Anaemia occurs in many individuals, but the incidence increases in pregnancy. One of the most common causes of anaemia in pregnancy in Anguilla is that caused by iron deficiency. The symptoms and signs of anaemia during pregnancy can be very severe at times. Left untreated anaemia during pregnancy can have negative effects for both the developing fetus and the pregnant woman.
Anaemia in pregnancy
If you are pregnant, you are at an increased risk of iron deficiency anaemia, a condition in which you do not have enough healthy red blood cells to carry adequate oxygen to the body’s tissues. A haemoglobin <110 g/L in the first trimester and <105 g/L in the second and third trimesters is often used as the definition of anaemia during pregnancy. A ferritin level of <15 micrograms/L or serum iron level of <12 micromoles/L can also be used to make the diagnosis of iron deficiency anaemia during pregnancy.
Causes of anaemia in pregnancy
It is normal for the levels to drop a little in pregnancy because there is far more fluid in your blood to dilute the red blood cells. This is normal for pregnancy. Anaemia can occur from other causes and include the following:
• A diet low in iron
• Pregnancies close together
• Carrying twins or triplets
In addition to iron deficiency as a cause of anaemia in pregnancy, there are other less common causes during pregnancy, and include the following:
• Folic acid deficiency
• Vitamin B12 deficiency
• Sickle cell disease
• Chronic illnesses like chronic inflammatory bowel disease.
What are the risk factors for iron deficiency anaemia during pregnancy?
You are at increased risk of developing anaemia during pregnancy if you:
• Are vomiting frequently due to morning sickness
• Do not consume enough iron
• Have a heavy pre-pregnancy menstrual flow
• Have a history of anaemia before your pregnancy.
What are the symptoms of iron deficiency anaemia during pregnancy?
The symptoms and signs of iron deficiency during pregnancy will vary from one individual to another and some of these symptoms are often similar to general pregnancy symptoms. Blood test can determine if the symptoms are the result of iron deficiency. Signs and symptoms include:
• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Cold hands and feet
• Headache
If you are concerned about your level of fatigue or any other symptoms, talk to your obstetrician or healthcare provider. It is important to see your obstetrician early in your pregnancy so that iron deficiency anaemia, and other disorders, can be detected and treated before they have complications. If anaemia is severe, and goes untreated, it can increase the pregnant woman’s risk of serious complications like preterm delivery.
Treating anaemia in pregnancy
Following discussion with your obstetrician, he/she might advise several options. Advice on diet might be recommended. Iron supplements are available in tablets or in a liquid form. If you have been prescribed iron supplements, it is important to take them and to finish the course.
Iron supplements can often cause constipation or diarrhoea and some women are unable to take them. Iron supplements are better absorbed if taken an hour before meals. However, side effects on the gut, such as abdominal discomfort, constipation, diarrhoea and nausea can occur. Some of these symptoms may be resolved by taking the iron with or after food.
If you are taking a prenatal vitamin that contains iron, and you are anaemic, your healthcare provider might recommend testing to determine other possible causes. In some cases, you might need to see a doctor who specializes in treating blood disorders (haematologist). If the cause is iron deficiency, additional supplemental iron might be suggested. If you have a history of gastric bypass or small bowel surgery, or are unable to tolerate oral iron, you might need intravenous iron administration.
Can iron deficiency in pregnancy prevented?
In some cases it might be possible to prevent iron deficiency during pregnancy. Sticking to a good diet is often helpful. Eating iron-rich foods are recommended. Iron rich foods include:
• Dark-green leafy vegetables such as kale and spinach
• Iron-fortified cereals or bread
• Brown rice
• Pulses and beans
• Nuts and seeds
• White and red meat (in moderation)
• Fish
• Eggs (these must be well cooked during pregnancy)
• Dried fruit, such as dried apricots, prunes and raisins.
Your daily diet should include foods from all the major food groups to ensure it is healthy and balanced. It is important to be aware that food and drink containing vitamin C are important as vitamin C helps your body absorb iron.
Consuming large amounts of some foods and drinks, as well as certain medicines, may make it harder for your body to absorb iron. These include using large amounts of tea, coffee and antacids.
Conclusion
It is normal to have mild anaemia when you are pregnant due to body changes. In Anguilla some pregnant woman have moderate or severe anaemia, and this is usually because of low iron or vitamin levels or from other reasons. If anaemia is severe and goes untreated, it can increase the pregnant woman’s risk of serious complications like preterm delivery. Detecting and treating anaemia during pregnancy is one of the benefits of the pregnant woman having regular prenatal check-ups.
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-five years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828
