Could your pregnancy fatigue be caused by anemia?

When you’re pregnant, you’re not only eating for two—you’re also generating blood for two. Pregnancy and delivery requires that your body increase its blood volume by 50 percent. But while necessary, this change also puts you at risk for a super common complication of pregnancy: iron-deficiency anemia.

Iron-deficiency anemia occurs when the body does not have enough iron to make the hemoglobin (a protein in the red blood cells) that transports oxygen throughout the body. Though there are other causes of anemia (which is a shortage of red blood cells or hemoglobin), iron-deficiency is most commonly associated with pregnancy because growing a baby, while also increasing the body’s production of hemoglobin-rich red blood cells, often requires more iron than a woman consumes.

According to the World Health Organization, 23 percent of pregnant Canadians end up anemic. The vast majority of these cases are iron-deficiency anemia, explains Anne McLeod, a Toronto-based hematologist who works with high-risk obstetrics patients. She notes that many women are iron deficient even before pregnancy because they don’t get enough iron in their diets and lose iron during menstruation.

While fatigue is a near-universal pregnancy symptom, it’s also the primary symptom of iron-deficiency anemia. Other common signs include dizziness, a racing heartbeat, irritability, and problems with concentration and decision-making. Some women also experience odd cravings. “Chewing ice is the most common,” says McLeod. Why people with iron-deficiency anemia have these cravings is unknown but, “It does go away as soon as we fix their iron levels.”

Since the signs of anemia can easily be dismissed as symptoms of pregnancy, it’s often only detected through a blood test. Stephanie Cooper, a Calgary-based OB/GYN and specialist in maternal-fetal medicine, explains that the complete blood counts performed early in pregnancy and again in the third trimester measure a woman’s hemoglobin levels. If those levels are low, and iron deficiency is suspected, she will often start patients on a six-week trial of iron supplements. She may also order a ferritin (iron storage) level test to confirm the cause of the anemia.

With red meat being the easiest way to consume high levels of dietary iron, vegetarians, vegans and women with limited diets are at a higher risk for iron-deficiency anemia. Certain medical conditions that prevent proper iron absorption, such as Crohn’s disease and Celiac disease, can also increase the odds, as can having a history of heavy periods. McLeod encourages women who are at risk of having low iron to speak with their physician about having a ferritin level test.

If it’s your second or third pregnancy (or even more), McLeod explains that you’re also at an increased risk because you may not have built up your iron stores enough between pregnancies, especially if you’re also losing the mineral through breastfeeding. Because of this, she encourages women to start taking prenatal vitamins as soon as they start trying to get pregnant and to continue while breastfeeding in order to rebuild their iron levels. According to Health Canada, these supplements should contain 16 to 20 milligrams of iron.

A well-rounded diet that features iron-rich foods like red meat, spinach, lentils and soybeans is also key. “Most people, if they’re taking a prenatal vitamin and eating a healthy diet, won’t have iron-deficiency anemia during pregnancy,” notes Cooper.

Fortunately, if you do have iron-deficiency anemia, it generally has minimal impact on the baby, says Cooper, who explains that, “Babies are really good parasites; they will steal whatever they can from the maternal supply.” But an extreme case of iron-deficiency anemia in mom could lead to a newborn with the condition and that can impact their growth and development. In Canada, anemia is usually noticed and treated before it reaches that point.

The condition’s impact on you is also usually minimal—apart from making you feel extra exhausted. However, if you experience postpartum hemorrhaging, it could make it more serious. “If someone is anemic, the concern is if they have excessive blood loss at the time of delivery, their body may not be able to cope,” explains Cooper, adding that, “You’re more likely to need a blood transfusion if you start the delivery being anemic.” McLeod adds that there are also some studies that suggest being iron deficient post-delivery may contribute to postpartum depression.

Even though complications from iron-deficiency anemia are rare when diagnosed and treated early, you’ll want to take iron supplements to get your hemoglobin levels back up to give you the energy you need to care for your baby. Some people experience nausea and constipation when taking iron pills. In those cases, the pricier—though gentler on the stomach—liquid version can be used. More rarely, iron might be administered by IV, particularly in cases where the anemia was only discovered shortly before the due date and there isn’t time to wait for oral supplements to rebuild iron stores, or if oral iron isn’t being absorbed properly.

Eating iron-rich food or cooking with a cast-iron pan, which can pass a bit of extra iron into food, will also help. And adding foods rich in vitamin C to those iron-rich foods, for example, adding orange slices to a spinach salad, will help your body better absorb the mineral.

While iron-deficiency anemia may be common, it’s also curable. With just a few changes, you can boost you iron levels and get your energy back—just in time for those sleepless nights with baby to begin.

Read more: Natural cures for common pregnancy symptoms Pregnancy insomnia: 4 tricks to help you sleep better