Physiologic Anemia of Pregnancy with Symptomatic Mild Anemia

Understanding the Cause

All pregnant women develop a degree of physiologic anemia due to blood volume expansion and hemodilution 2, 3
At 11 weeks gestation, hemoglobin <11 g/dL is considered anemic (normal cutoff is >11 g/dL in the first trimester) 1
This patient's hemoglobin of 11.5 g/dL is borderline but her symptoms of fatigue and lightheadedness indicate she is symptomatic from relative anemia 2, 3

The American College of Obstetricians and Gynecologists recommends prescribing 60-120 mg of elemental iron daily as first-line treatment for iron deficiency anemia in pregnancy 1
Treatment should continue until hemoglobin normalizes for gestational age, then reduce to a maintenance dose of 30 mg/day 1
Advise consuming iron-rich foods (red meat, poultry, fish, legumes, fortified cereals) 1
Recommend foods that enhance iron absorption, particularly vitamin C-containing foods (citrus fruits, tomatoes, peppers) taken with iron supplements 1

Reassess hemoglobin after 4 weeks of treatment, expecting at least a 1 g/dL increase in hemoglobin or 3% increase in hematocrit 1
If no response after 4 weeks despite compliance and absence of acute illness, further evaluation with MCV, RDW, and serum ferritin is necessary 1

Women with hemoglobin levels >10 g/dL (100 g/L) who are asymptomatic should maintain moderate-vigorous physical activity 2, 3
If symptomatic, consider reducing the intensity of prenatal exercise but remain physically active 2, 3

Refer to a physician familiar with anemia in pregnancy if hemoglobin drops to <9.0 g/dL or hematocrit <27.0% 1
If no response to iron therapy after 4 weeks in women of African, Mediterranean, or Southeast Asian ancestry, consider thalassemia minor or sickle cell trait 1

Do not dismiss symptoms of fatigue and lightheadedness as "normal pregnancy symptoms" without addressing the anemia 2, 3
Do not restrict physical activity unnecessarily, as complete inactivity could result in increased risk of adverse pregnancy outcomes 2, 3
Do not delay iron supplementation while waiting for ferritin results if clinical suspicion for iron deficiency is high 1