Anemia in Pregnancy Overview

Anemia in Pregnancy

• Anemia is a condition where the number of red blood cells or hemoglobin levels are insufficient to meet the body's needs. Factors influencing levels include age, sex, altitude, smoking, and pregnancy.

Definition of Anemia in Pregnancy

• The WHO defines anemia in pregnancy as a hemoglobin concentration below 11g/dL in the first and third trimesters, and 10.5g/dL in the second trimester.

Types of Anemia in Pregnancy

• Iron-Deficiency Anemia: This is the most common type. Insufficient iron prevents the body from producing enough hemoglobin, which carries oxygen. Pregnant women need more iron for increased blood volume and fetal development.

• Folate-Deficiency Anemia: Folate (vitamin B9) is essential for red blood cell production. A deficiency leads to megaloblastic anemia, causing red blood cells to be larger than normal and less functional. Adequate folate intake is important during pregnancy.

• Vitamin B12 Deficiency Anemia: Vitamin B12 is also crucial for red blood cell production. B12 deficiency can also result in megaloblastic anemia, although it is less common in pregnancy than iron or folate deficiency.

• Anemia of Chronic Disease: This type is related to chronic conditions like infections, inflammatory diseases, or chronic kidney disease. It occurs less frequently in pregnancy, but can still occur.

• Sickle Cell Anemia: This hereditary condition causes red blood cells to be sickle-shaped, hindering their ability to carry oxygen efficiently. Pregnancy can exacerbate symptoms, and special monitoring is essential.

• Thalassemia: Another hereditary blood disorder affecting hemoglobin production. In pregnancy, it can lead to mild or moderate anemia, sometimes more noticeable during pregnancy.

• Hemolytic Anemia: This happens when the body destroys red blood cells faster than they can be produced. Potential causes include autoimmune conditions, infections, or specific medications.

Causes of Anemia in Pregnancy

• Iron Deficiency: Increased iron demands during pregnancy due to blood volume expansion and fetal growth. Insufficient intake or poor iron absorption can contribute.

• Folate Deficiency: Inadequate intake of folate-rich foods or poor absorption can lead to megaloblastic anemia.

• Vitamin B12 Deficiency: Insufficient intake or absorption can be a factor leading to anemia.

• Increased Blood Volume: During pregnancy, blood volume increases, potentially reducing the apparent red blood cell count (physiological anemia/hemodilution).

• Chronic Conditions: Pre-existing conditions like sickle cell disease, thalassemia, or chronic kidney disease can increase the risk of anemia in pregnancy.

Risk Factors for Anemia During Pregnancy

• Nutritional Deficiencies: Inadequate intake of iron, folate, and vitamin B12.

• Young Maternal Age: Teenagers have a higher risk.

• Multiple Pregnancies: Carrying twins or more increases iron demands.

• Short Intervals Between Pregnancies: Closely spaced pregnancies can deplete iron stores.

• Low Socioeconomic Status: Limited access to nutritious food and healthcare.

• Non-compliance with Supplements: Failure to take prescribed iron supplements.

• Chronic Illnesses: Conditions like intestinal parasites can exacerbate anemia.

Signs and Symptoms of Anemia

• Fatigue
• Paleness (pallor)
• Shortness of breath
• Dizziness or lightheadedness
• Cold hands and feet
• Reduced exercise tolerance
• Difficulty concentrating

Diagnostic Investigations

• Clinical Assessment: History (including dietary, chronic, and obstetric), and physical examination.

• Laboratory Tests: Complete Blood Count (CBC), including Red Blood Cell Count (RBC), Hemoglobin (Hb), Hematocrit (Hct), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC).

• Additional Tests (as needed): Hemoglobin electrophoresis, urine or stool tests, Coombs test, ultrasound or endoscopy.

WHO Recommendations for Anemia in Pregnancy

• Iron Supplementation: Daily oral iron (30-60mg elemental iron) recommended, potentially higher doses in areas with high anemia prevalence and ideally taken on an empty stomach to aid in absorption.

• Folic Acid Supplementation: Daily 400 μg of folic acid is ideal, ideally before conception and during the first trimester to prevent neural tube defects and folate-deficiency anemia, and bolster overall fetal development.

• Screening: Screen for anemia at the first prenatal visit, and at 24-28 and 36 weeks.

• Follow-up Testing: Hemoglobin testing may be necessary, especially later in pregnancy, to monitor for developing anemia.

• IPT (Intermittent Preventive Treatment): Use of sulphadoxine-pyrimethamine for areas with high malaria transmission.

Management of Anemia in Pregnancy

• Dietary Recommendations: Eat iron-rich foods (lean meats, leafy greens, beans, lentils, fortified cereals), paired with vitamin C-rich foods (citrus fruits, bell peppers) to enhance iron absorption.

Treatment of Anemia During Pregnancy

• Oral Iron Supplements: For mild to moderate anemia. Iron supplements (ferrous sulfate or gluconate) are typically taken on an empty stomach or with vitamin C to improve absorption

• Intravenous (IV) Iron: For cases where oral iron is not tolerated or when anemia is more severe.

• Folate supplementation: Often crucial for red blood cell formation

• Education and counseling: Educate women about nutrition and iron, as well as signs of anemia

• Monitoring and Follow-up: Track hemoglobin levels and adjust treatment as needed; This is essential for effective management

• Postpartum Care: Monitor for anemia in the postpartum period, especially women with significant blood loss during delivery.

Complications of Anemia During Pregnancy

• Maternal Risks: Preterm delivery, placental abruption, severe postpartum hemorrhage, increased risk of maternal mortality and ICU admission.

• Fetal Risks: Low birth weight, stillbirth, fetal growth restriction, and developmental delays.