Despite being a preventable condition, anaemia persists and is associated with nearly half of maternal deaths in South Africa.
According to the World Health Organization, anaemia affects about 40% of pregnant women globally, with even higher rates in developing regions such as South Africa, where two out of three expectant mothers have low iron levels and one in three is anaemic.
World Anaemia Day, observed on Thursday, and South Africa’s Pregnancy Awareness Week both shine the light on anaemia — a global health challenge affecting many pregnant women and their newborns.
A recent study by University of Free State health sciences researchers looked at the association between iron status and birth outcomes of 427 pregnant women.
The study showed iron deficiency and anaemia were prevalent in the sample of pregnant women, despite the reported intake of prescribed iron supplements, with HIV-infected participants more likely to be iron-deficient and anaemic.
According to the researchers, iron is an essential element responsible for oxygen transport, energy production, DNA synthesis and muscle metabolism.
“Iron deficiency is the leading cause of anaemia, which is the most common nutritional deficiency in the world, affecting one-third of all women of reproductive age, 37% of pregnant women and 40% of children,” researchers said.
During pregnancy, there is an increased physiological requirement for iron due to the transfer of iron to both the growing foetus and placental structures, and the expansion of the red blood cell mass.
Anaemia in pregnancy, especially in the second trimester, has been associated with increased prematurity, low birth weight , foetal death and impaired cognitive and neuro-behavioural development.
“Additionally, iron deficiency can adversely affect the general wellbeing of pregnant women by causing breathing difficulties, fainting, tiredness, palpitations and sleep difficulties as well as increased risk of perinatal infection, pre-eclampsia and bleeding.”
The study says government has policies in place to the curb iron deficiency, including the mandatory fortification of maize meal and wheat flour with micronutrients such as iron to improve iron status of the entire population.
“Additionally, in South Africa, all pregnant women in the public health sector are routinely supplemented with single micronutrients in the form of 60 to 65mg of ferrous iron and 5mg of folic acid, beginning as early as possible after conception throughout pregnancy, irrespective of iron status, to prevent and/or treat iron deficiency anaemia and iron deficiency.
“Nonetheless, anaemia remains persistent, and is associated with nearly half of South African maternal deaths. Factors such as poor dietary iron intake, poor compliance to prenatal iron supplementation, HIV infection, obesity and infection-induced inflammation (which impedes iron absorption) increase the risk of anaemia,” the study states.
A 31-year-old expectant mother, who did not want to be named, said her iron deficiency posed a challenge in her pregnancy.
“I didn’t realise that feeling so tired while I was pregnant was not normal and that eating ice wasn’t just a pregnancy craving.
“I was sleeping all weekend and every afternoon when I got home from work. I was on oral iron for three months, but it didn’t seem to make any difference.
“I had an iron infusion, and after about 10 days I noticed a huge improvement in my energy levels and my mood. I never realised how bad I was feeling until I started feeling better, I literally thought pregnancy tiredness was normal. I have now had my baby and have coped well through the first six weeks.”
Sister Karin Davidson of the Cape Town Infusion Centre — a facility which specialises in medical-grade iron infusions — said maternal anaemia is not just a pregnancy concern, “it is a generational health crisis that can impact children’s development for years”.
“However, with proper screening and treatment, adverse outcomes can be successfully prevented.
“Up to 40% of women enter pregnancy without enough iron — and it’s an entirely preventable and treatable condition,” said Davidson.
“Research has shown children born to iron-deficient or anaemic mothers often face numerous health challenges that can persist through early childhood into adulthood. Babies store the iron they need for the first six months of their life in utero and children born with low iron stores can take up to seven years to catch up,” she said.
During pregnancy, blood volume increases by about 50%, requiring significantly more iron to produce additional red blood cells. Without adequate iron levels, both mother and baby face serious health risks, including increased risk of maternal mortality; higher chances of post-partum depression, a greater risk of pregnancy complications; reduced oxygen delivery to vital organs and an increased risk of blood transfusion during or after delivery.
Early detection of iron deficiency is crucial. Pregnant women should be aware of common symptoms:
- Unusual fatigue and weakness
- Shortness of breath
- Dizziness or lightheadedness
- Pale skin and mucous membranes
- Difficulty concentrating
- Heart palpitations
- Brain fog or poor cognitive functioning
- Pica — craving non-food substances such as ice, sand, clay.
Davidson said regular blood tests during antenatal check-ups are essential for monitoring iron levels.
She encouraged pregnant patients to advocate for themselves by insisting on iron level screenings during their first prenatal visit and again in each trimester of pregnancy.
“It’s important to note that while nutritional intervention cannot raise low iron levels in an anaemic patient, consistent focus on iron-rich foods, especially in pregnancy, can certainly play a part in preventing low iron levels developing in a pregnant patient.”
Davidson recommended increasing intake of iron-rich foods such as lean red meat, chicken and fish, dark leafy greens, legumes and iron-fortified cereal is recommended.
“Oral iron supplements are typically a first-line treatment, with healthcare providers prescribing appropriate dosages based on individual needs and iron store levels. For moderate to severe cases, or when oral supplements prove insufficient and when blood tests have shown low or insufficient iron stores, medical-grade iron infusions administered at a registered healthcare facility offer a highly effective solution.”
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