Anaemia in Pregnancy
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults, Updated for the 2023 Edition
O99.0 + (D50.9/D64.9)
DESCRIPTION
Haemoglobin (Hb) <11 g/dL. Anaemia in pregnancy is most commonly due to iron deficiency. Hb levels in pregnancy should be checked routinely on-site at the first antenatal visit, and again at 30 weeks and 38 weeks. If Hb falls below 10g/dL, commence treatment with iron and do a FBC.
LoE: IVbi
GENERAL MEASURES
A balanced diet to prevent nutritional deficiency.
Advise against eating soil, clay, charcoal, and excessive consumption of tea and coffee.
MEDICINE TREATMENT
Prophylaxis Z34.9 + (Z29.9)
- Ferrous sulphate [sulfate] compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) twice daily.
OR
- Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) daily.
LoE: IVbii
If daily iron is poorly tolerated (e.g., epigastric pain, nausea, vomiting, and constipation), intermittent iron supplementation may be administered:
- Ferrous sulphate [sulfate] compound BPC (dried), oral, 340 mg per week, (± 110 mg elemental iron), with meals.
OR
- Ferrous fumarate, oral, 400 mg per week (± 130 mg elemental iron).
LoE: IVbiii
(For folic acid supplementation guidance to prevent neural tube defects, see Primary Health Care STGs and EML, section Antenatal supplements).
Treatment: Iron deficiency (Hb <10g/dL)
- Ferrous sulphate [sulfate] compound BPC, oral (dried), 170 mg (± 55 mg elemental iron) 12 hourly.
LoE:IIbiv
OR
- Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) 12 hourly.
- Continue for 3-6 months after the Hb reaches normal to replenish iron stores.
- Hb is expected to rise by at least 1.5 g/dL in two weeks.
- When using iron together with calcium supplementation, ensure that iron and calcium are taken at least 4 hours apart from one another.
- If Hb has not increased after 4 weeks of therapy, do a FBC to confirm hypochromic microcytic anaemia.
LoE:IIIbv
Parenteral iron - See: Anaemia, iron deficiency.
If there is no response to oral iron, and iron deficiency is confirmed, review adherence to oral iron, and consider:
- Iron, IV, e.g.:
- Iron sucrose, IV, 200 mg in 200 mL sodium chloride 0.9%, over 30 minutes, given on alternate days until the total dose has been given.
- Note: Test dose is not required but administer only where personnel and therapies are readily available to manage anaphylactic-type reactions.
- An initial total dose of 600 mg is usually adequate to raise the Hb to acceptable levels.
- For markedly anaemic or very obese women, consult the package insert on the total dose of iron infusion.
LoE:IVb
REFERRAL/CONSULTATION
No response to management.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026
Chapter 6 Obstetrics_6.1 Anaemia in Pregnancy