Anemia in Pregnancy

Anaemia in pregnancy is haemoglobin concentration of < 11 g/dL. It is described as severe if the Hb is < 7 g/dL. Anaemia has adverse effects on the health of the woman and the outcome of the pregnancy. It is associated with an increased rate of miscarriage, preterm delivery, foetal growth restriction, foetal death and increased perinatal loss. It is also associated with ante- and post-partum haemorrhage and an increased maternal mortality rate.
Ideally no woman should go into labour with anaemia. Appropriate measures including blood transfusion may be required to correct the anaemia especially if a woman is close to her expected delivery date.

 

Types of Anemia in Pregnancy
 Various types of anemia can occur during pregnancy. These are some examples:

• Iron deficiency anemia: Anemia of this type occurs when the body does not have enough iron to produce enough hemoglobin. This is a protein found in red blood cells. It is responsible for transporting oxygen from the lungs to the rest of the body. The blood cannot carry enough oxygen to tissues throughout the body in iron-deficiency anemia. The most common cause of anemia during pregnancy is iron deficiency.
• Deficiency of vitamin B12: Vitamin B12 is required by the body to create  healthy red blood cells. A pregnant woman's body cannot make enough healthy red blood cells if she doesn't consume enough vitamin B12 in her diet. The chance of having vitamin B12 deficiency is higher in women who don't consume meat, poultry, dairy products, or eggs. This condition may increase the risk of birth problems such as neural tube abnormalities, and  preterm labor.
•  Anemia due to a lack of folate: The vitamin folate is naturally present in some foods, such as green leafy vegetables. The body requires folate, a type of B vitamin, to create new cells, including healthy red blood cells.  Women require more folate when they are pregnant. But occasionally thier diets don't provide them with enough. This prevents the body from producing enough healthy red blood cells to carry oxygen to all body tissues. Folic acid is the name for synthetic folate supplementation. Folate deficiency can directly cause some birth defects, such as low birth weight and abnormalities of the neural tube (spina bifida)
  

 

Effects of Anemia in Pregnancy on the Unborn Baby

Premature birth is more likely when a pregnant woman has severe anemia (when delivery occurs before 37 complete weeks of pregnancy). Low birth weight and postpartum depression are also linked to iron deficiency anemia during pregnancy. Additionally, some studies indicate a higher risk of newborn death right before or right after birth.

 

Causes Of Anemia in Pregnancy

Iron is used by the body to produce hemoglobin. Hemoglobin is a protein found in red blood cells that transports oxygen to tissues. Your body needs more iron when you are pregnant because of the increased blood volume. Your body uses iron to produce more blood in order to provide oxygen to your baby. You could develop iron deficiency anemia if you don't have enough iron stores or get enough iron during pregnancy. 

The folowing factors can cause Anemia in Pregnancy:

• Physiological (due to blood volume expansion in pregnancy)
• Poor dietary intake  of iron, folate and vitamin B12
• Haemolytic disorders (e.g sickle cell disease, G6PD defect)
• Malaria
• Infestations with hookworm, ascaris, schistosomes
• Chronic infections e.g. TB, UTI, HIV
• Bleeding complications in pregnancy e.g. APH

SYMPTOMS

• Dizziness
• Swelling of the feet
• General weakness
• Easy fatiguability

SIGNS

• Mucosal pallor
• Jaundice (may or may not be present)
• Hepato-splenomegaly (may or may not be present)
• Heart failure in severe cases

INVESTIGATIONS

• FBC
• Peripheral blood film comment
• Blood film for malaria parasites
• Sickling and Hb electrophoresis
• G6PD activity
• Serum iron, total iron binding capacity, ferritin
• Stool analysis for hookworm ova
• Urinalysis for schistosoma ova and urobilinogen

TREATMENT
Treatment objectives

• To relieve symptoms
• To correct haemoglobin level before patient reaches term or goes into labour
• To identify and treat underlying cause
• To recognize and manage the associated complications in mother e.g. cardiac failure, and baby e.g. intrauterine growth restriction

Non-pharmacological treatment

• Encourage intake of foods such as red meat, poultry, fish, dark leafy vegetables, shell fish, dried fruits which are rich in iron, folate, vitamins B and C
• Avoid tea, coffee, bran, cola and unhealthy habits such as eating of clay, which inhibits iron absorption
• Encourage intake of folate and vitamin rich foods including beans, avocado, citrus fruits, spinach and mangoes
• Protein rich foods must also be included in the diet
• Ensure these anaemic patients are seen more frequently in the antenatal clinic and their response to treatment monitored with haemoglobin level checks.

Pharmacological treatment

• Ferrous sulphate or Ferrous gluconate
• Folic Acid
• Blood transfusion