One of the most common medical complications in pregnancy is that of anaemia. Anaemia can cause problems for the pregnant woman and also the developing fetus. Early identification and expert management of anaemia in pregnancy can prevent many complications during pregnancy, and lead to a successful pregnancy and delivery. The two most common causes of anaemia in pregnancy are iron deficiency and acute blood loss.
Aneamia in pregnancy
Iron deficiency is the most common cause of anaemia in pregnancy worldwide.
Iron requirements increase during pregnancy, and a failure to maintain sufficient levels of iron may result in adverse maternal-fetal consequences.
Anaemia in pregnancy may be defined as a haemoglobin (Hb) below 110 g / L in the first trimester and below 105 g / L in the second and third trimesters.
Anaemia can leave you feeling tired and weak. If it is severe but goes untreated, it can increase your risk of serious complications.
Uncorrected anaemia increases pregnancy morbidity especially if there is postpartum haemorrhage. Severe iron deficiency in pregnancy is associated with low birth weight, preterm birth, perinatal mortality and postnatal depression.
Diagnosis of iron deficiency
Women who are pregnant should be screened for anaemia at their booking visit. This is usually in the first twelve weeks of pregnancy. Anaemia can be diagnosed with a complete blood picture. Confirmation of iron deficiency, when required, involves measurement of serum ferritin which can be supported by serum transferrin saturation and serum soluble transferrin receptor.
Haemoglobin levels (Hb) and mean cell volume (MCV) are used as the first screening indicators of iron deficiency.
Treatment
Treatment of iron deficiency has obvious benefits for the mother. Oral iron supplementation is the first line of management
A high iron diet should be recommended where possible. Intravenous and intramuscular iron treatments carry a small risk of anaphylactic reaction. Their use should be reserved for cases of severe iron deficiency anaemia resistant to oral iron treatment.
For iron-deficient anaemia, the recommended dose is 40-80 mg of elemental iron per day. Depending on the preparation taken, the total dose can be achieved with one tablet taken daily or every second day, preferably on an empty stomach one hour before meals, with a source of vitamin C such as orange juice to maximise absorption. Do not take iron tablets with dairy products, tea / coffee or cereals as these inhibit iron absorption.
Some patients do not take iron tables due to side effects. The side effects of oral iron can exacerbate those of pregnancy such as constipation, heartburn, nausea and vomiting. Patients should be counselled regarding these symptoms, including blackening of stools.
Other causes of anaemia in pregnancy
In Anguilla other causes of anaemia in pregnancy include sickle cell disease, and megaloblastic anaemia. This is due to folate deficiency and vitamin B12 deficiency. Except in strict vegans, true vitamin B12 deficiency is unlikely despite the increased requirements of pregnancy due to the extent of vitamin B12 stores. Other conditions may occur in pregnancy that give rise to anaemia. These are uncommon and should be managed by an experienced obstetrician and physician according to the diagnosis.
Conclusion
Several types of anaemia can develop during pregnancy but, in Anguilla, iron deficiency anaemia is the most common. Once diagnosed early, and correctly managed, many of the complications can be prevented. All pregnant women who have anaemia should be managed by an experienced obstetrician because such a pregnancy is considered a high risk one.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
