Dear Doctor,

I am in still in the first trimester of my first pregnancy and I recently found out that I am anaemic. I was advised to eat more vegetables to fix this. As a doctor, what do you recommend?

Jennifer

Dear Jennifer,

IRON and vitamin B12 (component of vitamin B. complex) are essential elements for manufacture of haemoglobin, the component of red blood cells, which transports oxygen to the body cells.  Less than normal haemoglobin is anaemia. It can occur due to either dietary deficiency or poor absorption of these elements because of some disease process. Iron deficiency anaemia can also occur because of excess blood loss from the body. Few cases can be due to abnormalities in haemoglobin since birth or diseases of bone marrow. Chronic diseases like blood cancer, other tumours, hypothyroidism, and et cetera, can also cause anaemia.

In women, requirement of iron and calcium increases during changing phases of life like puberty, pregnancy, lactation and menopause. If this requirement is not fulfilled by diet, iron deficiency sets in. If not corrected, it increases gradually. Anaemia can become more severe, from one pregnancy to another. Blood loss during menstrual cycles and even during child birth also contributes to the anaemia.

Early tiredness, joints and muscular pains, breathlessness on exertion, shiny tongue, ulcers in oral cavity, are some of the manifestations of anaemia. Severe, persistent anaemia tends to put a burden on the heart, as it has to pump blood more forcibly to perfuse the whole body. This results in heart failure, manifesting as palpitations, breathlessness on mild exertion or even rest and swelling over feet.

Anaemia during pregnancy needs to be corrected, otherwise the mother becomes weak. The baby is also at risk of being born with less than normal expected weight. Severe anaemia in pregnant woman can cause mental retardation in the new-born. 

The precise cause of anaemia can be determined by clinical history, full blood count, estimating blood levels of iron and vitamin B12 and a bone marrow biopsy where needed. Treatment of underlying cause helps to correct the anaemia. Supplements of iron and vitamin B12 are useful. They are used as tablet or injection form, as per the need.

Regarding diet, green leafy vegetables, other vegetables like pumpkin and beet root, are good sources of iron. Citrus fruits like lemon, orange, tangerine, contain iron and vitamin C as well. Vitamin C helps in absorption of dietary iron from other food items in the body. Fruits like apples, bananas, passion fruit, also provide iron to the body.

Whole grains, cereals, nuts, soya, cheese, yoghurt, red meat, are dietary sources of vitamin B12.

One should include iron and vitamin B12 and vitamin C rich foods in the diet. Small frequent meals help in better assimilation of nutrients including iron and vitamin B12 in the body.  If there is vomiting due to pregnancy it also needs to be treated. Because if food taken is thrown out, nutrients will not be absorbed in the body to help in manufacture of haemoglobin.                                                   

  Dr. Rachna   Pande is a  specialist in internal medicine.