Pregnancy brings profound physical and physiological changes, and feeling tired is often considered part and parcel of the experience.
But when fatigue becomes persistent, excessive or difficult to manage, it should not simply be dismissed as “normal pregnancy tiredness”.
Doing so may mean overlooking a common and treatable condition, iron deficiency anaemia (IDA).
Anaemia is one of the most common medical conditions affecting pregnant women worldwide. The World Health Organization (WHO) defines anaemia in pregnancy as a haemoglobin concentration below 11 g/dL, although its interpretation may also take into account factors such as the stage of pregnancy and other clinical considerations.
Iron deficiency is the most common nutritional cause of anaemia. However, anaemia can also have several other causes, including folate or vitamin B12 deficiency, blood loss, inflammation and inherited blood disorders.
Fatigue during pregnancy is understandable. A growing baby, hormonal changes, disrupted sleep and increased physical demands can all contribute to tiredness.
However, persistent fatigue accompanied by symptoms such as weakness, dizziness, shortness of breath or heart palpitations may also indicate anaemia.
As these symptoms can overlap with the normal experiences of pregnancy, they should not be assessed in isolation.
Importantly, iron deficiency can develop before anaemia becomes apparent. A woman may therefore have depleted iron stores even before her haemoglobin falls below the diagnostic threshold.
Recognising iron deficiency early provides an opportunity to address it before it progresses.
This is why antenatal care matters. Rather than relying on symptoms alone, routine antenatal assessments and appropriate blood tests can help identify anaemia and guide further evaluation.
Pregnancy significantly increases the body’s need for iron. Iron is required to support the expansion of the mother’s blood supply, the development of the placenta and the needs of the growing baby.
For women who enter pregnancy with low iron stores, meeting this increased demand can be particularly challenging.
This is a relevant concern in Malaysia. A systematic review of studies involving pregnant women in Malaysia reported that the prevalence of anaemia ranged from 19.3 to 57.4 per cent, while iron deficiency ranged from 31.6 to 34.6 per cent.
The findings also highlighted factors associated with anaemia and iron deficiency, including late antenatal booking and non-adherence to prescribed iron supplementation.
For the mother, iron deficiency anaemia can affect well-being, energy levels, and physical functioning. As it becomes more severe, it can also reduce a mother’s ability to tolerate blood loss during childbirth.
Women who are already significantly anaemic have less physiological reserve to compensate for blood loss during delivery.
For the baby, maternal anaemia and iron deficiency have also been associated with adverse pregnancy outcomes, including preterm birth, low birth weight and reduced neonatal iron stores.
Adequate iron is particularly important for foetal development, including brain development.
This does not mean that every woman with mild anaemia will experience complications. Many women with mild anaemia have otherwise uncomplicated pregnancies.
However, leaving iron deficiency unaddressed may mean entering childbirth with depleted iron stores and reduced reserves, while potentially carrying the effects into the postpartum period.
Malaysia’s antenatal care system includes routine haemoglobin assessment, allowing healthcare professionals to identify anaemia during pregnancy and determine the appropriate next steps.
Further testing may be needed to establish whether iron deficiency is the underlying cause or whether another condition is contributing to the anaemia.
Early management can help prevent iron deficiency from becoming more severe. When recommended by a health care professional, iron and folic acid supplementation, together with a balanced diet containing iron-rich foods, can support maternal and foetal health.
For pregnant women, this means attending antenatal appointments, completing recommended blood tests, discussing persistent symptoms with their health care provider, and taking prescribed supplements as advised.
Fatigue may be common during pregnancy, but persistent or excessive tiredness, especially when accompanied by breathlessness, dizziness, weakness, or palpitations, should not be dismissed as normal.
Dr Farzana Rizwan and Dr Malar Kandasamy are senior lecturers at the Faculty of Health and Medical Sciences, School of Medicine, Taylor’s University, and Assoc Prof Dr Ganesh Ramachandran is head of the School of Medicine.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova.
