Feeling exhausted in pregnancy is so common that many Pakistani women assume it is simply their lot — kamzori that must be endured. Often, though, that bone-deep tiredness has a name, a cause and a cure: anaemia. Studies suggest that around 40 to 50 percent of pregnant women in Pakistan are anaemic, one of the highest rates in the region. Treating it is one of the simplest, cheapest ways to protect both mother and baby.
What is anaemia in pregnancy?
Anaemia means the blood has too little haemoglobin, the iron-rich protein that carries oxygen. The World Health Organization defines anaemia in pregnancy as haemoglobin below 11 g/dL. In pregnancy, blood volume expands and the baby draws iron for its own growth, so a mother's iron needs roughly double. In Pakistan, the problem is worsened by low dietary iron, closely spaced pregnancies, teenage pregnancy, heavy periods before conception, and tea drunk with meals, which blocks iron absorption.
Iron deficiency causes most cases, but folate and vitamin B12 deficiency also contribute, and in some families inherited conditions like thalassaemia trait cause anaemia that iron alone cannot fix — an important distinction in Pakistan, where thalassaemia trait is common.
Why it matters for you and your baby
Untreated moderate-to-severe anaemia in pregnancy raises the risk of premature birth, low birth weight, and poor iron stores in the baby affecting early brain development. For the mother, it causes exhaustion, reduced resistance to infection, and — most seriously — far less reserve to tolerate blood loss at delivery. Anaemia is one of the major contributors to maternal deaths in Pakistan. This is not a minor lab number; it is a safety issue for childbirth.
Symptoms
- Tiredness and weakness beyond normal pregnancy fatigue
- Pale skin, inner eyelids, nail beds and palms
- Breathlessness on climbing stairs or routine work
- Dizziness, headaches or racing heartbeat
- Cold hands and feet, brittle nails, hair fall
- Pica — unusual cravings for clay, mud, chalk or ice, a classic sign of iron deficiency seen often in Pakistan
Mild anaemia may cause no symptoms at all, which is why testing matters.
Danger signs — go to hospital now
Go to an emergency department, or call Rescue 1122, if a pregnant woman has:
- Severe breathlessness at rest or when lying down
- Chest pain or palpitations that do not settle
- Fainting
- Any vaginal bleeding
- Severe headache with blurred vision or swelling (possible pre-eclampsia)
- Reduced or absent baby movements
How doctors test for it
- CBC (complete blood count) — a simple, inexpensive test at any lab in Pakistan, checked at booking and again in the third trimester as WHO and UK NICE guidance recommends. It shows haemoglobin and red cell size, which hints at the cause.
- Ferritin — measures iron stores and confirms iron deficiency.
- Additional tests where needed — B12 and folate levels, stool testing, and haemoglobin electrophoresis if thalassaemia trait is suspected (small red cells not improving with iron). Couples with thalassaemia trait should receive genetic counselling.
Treatment overview
- Iron and folic acid supplements — WHO recommends daily iron and folic acid for all pregnant women, and these are provided free at government antenatal clinics and lady health worker programmes across Pakistan. Treatment doses for established anaemia are higher and set by your doctor. Iron absorbs best away from chai and with vitamin C, such as a glass of lemon water; constipation and dark stools are common, manageable side effects — tell your doctor rather than quitting.
- Injectable (IV) iron — for later pregnancy, poor tolerance of tablets, or moderate-to-severe anaemia, modern intravenous iron given in hospital raises haemoglobin faster and is increasingly used in Pakistani obstetric units.
- Blood transfusion — reserved for severe anaemia near delivery or with complications, decided by specialists.
- Treating the cause — deworming where indicated, treating bleeding sources, and correcting B12 or folate deficiency.
Desi wisdom holds some truth here: foods our grandmothers praised — kaleji (liver), gur, dates, anar — genuinely carry iron. But food alone usually cannot correct established anaemia in pregnancy; supplements plus food work together. Avoid unregulated tonics of unknown content, and never take extra iron beyond prescription, especially if thalassaemia trait is possible.
Prevention and diet, Pakistani style
- Iron-rich foods daily: kaleji and red meat (well cooked), chicken, eggs, daal, chana, lobia, palak and other saag, dates, gur and til
- Pair iron foods with vitamin C: lemon on salad, amrood, malta, kinnow
- Keep chai and coffee at least one hour away from meals and iron tablets
- Space pregnancies at least 24 months apart where possible, per WHO family planning guidance, to let iron stores recover
- Start folic acid before conception when planning pregnancy
Notes for different situations
- Teenage mothers: still growing themselves, they have the highest anaemia risk and need especially close antenatal care.
- Multiple pregnancy (twins): iron needs are even higher; expect closer monitoring.
- After delivery: anaemia does not end at birth — blood loss at delivery plus breastfeeding demands mean iron should usually continue for months postpartum; ask your doctor.
- Mothers with diabetes or blood pressure issues in pregnancy: keep all antenatal visits, since risks add up; our blood pressure guide explains pre-eclampsia warning signs.
Frequently asked questions
Pregnancy mein haemoglobin kitna hona chahiye?
WHO defines anaemia in pregnancy as haemoglobin below 11 g/dL. Between 10 and 10.9 is mild, 7 to 9.9 moderate, and below 7 severe, needing urgent treatment. A CBC at booking and in the third trimester keeps you informed.
Khoon ki kami mein kya khana chahiye?
Kaleji, red meat, chicken, eggs, daal, chana, palak and saag, dates, gur and til are iron-rich desi options. Add vitamin C (lemon, malta, amrood) to boost absorption, and keep chai away from meals. Food supports treatment but usually cannot replace prescribed iron in pregnancy.
Kya iron ki goliyan bache ko nuqsan deti hain?
No — prescribed iron and folic acid protect the baby, supporting growth and brain development. Side effects like constipation, nausea and dark stools affect the mother and are manageable. Take tablets as prescribed and discuss problems with your doctor instead of stopping.
Iron ki goli kab aur kaise leni chahiye?
Iron absorbs best on a relatively empty stomach with water or lemon water, at least an hour away from chai, milk and calcium tablets. If it upsets your stomach, taking it with a small meal is better than skipping it. Your doctor will set the dose and timing.
Can anaemia harm my baby during delivery?
Severe anaemia leaves little reserve for normal blood loss at delivery, raising the risk of complications and transfusion. It also increases chances of early birth and low birth weight. This is exactly why anaemia found early in pregnancy is treated promptly — it makes delivery safer.
Expecting, exhausted and unsure whether it is normal? Try our free symptom check and discuss the results at your next antenatal visit. This article is general health education, not a diagnosis. Always consult a doctor about your own health.