia.  While many people are aware of the connection between iron deficiency and anemia, there are actually three types of nutritional anemias: iron deficient anemia, folic acid anemia, and vitamin B12 anemia.  Because B12 anemia is rare, we will focus more on prevention of anemia caused by iron and folic acid deficiency.

Before covering these, we should also mention that given the marked increase in blood volume during pregnancy (50% greater than pre-pregnancy volume), it is natural for the red blood cell count to drop in the middle of pregnancy, simply because the blood becomes more diluted.  (The red blood cell count remains stable but the blood volume increases.)

But we digress.  Ideally, we recommend that women have blood work and a nutritional assessment prior to conception (see here for more about preconception planning) to determine their pre-pregnancy blood counts and begin eating optimally for pregnancy (some women are iron-deficient going into pregnancy).  However, a simple blood test during pregnancy can help us diagnose anemia and determine the appropriate action to take.

Treatment of Anemia in Pregnancy

Often, nutritional supplementation is our first course of action to address anemia in pregnancy.  As with most issues, prevention is preferred to waiting until a condition manifests and treating it, so let’s talk about dietary prevention of anemia (you can follow these before conception, during pregnancy, and even after birth, especially if you’ve experienced blood loss or are healing from birth).  These same dietary principles apply when treating anemia as well, though additional iron supplementation is commonly advised.

Dietary Prevention and Treatment of Anemia

Folic Acid

Folic acid is a B vitamin found in the following foods, which can be eaten throughout pregnancy:

  • Dark leafy greens** (aim to consume two large servings per day)
  • Wheat germ
  • Molasses
  • Nutritional yeast
  • Root vegetables**
  • Beans
  • Milk
  • Liver (organic liver is preferred as animal liver is prone to high concentrations of environmental and systemic toxins)
  • Spirulina
  • Herbs such as nettles and dandelion

**To obtain the highest amounts of folic acid through vegetables, consume them raw, steamed, or lightly sautéed.


Iron is essential in pregnancy to ensure the red blood cells can adequately oxygenate both mom and baby.  Baby also stores iron in its liver prior to birth and will depend on these iron reserves for the first 6 months of life, since breast milk is naturally low in iron.

Iron supplements are often suggested during pregnancy.  In pregnancy, it is difficult to get enough iron solely from your diet to treat anemia.   We recommend a plant based iron supplement that is well tolerated and does not cause the more common side-effects such as constipation and gastrointestinal upset seen when taking synthetic iron.

Regardless, consuming iron rich foods is an ideal way to build your blood and increase your iron to prevent or help in treating anemia in pregnancy.

Iron Rich Foods include:

  • Organic red meat and dark meat chicken and turkey contain the highest amounts of iron (and also provide lots of protein).
  • Beans and legumes (which also contain protein and lots of fiber)
  • Eggs
  • Dark green leafy vegetables (which also have minerals calcium and magnesium and chlorophyll, which dramatically reduce symptoms of anemia)
  • Seaweeds (such as kelp/kombu and dulse)
  • Berries and cherries
  • Sunflower and pumpkin seeds
  • Dried fruit (organic and unsulphured) such as peaches, apricots, raisins, prunes and figs
  • Nettles (Urtica diocea), Alfalfa (Medicago sativa), and Yellow Dock (Rumex crispus) are high in iron and powerful blood builders.  They can be taken as advised by your midwife as teas or in capsule form.
  • Nutritive Syrups such as Floradix or local herbalist-made syrups may also be an option

Given that dark leafy greens are excellent sources of both folic acid and iron, a great way to prevent anemia in pregnancy is to eat your greens! 


Can’t stomach the thought of a rabbit’s smorgasbord on your plate?  Get creative.

Ways to sneak greens into other foods:

  • Chop up greens and add it to your pasta sauce or lasagna
  • Mix cut-up spinach into an omelet/eggs
  • Add small pieces of kale to your chicken soup
  • Sautee garlic, onions, or shallots in butter or olive oil.  Add greens. Cook them until wilted and soft. Add a splash of white wine or vinegar and cook until the flavors blend.

In addition to diet, cooking in a cast iron pot/pan can increase the iron content in foods.  Regular exercise increases the body’s need for oxygen, which causes the body to respond by allowing iron to be absorbed more easily.

 Tips for Iron Absorption from Food and Supplements

Because iron is not always well utilized by the body, follow these steps to optimize iron absorption in the body:

  • Eat iron with Vitamin C rich foods
  • Avoid caffeine, which inhibits iron absorption
  • Carbonated beverages may reduce iron absorption
  • Insure proper hydrochloric acid in the stomach.  A good acid level helps with digestion and absorption.   Avoid drinking lots of liquid at meals and use vinegar in your cooking or as a supplement with meals (apple cider vinegar is great).
  • Help prevent the destruction of red blood cells by eating vitamin E containing foods such as nuts, seeds, eggs, dairy, whole grains, high quality oils, avocados, soy, sea vegetables.
  • Avoid calcium ingestion with iron, e.g. milk antacid, prenatal supplements

Always speak with your midwife if you are concerned or have questions about anemia, optimal nutrition and intake of folic acid and iron, and related issues.  Anemia in pregnancy is manageable and it is much better to discover it and treat it before birth, to give you and baby the best chance at a healthy, happy pregnancy, birth and postpartum.