Why it matters so much here
National survey data puts anaemia in Indian pregnancies above 50 percent. Untreated, it increases the risk of preterm birth, low birth weight, postpartum haemorrhage and maternal exhaustion, and it affects the baby's iron stores for the first six months of life. It is also one of the most straightforward problems in antenatal care to fix — provided it is measured properly.
The tests, and what each one tells you
- Haemoglobin (Hb) — the headline number, but a late indicator. It falls only after iron stores are exhausted.
- Complete blood count with indices — MCV and MCH show whether the red cells are small and pale, which points to iron deficiency rather than another cause.
- Serum ferritin — the most useful single test. It measures stored iron. Below 30 ng/mL indicates deficiency in pregnancy even with a normal haemoglobin; below 15 is clear depletion. Ferritin rises with infection, so it is interpreted alongside CRP.
- Serum iron, TIBC and transferrin saturation — supporting tests when the picture is unclear.
- Peripheral smear — helps distinguish iron deficiency from thalassaemia trait, which is common in parts of India and needs different management.
- Vitamin B12 and folate — deficiency is very common in vegetarian diets and produces anaemia that iron alone will not correct.
- Haemoglobin electrophoresis or HPLC — for suspected thalassaemia or sickle cell trait, important for both you and the baby.
Reading your report
Anaemia in pregnancy is defined as Hb below 11 g/dL in the first and third trimesters and below 10.5 in the second, when physiological dilution is greatest. Below 7 g/dL is severe and needs urgent treatment. If your Hb is 11.2 but your ferritin is 12, you are iron deficient without being anaemic yet — and that is the ideal point to intervene.
Treatment
Oral iron, usually 60 to 100 mg of elemental iron daily, is first line. Taking it correctly roughly doubles its effect:
- Empty stomach, with lemon water, orange juice or amla.
- No tea, coffee, milk, curd or calcium tablet within two hours.
- Alternate-day dosing is now known to improve absorption and reduce side effects for many women — ask your doctor.
- Expect black stools; that is normal. Constipation and nausea are common and manageable with fibre, fluid and timing changes.
Intravenous iron — ferric carboxymaltose or iron sucrose — is used when tablets are not tolerated, absorption is poor, anaemia is severe, or you are close to delivery and need a fast correction. It is safe from the second trimester and often given as a single sitting.
Follow-up
Recheck haemoglobin and ferritin four weeks after starting treatment. A rise of at least 1 g/dL confirms the diagnosis and that treatment is working. If there is no rise, the cause is something else — B12 deficiency, thalassaemia, ongoing blood loss or malabsorption — and needs investigation rather than a higher iron dose. Continue iron for three months after haemoglobin normalises to rebuild stores, and for at least six weeks postpartum.