Physiologic Anemia of Pregnancy

Pathophysiology

All pregnant women develop physiologic anemia due to plasma volume expanding 40-50% while red cell mass increases only 20-30%, creating a relative hemodilution 1
At 11 weeks gestation, hemoglobin <11 g/dL is considered anemic, making a patient's value of 11.5 g/dL borderline but symptomatic from relative anemia 2

The American College of Obstetricians and Gynecologists recommends iron supplementation for pregnant women with hemoglobin levels below 11 g/dL in the first and third trimesters, and below 10.5 g/dL in the second trimester, with a dose of 60-120 mg of elemental iron daily as first-line treatment 1, 2
Iron supplementation should be continued until hemoglobin normalizes for gestational age, then reduced to a maintenance dose of 30 mg/day 2
Hemoglobin should be rechecked after 4 weeks, expecting at least a 1 g/dL increase 1, 2

The American Heart Association recommends emphasizing iron-rich foods including red meat, poultry, fish, legumes, and fortified cereals 1, 2
Vitamin C-containing foods (citrus fruits, tomatoes, peppers) should be taken with iron supplements to enhance absorption 1, 2

The British Journal of Sports Medicine recommends that pregnant women accumulate at least 150 minutes of moderate-intensity physical activity each week to achieve clinically meaningful reductions in pregnancy complications 4, 1
Women with hemoglobin >10 g/dL who are symptomatic should consider reducing the intensity of prenatal exercise but remain physically active 1, 2

The European Society of Cardiology advises against dismissing fatigue and lightheadedness as "normal pregnancy symptoms" without addressing the anemia, as these symptoms require evaluation and treatment, not reassurance alone 1, 2
The American College of Cardiology recommends not delaying iron supplementation while waiting for ferritin results if clinical suspicion for iron deficiency is high 2
Complete bed rest or activity restriction should not be advised, as this increases the risk of pregnancy complications 4, 1