ANEMIA IN PREGNANCY
Written by Dr.M.D.Mazumdar, MD
The term 'anemia' is used when the level of haemoglobin in the blood falls to less than 10 gm %. It is very commonly encountered in pregnancy because of the increased requirements of all the vitamins and minerals, especially iron, at this time.
Anemia can cause complications like low birth weight baby, intra-uterine growth retardation (IUGR), preterm labor and postpartum complications like genital infections and breast abscess.
Risk Factors for Developing Anemia
- Multiple pregnancy.
- Poor Diet
- Having two or more pregnancies close together.
- Heavy Pre-pregnancy menstrual flow.
- Nausea and vomiting causing decreased food intake.
- Poor Apppetite.
Causes of Anemia
- Iron Deficiency: the most common reason for anemia during pregnancy.
- Folic Acid and/or Vit B12 Deficiency: Anemia due to folic acid or Vit B12 is less common but not unknown.
- Combination of both Iron and Vitamin B Deficiency
- Vit C deficiency: Uncommon.
Only iron deficiency anemia will be discussed on this page.
Grading of Iron Deficiency Anemia
Iron deficiency anemia is graded according to the haemoglobin level in the blood.
- Mild Anemia: Hb level between 8.0gm % to 10.0gm%
- Moderate Anemia: Hb level between 5.0gm% to less than 8.0gm%
- Severe Anemia: Hb level less than 5.0 gm%.
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Signs and Symptoms of Anemia
Mild Anemia
The patient has no complaints specific to anaemia. Diagnosis is made on routine blood examination.
Moderate Anemia
- Excessive tiredness
- Palpitation
- Occasional breathlessness, especially during exertion such as on climbing stairs
- Pallor of the sclera, lips and nailbed.
- Prone to develop infecitons like UTI and vaginitis.
Severe Anemia
- Patient looks ill and exhausted
- There is breathlessness and palpitation even on resting
- Some patients prefer to sleep in a propped up position rather than lying down, to decrease breathlessness.
- Ulcers of the lips and gums may occur.
- Edema all over the body (anasarca).
- Enlargement of the heart and cardiac murmurs due to congestive cardiac failure.
Symptoms of Anemia
Treatment of Anemia in Pregnancy:
Anemia is usually diagnosed at the first antenatal visit when the blood is routinely examined for haemoglobin level. Pregnant women can also use home test kits for self-diagnosis of anemia, but it is better to get a proper laboratory test done for accuracy.
- Diet advice: Dietary advice to increase iron consumption is given. Foods rich in iron are liver, meat, egg, fish and milk.
For a vegetarian diet - green, leafy vegetables, beans, peas, whole wheat, legumes, and raisins are advisable. Sprouting grams are a very rich source of Vit B12. Food containing Vitamin C like lemon, lime and oranges should be also taken as Vit C helps in absorption of iron.
- Iron Supplementation: Where adequate diet cannot be ensured, prophylactic iron should be prescribed. Daily iron supplementation should be between 60-120 mg of elemental iron in the form of Ferrous sulphate, ferrous fumarate, or ferrous gluconate.
Vitamin C 500mg tablets should be prescribed to increase the absorbtion of iron from the gut.
Folic Acid and Vitamin B Complex can be given daily to treat anaemia due to deficiency of Vitamin B or Folic Acid. .
- If Anemia is Severe: If the anemia is severe, it cannot be treated by oral supplementation alone.
The patient has to be admitted in a hospital and investigated thoroughly for other causes of anemia. She should be kept at complete bed rest with adequate high protein diet, supplementary injections of Vit B12, Folic Acid and Vit C if necessary should be given.
Injections of iron preparations are rarely used nowadays as severe local reactions at the site of the injection can occur. Blood transfusion using only the red blood cells (packed cell transfusion) is a better form of replacing the deficient iron.
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