In pregnancy, hemoglobin levels are generally lower as they become diluted due to the 50% increase in blood volume. Levels tend to really fall around the 28 week mark of gestation. This does not necessarily mean you are anemic; however, your midwife or doctor may recommend you supplement with extra iron. The ability for a woman to maintain iron levels throughout her pregnancy depends on how high her preconception values were and her ability to absorb iron. Only one in five women begins their pregnancies with adequate iron. Some women may require an iron transfusion during pregnancy if levels drop too much. This can be defined as serum ferritin below 12 ug/L and hemoglobin below 110 in first and third trimester and below 104 in the second trimester.
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