Anaemia is one of the most common medical disorders that occurs in pregnant women. In Anguilla iron deficiency anaemia is very common and is the most common anaemia associated with pregnancy on the island.
What is anaemia?
Anaemia is a condition that develops when your blood lacks enough healthy red blood cells or haemoglobin. Haemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your haemoglobin is abnormal or low, the cells in your body will not get enough oxygen. During pregnancy there is an increase in plasma volume which results in haemodilution. Thus during pregnancy, anaemia is defined as haemolglobin (Hb)< 10 g/dL. If Hb is < 11.5 g/dL at the onset of pregnancy, women may be treated prophylactically because subsequent hemodilution usually reduces Hb to < 10 g/dL. Despite haemodilution, O2-carrying capacity remains normal throughout pregnancy.
Anaemia occurs in up to one third of women during the 3rd trimester. The most common causes in Anguilla are:
• Iron deficiency
• Folate deficiency
• Sickle cell diseae
What are some signs and symptoms of anaemia?
In some patients it might be difficult to differentiate the signs and symptoms of a normal pregnancy and anaemia. Indeed, early symptoms of anaemia might not exist or may be very vague like, fatigue, weakness, light-headedness, mild dyspnoea during exertion. Other symptoms and signs of anaemia may include pallor and, if anaemia is severe, tachycardia or hypotension.
Anemia increases risk of preterm delivery and postpartum maternal infections.
Diagnosis
During a clinical examination of the patient, the diagnosis can be made if the anaemia is very severe. Often the diagnosis is confirmed with a blood test. Other tests might be warranted in some patients, such as stool tests, and bone marrow biopsy.
Iron deficiency anaemia in pregnancy
About 95% of anaemia cases during pregnancy are due to iron deficiency. The cause is usually due to:
• Inadequate dietary intake (especially in adolescent girls)
• A previous pregnancy (less than two years)
• The normal recurrent loss of iron in menstrual blood, and in some women who have prolonged and excessive menses.
Other causes of anaemia in pregnancy
In Anguilla, other common causes of aneamia in pregnancy include folic acid deficiency and sickle cell disease.
Preexisting sickle cell disease, particularly if severe, increases the risk of maternal infection (most often, pneumonia, urinary tract infections, and endometritis), pregnancy-induced hypertension, heart failure, and pulmonary infarction. Fetal growth restriction, preterm delivery, and low birth weight are common. Anaemia almost always becomes more severe as pregnancy progresses. Sickle cell trait increases the risk of urinary tract infections but is not associated with severe pregnancy-related complications.
Treatment of anaemia in pregnancy
Once the cause of anaemia is determined treatment can commence. Once the diagnosis is made early in the pregnancy, and treatment instituted, many of the complications associated with anaemia in pregnancy can be prevented. Iron deficiency anaemia is the most common cause of anaemia in Anguilla and this is usually treated with ferrous sulfate 325 mg tablets daily by mouth. One 325-mg ferrous sulfate tablet taken midmorning is usually effective. Higher or more frequent doses increase gastrointestinal adverse effects, especially constipation. About 20% of pregnant women do not absorb enough supplemental oral iron; a few of them will require parenteral therapy.
Prevention
A large number of women are known to be anaemic prior to pregnancy and many obstetricians and health providers on the island routinely give all pregnant women iron supplements. This practice is controversial and I personally do no not give iron supplements in the first trimester of pregnancy in women who are not anaemic. All pregnant women are encouraged to eat healthy during pregnancy and this will also prevent anaemia.
Complications of anaemia in pregnancy
Mild anaemia usually does not cause complications. However, left untreated, anaemia can become severe and lead to health problems including heart problems such as heart failure. In pregnant women, severe iron deficiency anaemia has been linked to premature births and low birth weight babies. Maternal conditions can be made worse by anaemia. These include postpartum haemorrhage and postpartum depression.
Conclusion
Anaemia is one of the most common medical disorders of pregnancy. In this condition there is not enough healthy red blood cells to carry oxygen to the tissues in the body. When the tissues do not receive an adequate amount of oxygen, many organs and functions are affected. Anaemia during pregnancy is especially a concern because it is associated with low birth weight, premature birth and maternal mortality. All pregnant women are encouraged to have regular visits to their doctor or healthcare provider so that disorders such as anaemia can be detected and treated, and complications be prevented.
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 MB BS DGO MRCOG, 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).
