Monday, 18 April 2016
Could you be anaemic?
Feeling tired and irritable is normal when you’re pregnant/a new mum. But it can also be a sign of anaemia, as Helen Foster explains
Anaemia is a condition that occurs when there are either too few red blood cells in the body to transport the oxygen you need around your body, or there’s a reduced amount of haemoglobin, a protein in the red blood cells where the oxygen is stored. Both of these are extremely common in mums-to-be because of changes that occur naturally in the blood during pregnancy.
‘When you’re pregnant, the volume of your blood will increase to take into account the extra you need to supply the womb and placenta,’ explains consultant obstetrician Dr Penelope Law from London’s Portland Hospital for Women and Children. ‘This change in volume also decreases the concentration of substances in the blood – so technically, most women are slightly anaemic for most of their pregnancy.’
However, anaemia is also related to our iron levels. We need iron to make red blood cells so if your intake is low – or your need for iron increases – you might become iron deficient and go on to develop anaemia. And guess what? The foetus and placenta both need iron for growth – a lot of it.
‘The amount of iron you need to take in when you’re pregnant increases by half,’ says consultant haematologist Dr Sue Pavord from Oxford University Hospitals. ‘If your diet is low in iron – for example, you’re vegetarian or simply don’t eat much red meat – you might not be taking in as much as you need.’
Expecting twins, triplets (or more), or having a baby within a year of your previous one, can further increase the amount of iron your body needs to maintain a healthy level. The good thing is that doctors know you’re at risk of anaemia when you’re pregnant, so you’re checked twice for the condition – once when you’re first booked in with your midwife and then again at 28 weeks. If anaemia is diagnosed, you’ll be given iron supplements.
‘These used to be given to all women as standard during pregnancy, but over time it was realised that they can cause side effects such as nausea and constipation, so it was decided that the mother’s discomfort wasn’t worth it if she was only mildly iron deficient,’ says gynaecologist Pradnaya Pisal of London Gynaecology. But while mild iron deficiency is something your body can handle in normal circumstances, childbirth can tip you into anaemia.
Fact is, birth can be a messy business and even during a normal delivery the average woman loses about 500ml of blood. If your iron stores are high this isn’t a problem – your body can rev up the creation of red blood cells to compensate for the drop within a few months. However, if you’re borderline anaemic to start with, even this normal loss can be too big for your body to counteract alone.
‘Some types of delivery can also mean you lose a bit more blood,’ says Pradnaya. ‘After childbirth, the uterus contracts to stop any bleeding, but in induced labour or after a caesarean this doesn’t happen quite so quickly, which can increase the amount of blood you lose. Women who suffer with fibroids or adenomyosis (a problem associated with endometriosis) can also lose more during birth.’
If you do lose a lot of blood, you’ll probably be given a blood transfusion to replace your red cell stores. If it’s a smaller loss, you’ll be advised to take iron supplements to fuel your body’s ability to make its own cells.
‘It takes about three months to build up adequate iron stores in the bone marrow, so even if you had a transfusion at birth there might be a month or two after delivery when your system is still deficient,’ says Dr Virginia Beckett, spokesperson for the Royal College of Obstetricians and Gynaecologists. ‘This is also why it’s so important to keep taking iron supplements for the full three months.’
Even if you come out of the delivery room with Ok iron stores, after birth your levels can drop below a healthy threshold. Breastfeeding will increase the body’s demand for iron, so if you’re not compensating for that with lots of iron-rich foods, you could still become deficient. And if you’re not breastfeeding, your periods will return – and the extra blood loss of a heavy period shortly after the demands of delivery can also trigger anaemia.
One problem with detecting postnatal anaemia is that its main symptom is tiredness – something you’d expect to feel as a new mum. ‘I had no clue,’ says Samantha, 33 and mum to Michael, four. ‘I thought I felt sluggish because I had a newborn who wanted to be fed every three hours – but it went on for months and after repeated trips to the doctor I had a blood test, and discovered I was anaemic.’
So how do you know whether that ‘my-baby-won’t-sleep’ fatigue is being aggravated by a medical cause? Well, the tiredness of anaemia is usually not felt in isolation: you can also feel dizzy, weak or irritable. Another common sign is paleness – your whole face may look a bit more washed-out, or you might notice your lips or fingernails losing their pink flush of health. Other symptoms include a rapid heart rate, palpitations, shortness of breath and, strangely, cravings for ice. If your anaemia gets to quite an advanced level, you may also notice your hair thinning.
‘If you’re feeling extremely tired post-childbirth, and especially if that tiredness is associated with other symptoms such as breathlessness, ask your midwife to check your blood count – this is normally done within 23 days of delivery anyway, but you can also ask her to do it when she visits you at home,’ says Penelope. If your haemoglobin level is found to be below 10.5, you’ll probably be given iron supplements to rebalance things. And taking these properly is important, as iron can be a tricky mineral to absorb.
‘Food can interfere with absorption, so you should take supplements an hour before eating,’ says Sue. ‘Also, never wash them down with tea or milk as this reduces how much iron is absorbed – use water or, even better, orange juice as vitamin C increases its uptake.’
Other foods high in vitamin C include red peppers, tomatoes, citrus fruits and kiwi fruit.
The lower the dose of iron supplements you’re taking, the less likely you are to suffer with any side effects, but if you find that your bowels are affected, a natural remedy is prune juice (which also contains a small amount of iron itself). If you’re really suffering, don’t be afraid to ask your doctor for a mild laxative.
As Virginia says, it’s also important to take your supplements for the full three months they’ll be prescribed for. Oh, and keep them well out of sight of children – they can be very dangerous if swallowed by youngsters.
A blood test may reveal that you’re not officially anaemic, but ‘iron deficient’. Because of the side effects, your doctor is unlikely to recommend iron supplements at this point: instead, it’ll be suggested that you boost your iron levels naturally through diet.
‘The best way to do this is to eat red meat or poultry, as these contain the most absorbable forms of iron,’ says Sue. ‘Plant foods such as spinach do contain iron, but it’s in a form called non-haem iron, which isn’t as readily absorbed by the body.’
If you don’t eat meat, fortified foods such as certain breakfast cereals can help. Other sources include eggs, beans, lentils and bread.
Heart of the matter
If you don’t feel better after these changes, Virginia says to go back to your doctor. ‘It could be that the anaemia is linked to a pre-existing condition such as coeliac disease, which interferes with the absorption of nutrients. Or your symptoms may be caused by a different problem, perhaps hypothyroidism, which can develop during pregnancy and manifests in the same way.’
‘I was diagnosed with anaemia back in February 2014, three years after giving birth to my second child, Cosima,’ says 38-year-old Camilla. ‘I’m pretty sure that it had been undetected since she was born, as I was shattered and had moments of breathlessness. I started taking iron supplements and eating more iron-rich foods, but my levels weren’t increasing. It’s only since I’ve moved house that it’s been suggested I be tested for coeliac disease and thyroid conditions.’
Finally, if you’re planning another baby, you might want to cut out and keep our advice on boosting your iron levels. ‘If I could ask mums to do one thing before they become pregnant it would be to try to raise their iron stores,’ says Pradnaya. ‘If your levels are high before you conceive, the impact of the natural changes that occur during pregnancy are far easier for your body to manage, and you probably won’t need any supplements or other interventions.’