Anaemia in Pregnancy

Description

General measures

Medicine treatment

Referral

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DESCRIPTION

Anaemia in pregnancy is a Hb < 11 g/dL, most commonly due to iron deficiency. Hb levels should be checked at the booking visit, between 28 and 32 weeks, and at ± 36 weeks. 
Treatment is recommended when the Hb falls below 10 g/dL.
Women with iron deficiency often have 'pica', e.g. eating substances such as soil, charcoal, ice, etc.

GENERAL MEASURES

• A balanced diet to prevent nutritional deficiency.
• Reduce intake of tea.
• Do not drink tea within 2 hours of taking iron tablets.

MEDICINE TREATMENT

Established anaemia with Hb < 10 g/dL:

Continue for 3 months after the Hb normalises in order to replenish body iron stores. Hb is expected to rise by at least 1.5 g/dL in two weeks.

• Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) 12 hourly with meals.
  • Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk).

OR

• Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) 12 hourly.
  • Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk).

LoE:IIb²⁶

REFERRAL

Urgent (same day)

• Hb < 6 g/dL
• Hb = 6-7.9 g/dL with symptoms (dizziness, tachycardia, shortness of breath at rest)

Non-urgent (within 1 week)

• Hb = 6-7.9 g/dL without symptoms (to high-risk clinic if available)
• Hb = 8-9.9 g/dL and no improvement after one month of treatment (to high-risk clinic, if available)
• Hb < 10 g/dL at 36 weeks' gestation or more: transfer to hospital for further antenatal care and delivery

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.4.3 Anaemia in pregnancy