Low Hemoglobin During Pregnancy: Why It Happens and How It Can Be Managed

"Your hemoglobin is low" is one of the most common things a pregnant woman in India hears at her antenatal visit. According to the National Family Health Survey (NFHS-5), more than half of pregnant women in the country are anaemic, and Chhattisgarh sits close to that national picture. Because it is so common, it is often shrugged off. It should not be. Anaemia is one of the most preventable causes of complications at delivery, and in most women it is also one of the most treatable.

What Hemoglobin Level Is Normal in Pregnancy?

Hemoglobin is the protein in red blood cells that carries oxygen. In pregnancy it is measured in grams per decilitre (g/dL), and the World Health Organization thresholds used in India are:

A slight fall in hemoglobin during pregnancy is expected. Your blood volume rises by nearly half, and the fluid part rises faster than the red cells, which dilutes the blood. That is why the cut-off is lower in pregnancy than for other women. A result below 11 g/dL, however, is more than dilution and deserves attention.

Why Hemoglobin Drops During Pregnancy

A pregnant woman needs roughly two to three times as much iron as she did before, mainly in the second and third trimesters when the baby builds its own iron stores. Many women start pregnancy with low reserves, so the gap opens quickly. The common causes:

• Iron deficiency: by far the most common cause, from low reserves before pregnancy plus the extra demand.
• Folic acid or vitamin B12 deficiency: B12 deficiency is particularly common in vegetarian diets.
• Heavy periods before pregnancy: from conditions such as fibroids, which drain iron stores for years.
• Closely spaced pregnancies: less than 18 months between deliveries leaves little time to rebuild iron.
• Worm infestation: hookworm causes slow blood loss from the gut, which is why deworming is part of antenatal care.
• Malaria: destroys red blood cells and remains a concern in parts of Chhattisgarh.
• Inherited blood conditions: sickle cell disease and thalassaemia, covered below.
• Twins or triplets: higher demand for iron.

Symptoms of Low Hemoglobin

Mild anaemia often causes no symptoms at all, which is why it is picked up on blood tests rather than by how you feel. As it worsens, you may notice:

• Tiredness beyond the normal fatigue of pregnancy
• Breathlessness when climbing stairs or walking briskly
• Pale skin, pale inner eyelids, pale nails or tongue
• Dizziness or feeling faint, especially when standing up
• A racing or pounding heartbeat
• Headaches and difficulty concentrating
• Cold hands and feet
• Craving to eat non-food items such as mud, chalk, ice or raw rice, a sign called pica

Breathlessness at rest, chest pain or fainting means you should be seen urgently rather than waiting for your next visit.

Why Anaemia Matters for Mother and Baby

The practical message is timing. Hemoglobin rises slowly, by roughly 1 g/dL every two to three weeks on effective treatment. Anaemia found at 34 weeks leaves very little time to correct it before delivery, which is why testing early and repeating it matters.

Tests That Find the Real Cause

Treating every low hemoglobin with iron tablets works for most women, but not all. If the number does not rise, the cause needs to be found. A low hemoglobin during pregnancy doctor will usually check:

• Complete blood count with red cell indices: small pale cells point to iron deficiency or thalassaemia; large cells point to folate or B12 deficiency.
• Serum ferritin: the best single measure of iron stores.
• Peripheral smear: a look at the red cells under the microscope.
• Sickle cell test and hemoglobin electrophoresis (HPLC): to detect sickle cell or thalassaemia trait.
• Vitamin B12 and folate levels: where cells are large or diet is vegetarian.
• Stool examination and malaria test: when history suggests them.

Sickle Cell and Thalassaemia in Chhattisgarh

This is the part of anaemia care that is most specific to Chhattisgarh. The state carries one of the highest burdens of the sickle cell gene in India, particularly in some communities, and it is a focus of the national Sickle Cell Anaemia Elimination Mission. Thalassaemia trait is also seen across the region.

This matters in pregnancy for three reasons:

• Iron may not be the answer. A woman with thalassaemia trait can have a low hemoglobin with normal iron stores. Giving her extra iron for months does not help, and in some blood conditions can cause iron to build up.
• Sickle cell disease makes pregnancy high-risk. Women with the disease have more pain crises, infections, preeclampsia and preterm birth, and need specialist monitoring throughout.
• The baby can inherit it. If both parents carry the trait, each pregnancy has a one in four chance of the baby having sickle cell disease. Testing the partner, ideally early in pregnancy, gives the couple time to understand their options.

If you or your family have ever been told about sickle cell, or if your hemoglobin does not rise on iron, ask for screening. It is a simple blood test.

Treatment: Tablets, IV Iron and Transfusion

Iron and folic acid tablets

Under India's Anaemia Mukt Bharat programme, every pregnant woman is advised to take one iron and folic acid tablet daily from the second trimester for at least 180 days, continuing for six months after delivery. Women who are already anaemic are given a higher treatment dose. To get the most from them:

• Take them on an empty stomach or between meals, with water or lemon water
• Keep tea, coffee and milk at least an hour away from the tablet; they block absorption
• Take calcium tablets at a different time of day, at least two hours apart
• Constipation and black stools are common and harmless; more water, fibre and fruit help
• If tablets make you sick, tell your doctor rather than stopping; a different preparation or timing usually solves it

IV iron

For moderate or severe anaemia in the second or third trimester, or when tablets are not tolerated or not working, iron can be given through a drip. Ferric carboxymaltose, the most commonly used form, can replace a large amount of iron in one or two short sessions and raises hemoglobin faster than tablets. It is given in a hospital setting with monitoring. It is generally avoided in the first trimester.

Blood transfusion

Reserved for severe anaemia, particularly close to delivery when there is no time for iron to work, or when there is heavy bleeding. It works immediately but carries its own risks, so the aim of early testing is to avoid ever needing it.

Treating the cause

Deworming tablets in the second trimester, vitamin B12 or folic acid where deficient, malaria treatment if present, and specialist care for sickle cell disease.

Iron-Rich Foods and How to Absorb Them

Diet alone rarely corrects anaemia in pregnancy, but it supports treatment and helps prevent a relapse. Everyday options from a Chhattisgarh kitchen:

The trick is combining them. Iron from plant foods is absorbed much better when eaten with vitamin C, so squeeze lemon on your dal or sabzi, or eat a guava or amla with the meal. Cooking in an iron kadhai adds a small amount of iron to food. And move the after-meal cup of tea to at least an hour later.

Anaemia Care Across Chhattisgarh

Iron and folic acid tablets and hemoglobin testing are available free at government health centres across the state, and every pregnant woman should use them. Where a specialist adds value is in finding out why the number is not rising, deciding when IV iron is needed, screening for sickle cell and thalassaemia, and planning a safe delivery for a woman whose anaemia has not fully corrected.

Dr. Ankita Bansal Goyal (MD, FMAS, PGIMER Chandigarh) provides anemia during pregnancy treatment in Chhattisgarh at Sankalp Hospital, Bilaspur Road, Ambikapur, as part of high-risk pregnancy care. If you are looking for a pregnancy doctor near me in Surguja, Surajpur, Balrampur, Jashpur or Korea district, the clinic is open Monday to Saturday, 9:00 AM to 5:00 PM. Bring all your previous hemoglobin reports so the trend can be seen.

Frequently Asked Questions