• Dr Peter Chew

Blackout during pregnancy: Am I anemic?

She was glad that her symptoms of morning sickness were over. Her husband suggested that they go for celebration with a good meal. Halfway through the lunch, she suddenly felt dizzy  blacked out for a few seconds. She was perspiring profusely when her panicky husband brought her to my clinic.


N, 30, was a first-time mum at 15 weeks of gestation. She looked pale on examination. Her blood pressure and heart rates were normal. Obstetrical examination was normal. There was no vaginal bleeding. Blood tests revealed that her hemoglobin was 9.2gm/dl and the blood level of iron was low.


N was suffering from pregnancy anemia due to iron deficiency. Anemia is a condition in which there is not enough red blood cells to carry adequate oxygen to the tissues in the body.


How common is iron deficiency anemia during pregnancy?  

According to a recent study (GUSTO study 2019), about one in five Singaporean women aged 15 to 49 years had anemia while pregnant. 91% of these women were found to be iron deficient.

What causes iron deficiency anemia during pregnancy?

The body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to the tissues. During pregnancy, the body needs more iron to make more blood to supply oxygen to the baby. If the pregnant mum does not have enough iron reserve or gets enough iron during pregnancy, she will develop iron deficiency anemia.


How does iron deficiency anemia during pregnancy affect mother and baby?

Currently, there is no study to show that anemia per se increases the risk of maternal death. Anemic mothers are more vulnerable to getting infection. But there is also a dearth of information on the frequency and severity of infection in these women. During pregnancy or labour, should the mother have excessive bleeding, she is more vulnerable to shock.


With regards to the foetus, severe anemia increases the risk of premature birth, The baby’s birth weight may be low and the risks of intellectual disability, autism or attention deficit hyperactivity disorder (ADHD) are increased. Some studies also show an increased risk of infant death immediately before or after birth.

What are the risk factors for iron deficiency anemia during pregnancy?

Risks factors include:

  • Age: Adolescent girls and women over 35

  • Race: In Singapore, iron deficiency is more common in Malays and Indians

  • Educational levels: Gusto study revealed that pregnant mothers who attained university qualification are more likely to be iron depleted

  • A closely spaced pregnancy

  • Multiple pregnancy

  • Frequent vomiting due to morning sickness

  • Inadequate intake of iron from diet and prenatal supplements

  • Anemia before getting pregnant

What are the symptoms of iron deficiency anemia during pregnancy?

The signs and symptoms include:

  • Fatigue

  • Weakness, shortness of breath

  • Pale skin, brittle hair and nails

  • Irregular heartbeats

  • Dizziness or lightheadedness

  • Cold hands and feet 

As symptoms of anemia often mimic those of normal pregnancy, most women often disregard them. It is important, therefore, to routinely test women for anemia and check their haemoglobin levels at regular intervals throughout pregnancy.  


How can iron deficiency anemia during pregnancy be prevented and treated?

Good nutrition and balanced diet can prevent iron deficiency anemia during pregnancy. Dietary sources of iron include lean red meat, poultry, fish and green leafy vegetables and fruits. A high content of vitamin C in vegetables and fruits will enhance iron absorption.


Taking a prenatal vitamin that contains iron can help prevent and treat iron deficiency anemia during pregnancy. The daily requirement of iron is 27 milligrams a day. If the hemoglobin levels remain low despite dietary and prenatal iron treatment, iron transfusion through intravenous route may be considered. Blood transfusion is rarely necessary.


N’s condition improved with increased intake of iron-rich food and prenatal supplements. Her haemoglobin level was restored to normal after 4 weeks. There was no further episode of dizziness.

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