Pregnancy Anemia Stuck Around 90 g/L? Here's What You Need to Know and How to Address It Effectively

During pregnancy, many women experience low hemoglobin levels—often hovering around 90 g/L—which can be frustrating despite ongoing efforts to improve nutrition and take supplements. This condition, commonly referred to as pregnancy-related anemia, can stem from both physiological changes and underlying nutritional deficiencies. Understanding the root cause is essential for effective treatment and long-term improvement.

Understanding the Two Main Types of Pregnancy Anemia

Anemia during pregnancy typically falls into two categories: physiological (dilutional) anemia and pathological anemia. While the former results from natural bodily changes during gestation, the latter arises due to specific nutrient deficits that must be corrected through targeted interventions.

1. Physiological Anemia: A Natural but Manageable Condition

In early pregnancy, hormonal shifts often lead to significant nausea and vomiting—commonly known as morning sickness—which can severely impact appetite and nutrient intake. As blood volume expands by up to 50% to support fetal development, hemoglobin becomes diluted, leading to lower concentration levels even if red blood cell mass remains stable. This phenomenon is called physiological or dilutional anemia.

When combined with poor dietary intake of key nutrients like iron, folic acid, and vitamin B12, this natural process may push hemoglobin levels down to around 90 g/L. Although not always dangerous, it should not be ignored. Women experiencing this condition are advised to focus on nutrient-dense foods such as lean meats, poultry, fish, eggs, legumes, dark leafy greens, and fortified grains.

In some cases, oral supplementation with ferrous sulfate or multivitamins containing iron and folic acid may be necessary to bridge nutritional gaps and support healthy blood production throughout pregnancy.

2. Pathological Anemia: When Deficiencies Require Medical Intervention

Unlike physiological anemia, pathological anemia indicates a true deficiency in essential hematopoietic nutrients. If left untreated, these conditions can persist and prevent hemoglobin from rising above 90 g/L, increasing risks for both mother and baby—including preterm birth, low birth weight, and postpartum complications.

Common Forms of Pathological Anemia in Pregnancy

a) Iron-Deficiency Anemia: The Most Prevalent Type

As stored iron (ferritin) depletes, red blood cells become smaller and paler—a hallmark of microcytic hypochromic anemia visible in complete blood count (CBC) tests. Symptoms include chronic fatigue, dizziness, shortness of breath, pale skin, and brittle nails. Some women may also develop pica (craving non-food items) or spoon-shaped fingernails (koilonychia).

Treatment involves replenishing iron stores through oral or intravenous methods. Options include oral ferrous fumarate or succinic acid-based iron supplements like ferrous succinate with folic acid. For those who cannot tolerate oral iron or have severe deficiency, intravenous formulations such as iron sucrose or ferric carboxymaltose injections offer faster recovery.

b) Megaloblastic Anemia: Caused by Folate or Vitamin B12 Deficiency

This type appears as macrocytic anemia on blood work, where red blood cells are abnormally large. Pregnant women with this condition often report symptoms beyond typical anemia, including a sore, beefy-red tongue (glossitis), tingling or numbness in hands and feet (peripheral neuropathy), and cognitive difficulties.

Folate deficiency is more common and usually managed with daily folic acid tablets (typically 400–800 mcg). However, vitamin B12 deficiency—especially in vegetarian or vegan mothers—requires additional attention. Treatment includes high-dose oral cyanocobalamin or regular intramuscular B12 injections, along with dietary adjustments emphasizing dairy, eggs, fortified cereals, and, when possible, fish and lean meat.

Key Steps to Improve Hemoglobin Levels During Pregnancy

If your hemoglobin remains stuck around 90 g/L despite dietary changes, don't self-diagnose or delay care. Visit a hematologist or obstetric specialist for comprehensive testing, including CBC, serum ferritin, vitamin B12, folate levels, and reticulocyte count to determine the exact cause.

Nutrition plays a pivotal role. Prioritize iron-rich foods such as:

• Red meat, especially liver (in moderation due to high vitamin A)
• Poultry and fish (like salmon and sardines)
• Plant-based sources: lentils, spinach, tofu, pumpkin seeds
• Vitamin C-rich fruits (oranges, strawberries, bell peppers) to enhance non-heme iron absorption

Avoid consuming tea, coffee, or calcium supplements with meals, as they inhibit iron absorption.

Final Thoughts: Early Action Leads to Better Outcomes

Persistent anemia during pregnancy isn't something to overlook. Whether caused by normal physiological changes or actual nutrient deficiencies, consistent monitoring and proper intervention are crucial. With the right combination of medical guidance, lab testing, and smart nutritional choices, most women can successfully raise their hemoglobin levels and enjoy a healthier pregnancy journey.