Postpartum Anemia: Causes, Symptoms, Treatment And Prevention

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New mothers are often so busy taking care of the baby that they forget to take care of themselves. Neglecting your health after childbirth can give rise to several health complications, one of which is postpartum anemia. It is the most prevalent problem in the world, especially in developing countries, causing maternal morbidity.

MomJunction explains postpartum anemia, its causes, symptoms, and the various treatment options.

What Is Postpartum Anemia?

Postpartum anemia is chronic iron deficiency post-delivery, when hemoglobin levels are less than 110 g/L at one week postpartum and less than 120 g/L at eight weeks postpartum (1).

Anemia Develops In 3 Stages (2)

  1. First stage: The iron levels in the bone marrow start to deplete, causing an overall reduction in the iron content in the blood. No specific symptoms of anemia are noticed at this stage.
  1. Second stage: The side-effects of anemia start to show up. You start feeling more tired and may have headaches. The deficiency can be detected with a blood test. At this stage, the hemoglobin production starts getting affected.
  1. Third stage: The hemoglobin levels go down further, causing severe anemia. The symptoms include extreme tiredness and exhaustion, making you feel sick.

Knowing what brings down the hemoglobin levels is essential to avoid the condition.

[Read: Anemia During Pregnancy]

What Causes Anemia After Pregnancy?

Postpartum anemia could develop due to (3):

  • Poor diet: Insufficient intake of iron before or during pregnancy can lead to postpartum anemia. The iron requirement during pregnancy is 4.4mg per day. Since you do not get enough iron from food alone, it is important to take iron supplements during pregnancy and before conception.
  • Blood loss: Significant blood loss during menstruation can also lead to loss of iron before conception.
  • Peripartum blood loss: Heavy blood loss during delivery (exceeding 500ml) can deplete the body’s iron reserves and lead to anemia after delivery (4). The greater the blood loss, the higher the risk of anemia in the mother.
  • Intestinal diseases: In the case of intestinal disorders such as celiac disease, Crohn’s disease, and inflammatory bowel disease, the presence of worms, malabsorption of iron becomes a concern (5).

When the iron levels go down, you will experience certain changes in the body.

What Are The Symptoms Of Postpartum Anemia?

Here are the signs and symptoms indicating iron deficiency after childbirth (6):

  • Feeling overly exhausted and tired
  • Pale skin
  • Weakness
  • Feeling depressed
  • Feeling confused
  • Reduced quality and quantity of breast milk, which is associated with low weight gain in babies (7)
  • Shortness of breath
  • Lightheadedness or dizziness
  • Rapid heartbeat
  • Headaches
  • Irritability
  • Mood swings
  • Reduced sex drive
  • Decreased immunity

You may not be experiencing all these symptoms at a time, but if you find any of the symptoms mentioned above unmanageable, consult your doctor to avoid complications.

[Read: What Causes Postpartum Preeclampsia]

Risks Factors For Postpartum Anemia

Women who fall under the following categories are at a greater risk of developing postpartum anemia:

  • Iron deficiency before or during pregnancy
  • Multiple pregnancies
  • Pre-pregnancy BMI over 24
  • Cesarean section
  • Short recovery time between pregnancies
  • Bleeding during pregnancy
  • Premature or post-term delivery
  • High blood loss during pregnancy
  • Placenta Previa
  • Hypertension
  • Multiple births
  • Low income (9)

Does Anemia Affect Breastfeeding?

Anemia after delivery is associated with insufficient milk syndrome, which brings down the duration of full breastfeeding and leads to weaning at an earlier age. Early weaning also leads to poor weight gain in infants (7). Around 22% of first-time mothers suffer from postpartum anemia, with a hemoglobin level of less than 10 g/L.

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Treating anemia soon after diagnosis can prevent breastfeeding problems.

How Is Postpartum Anemia Treated?

Treatment of postpartum anemia includes some changes to your diet and lifestyle with recommended iron supplements. If the diagnosis confirms iron deficiency anemia, 100-200mg daily dose of oral ferrous iron is given for women with mild to moderate anemia after childbirth. You may require intravenous ferric iron from 800-1500mg in the case of severe deficiency.

Your doctor will order hemoglobin analysis after two weeks to check if the treatment is successful. Blood transfusion is only given for women who have circulatory problems due to blood loss (4). For more severe forms of anemia, there are various medical treatments that can be implemented under the guidance and supervision of specialists.

Here are a few tips to follow for managing anemia after delivery:

  1. Iron supplements: Take iron supplements to improve the iron levels in the blood. You can take tablets, capsules, or tonics as recommended by the doctor.
  1. Eat iron-rich foods including (10):
  • Leafy Greens such as spinach
  • Beans
  • Lentils
  • Apricots
  • Pumpkin
  • Tofu
  • Cereal
  • Brown Rice
  • Asparagus
  • Potato
  • Squash
  • Peas
  • Iron-fortified bread
  • Oysters
  • Chicken
  • Strawberries
  1. Reduce tea intake: It contains an ingredient called tannin, which slows down iron absorption in the body. Similarly, a lot of calcium intake can also reduce the absorption of iron in the body (10).
  1. Eat vitamin C rich foods: Eating foods rich in vitamin C can help increase iron absorption in the body. Fruits like oranges and strawberries are good sources of vitamin C (10).

[Read: Postpartum Hemorrhage]

  1. Stay hydrated: Drinking more fluids helps you improve your blood flow after childbirth. Fluid intake may also help prevent blood clots and urinary tract infections. If iron supplements cause bloating, then fluids can help tackle it. Have more than three liters of fluids per day during postpartum (11).
  1. Avoid constipation: Stool softeners can help with constipation, which is a side effect of iron supplements. You can also increase fluid intake to tackle constipation.
  1. Good rest: Get enough rest and avoid overexertion if you feel very tired and exhausted due to low iron levels.
  1. Protect yourself from infections: Infection risk may increase as anemia brings down the immunity level of your body. In case you notice any signs of infection, contact the doctor and take antibiotics if necessary.
  1. Follow up with the doctor: If you are diagnosed with postpartum anemia. Get blood tests to help the doctor determine your condition and take the necessary steps. If the iron level continues to drop, then the doctor may advise iron injections, IV drip, or a blood transfusion.

If you experience any unusual symptoms post-delivery, consult a doctor immediately. Talk to a nutritionist to help improve the diet and replenish any lost nutrients after childbirth, to maintain iron levels in the body. Anemia after delivery can be prevented by following an iron-rich diet and taking iron supplements during pregnancy. Your doctor may prescribe  30-50mg/daily of prophylactic iron supplementation during your prenatal visit to prevent anemia during and after pregnancy (9).

Do you have any experiences to share? Tell us about them in the comments section below.


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