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Anaemia in Pregnancy



Anaemia in Pregnancy is defined as hemoglobin levels less than 11 g/dl in early pregnancy and less than 10.5 g/dl in the 2nd and 3rd trimester of pregnancy. Mild anemia– hemoglobin: 8–11g/dl; Severe anemia– hemoglobin<7g/dl. Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery and perinatal mortality. Severe anaemia with maternal hemoglobin levels less than 6 g/dL has been associated with abnormal fetal oxygenation resulting in non-reassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilatation and fetal death. Thus, maternal transfusion should be considered for fetal indications.  


Diagnostic Criteria


  • Tiredness, weakness, palpitations and dyspnea 

  • Exercise intolerance 

  • Pallor of skin and mucous membranes 

  • Dizziness, faintness, headache 

  • Intermittent claudication (ache, cramp, numbness or sense of fatigue) 

 Note: Some patients with anaemia in pregnancy may be asymptomatic 




  • Full blood count and blood cross-match - red cell morphology

  • Red blood cell electrophoresis if haemoglobinopathies suspected

  • Blood smear for malaria 

  • Stool and urine analysis 

  • HIV test 

Non-pharmacological Treatment


  • Iron rich diet (fish, eggs, fruits and vegetables etc.) 

  • Prevent and early treatment of malaria 

  • Investigate and treat associated worm infestations  


Pharmacological Treatment 


Prophylaxis in Antenatal Care

  • Ferrous sulfate (PO) 200 mg 2–3 times per day


  • Folic acid (PO) 5mg once daily 



  • Ferrous sulfate should be taken in a full stomach and avoid to take it with tea/coffee

  • Where vomiting is experienced reduce dosage to tolerable level 


If Hb is <7g/dl give:

  • Ferrous sulfate 200mg (PO), 8 hourly until Hb is 12g/dl   Check If Hb>7 to 11 g/dl change dose to:

  • Ferrous sulfate 200mg (PO) 12 houly for 4 weeks  


  • Folic acid (PO) 5mg once a day for 4 weeks


  • Vitamin B12 tabs (PO) 12 hourly for 4 weeks  




Refer and transfuse in case of signs of severe anemia. 


Updated on, 3.11.2020


1. STG

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