Your First Antenatal Visit: What Happens and What to Bring
The first antenatal appointment sets the pattern for the whole pregnancy. Knowing what will happen — and what information to bring — makes it far more useful.
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More than half of pregnant women in India are anaemic. It is the most treatable cause of low birth weight, premature delivery and postpartum haemorrhage — and the treatment costs almost nothing.
Why pregnancy makes anaemia worse
Blood volume increases by around 45% during pregnancy, and the growing baby and placenta draw heavily on maternal iron stores. A woman who begins pregnancy with borderline iron reserves — which is common, given menstrual losses and a predominantly cereal-based diet — will become anaemic well before delivery.
Haemoglobin below 11 g/dL in pregnancy is anaemia. Below 7 g/dL is severe and needs urgent treatment, sometimes with intravenous iron or transfusion.
What it causes
- Extreme fatigue, breathlessness on mild exertion, and dizziness
- Reduced tolerance of even normal blood loss at delivery
- Higher risk of postpartum haemorrhage — a leading cause of maternal death
- Premature delivery and low birth weight
- Poorer iron stores in the newborn, causing infant anaemia
- Reduced ability to fight infection after delivery
- Poor milk production and slower recovery
Taking iron so that it actually works
- Take iron with vitamin C — a lemon squeezed into water, or an amla or orange — which markedly increases absorption
- Do not take it with tea, coffee, milk or calcium tablets; these block absorption. Separate them by at least two hours
- Take it between meals if tolerated, or after food if it causes nausea
- Expect black stools — this is harmless and expected
- For constipation, increase water and fibre rather than stopping the tablet
- Continue for at least three months after haemoglobin normalises, to refill stores
Worth knowing
Iron tablets are frequently abandoned because of nausea or constipation. Tell your doctor — changing the formulation or the timing usually solves it. Stopping does not.
Dietary iron in a vegetarian diet
Plant iron is absorbed less efficiently than iron from meat, so vegetarian households need both larger quantities and better absorption. Good sources include ragi, green leafy vegetables such as gongura, palak and methi, dates, jaggery, sesame seeds, garden cress seeds (halim), dals and soaked chana.
Cooking in iron vessels adds a genuine, measurable amount of iron to food, particularly with acidic preparations like tamarind-based curries. Sprouting and fermenting — idli, dosa, dhokla — reduce the phytates that block iron absorption. Adding a source of vitamin C to every meal is the simplest single change.
When tablets are not enough
Intravenous iron is used when anaemia is severe, when the pregnancy is advanced and there is not enough time for oral iron to work, when tablets cannot be tolerated, or when absorption is impaired. It raises haemoglobin far faster and is given in hospital as a short infusion.
Blood transfusion is reserved for very severe anaemia close to delivery or where there is cardiac strain. Anaemia should be identified and corrected early enough that transfusion never becomes necessary.
Key takeaways
- Haemoglobin below 11 g/dL in pregnancy is anaemia and needs treatment.
- Take iron with vitamin C and away from tea, coffee, milk and calcium.
- Black stools are expected and harmless; nausea and constipation can be managed without stopping.
- Severe or late-detected anaemia may need intravenous iron rather than tablets.
A note on medical advice
This article is general health education written and reviewed by the Department of Obstetrics & Gynaecology at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
AnaemiaPregnancyIronNutrition