Anemia—when your blood doesn’t have enough healthy red blood cells—affects more than one in three pregnant women worldwide, especially in poorer countries. This major research review looked at dozens of studies to find out what causes pregnancy anemia and what can actually be changed to prevent it. Scientists discovered that poor nutrition, not eating enough iron-rich foods, infections like malaria, and lack of medical care are the biggest preventable causes. The good news is that these are all things that can be fixed with better nutrition, supplements, infection treatment, and access to prenatal care.

The Quick Take

  • What they studied: What changeable factors cause anemia in pregnant women, and which ones have the strongest evidence behind them?
  • Who participated: This review analyzed 10 previous large studies that included thousands of pregnant women from around the world, with the heaviest focus on women in low- and middle-income countries.
  • Key finding: The research found that not eating enough variety of foods (2.4 to 3.6 times more likely to develop anemia), intestinal parasites (2.2 to 4.3 times more likely), malaria (2 to 11 times more likely), and being a teenager during pregnancy (2.6 times more likely) were the strongest preventable risk factors.
  • What it means for you: If you’re pregnant or planning to become pregnant, eating diverse, iron-rich foods, taking iron and folic acid supplements as recommended, getting treated for infections, and having regular prenatal checkups can significantly lower your anemia risk. This is especially important if you live in areas with malaria or parasites, are a teenager, or have limited healthcare access.

The Research Details

This was an ‘umbrella review,’ which means researchers looked at 10 previous large research studies (called systematic reviews and meta-analyses) instead of doing their own new study. They searched seven major medical databases for studies published between 2014 and 2024 that examined what causes anemia in pregnant women. The researchers carefully checked the quality of each study they included and used a standard system called GRADE to rate how confident they could be in the findings.

They organized all the risk factors they found into four main categories: nutrition problems (like not eating enough variety or skipping supplements), infections (like malaria and intestinal parasites), personal situations (like being a teenager, having babies close together, or living far from hospitals), and lack of healthcare access (like not getting prenatal checkups).

This approach is valuable because instead of looking at one small study, they combined evidence from many studies across different countries and populations, giving a much clearer picture of what actually causes pregnancy anemia.

Understanding which risk factors can actually be changed is crucial for creating real solutions. If doctors and public health workers know that poor nutrition, infections, and lack of prenatal care are the main preventable causes, they can design programs that target these specific problems rather than wasting resources on things that can’t be changed.

The researchers used strict scientific standards to evaluate each study they included, using a tool called the Joanna Briggs Institute checklist. However, they found that the studies varied quite a bit in their results (something called ‘heterogeneity’), and most of the evidence was rated as low-to-moderate certainty, meaning the findings are helpful but not absolutely definitive. This variation suggests that anemia causes may differ depending on where women live and their specific circumstances.

What the Results Show

The research identified several major preventable causes of pregnancy anemia. Poor nutrition was the strongest factor—women who didn’t eat a variety of foods were 2.4 to 3.6 times more likely to develop anemia. Women who didn’t take iron and folic acid supplements as recommended were 1.4 to 1.8 times more likely to become anemic.

Infections were another major cause. Women with intestinal parasites were 2.2 to 4.3 times more likely to have anemia, and women with malaria were 2 to 11 times more likely (the huge range shows this varies greatly by location). These infections drain the body’s iron and damage the intestines’ ability to absorb nutrients.

Personal circumstances also mattered significantly. Teenage girls who became pregnant were 2.6 times more likely to develop anemia. Women who had babies less than 24 months apart were 1.3 to 2.8 times more likely to be anemic because their bodies hadn’t fully recovered from the previous pregnancy. Women with less education, larger families, and those living in rural areas also had higher rates.

Finally, lack of healthcare access was important. Women who didn’t receive prenatal care were 1.4 to 2 times more likely to develop anemia, probably because they weren’t screened, treated, or given supplements.

The research also found that living in rural areas (1.56 times higher risk) and having a large family size (1.6 to 1.95 times higher risk) increased anemia risk, likely because these situations often come with less access to healthcare and nutritious food. Low maternal education (1.3 to 2 times higher risk) was also significant, possibly because education helps women understand nutrition and access healthcare.

This review confirms what smaller studies have suggested but provides stronger evidence by combining many studies together. It shows that while anemia in pregnancy is complex and has many causes, most of these causes can actually be prevented or treated. Previous research has focused on single factors, but this review shows that the best approach needs to address nutrition, infections, and healthcare access all together.

The biggest limitation is that the studies included in this review varied quite a bit in their methods and results, making it hard to say exactly how much each factor matters in every situation. The certainty of the evidence was rated as low-to-moderate, meaning while these findings are reliable, they’re not absolutely definitive. Also, most studies came from low- and middle-income countries, so the results may not apply exactly the same way in wealthy countries. The review couldn’t determine cause-and-effect with complete certainty—it shows these factors are connected to anemia, but doesn’t prove they directly cause it in every case.

The Bottom Line

For pregnant women (moderate confidence): Take iron and folic acid supplements as prescribed by your doctor, eat a variety of nutrient-rich foods including meat, beans, leafy greens, and fortified grains, and attend all prenatal appointments for screening and treatment. For public health programs (moderate confidence): Focus on improving nutrition education, ensuring supplement availability, treating infections like malaria and parasites, and improving access to prenatal care, especially in rural areas. For adolescent girls (moderate-high confidence): Provide extra nutritional support and healthcare if they become pregnant, as they face higher anemia risk.

This research is most important for pregnant women in low- and middle-income countries, especially those in rural areas, teenagers, and women with limited healthcare access. It’s also crucial for doctors, nurses, public health workers, and policymakers who create health programs. Women in wealthy countries with good healthcare access should still follow these recommendations, but their risk is generally lower.

If you start taking iron supplements and improve your diet, your blood iron levels can improve within 2-4 weeks, though it may take 8-12 weeks to fully correct anemia. If you have an infection like malaria or parasites, treating it can help prevent anemia from developing. Regular prenatal care throughout pregnancy is important for catching and treating anemia early.

Want to Apply This Research?

  • Track daily iron-rich food intake (servings of meat, beans, leafy greens, fortified cereals) and supplement adherence. Set reminders for taking iron and folic acid pills at the same time each day, and log any symptoms like unusual tiredness or shortness of breath to discuss with your doctor.
  • Use the app to create a simple meal plan that includes iron-rich foods at each meal. Set weekly goals like ’eat 5 different iron sources this week’ or ’take supplements 6 out of 7 days.’ If you live in an area with malaria or parasites, use the app to track when you take preventive medications and schedule regular health checkups.
  • Track hemoglobin levels from prenatal visits (if available) to see if your anemia is improving. Monitor energy levels, shortness of breath, and dizziness as informal indicators. Set monthly reminders to review your nutrition and supplement adherence, and flag any missed prenatal appointments to reschedule them.

This research review provides evidence-based information about anemia risk factors in pregnancy, but it is not a substitute for personalized medical advice. Pregnant women should work with their healthcare provider to assess their individual anemia risk, determine appropriate supplementation, and develop a nutrition plan tailored to their specific needs and circumstances. If you experience symptoms of anemia such as severe fatigue, shortness of breath, or dizziness during pregnancy, seek immediate medical attention. This information is most applicable to women in low- and middle-income countries but has relevance globally. Always consult your doctor before starting or changing any supplements or making significant dietary changes during pregnancy.