Anemia in Pregnancy

Anemia in PregnancyAnemia generally is a medical condition in which there is not enough healthy red blood cells to carry oxygen to the tissues in the body.

Anemia in pregnancy (according to WHO) as:

Hemoglobin (Hb) levels of < 11 g/dl in the first and last trimesters and <10.5 g/dl in the second trimesterOr Hematocrit (Hct) levels of < 33%

• Hematocrit is the percentage of red blood cells (RBC's) in the blood.• Hemoglobin is the protein in red blood cells that carries oxygen from

lung to other cells in the body.

Anemia Grades

- Grade 1 (Mild) = 9.5 – 11 g/dl Hb - Grade 2 (Moderate) = 8 – 9.5 g/dl Hb

- Grade 3 (Severe) = 6.5 – 8 g/dl Hb

- Grade 4 (Life Threatening) = < 6.5 g/dl Hb

- Non pregnant females: 12 – 15 g/dl = 38% – 46% Hct

- Pregnant: 11 – 12 g/dl = 35 – 44 % Hct

- Newborn: 14 – 24 g/dl = 55% – 68% Hct

Normal hemoglobin and Hematocrit values are:

Anemia increase the maternal and perinatal mortality and morbidity • On Mother:- Abortion- Postpartum depression- Increased risk of infections- Heart and lung problems

• On Baby:- Neural tube defects (a birth defect involving incomplete development of the brain and spinal

cord)- Mental problems- Low birth weight- Pre-term birth- Delayed growth in Infants and Children

Effects of Anemia on Pregnancy:

The most common symptoms of anemia during pregnancy usually appears in severe anemia;

-Pale skin, lips, and nails -Feeling tired or weak

-Dizziness -Shortness of breath

-Rapid heartbeat- Headache

-Cold hands and feet

Symptoms of Anemia During Pregnancy

All pregnant women are at risk for becoming anemic. That's because they need more iron and folic acid than usual to feed the fetus. But the risk is higher if:

-Are pregnant with multiples (more than one child) -Have had two pregnancies close together (in less than a year)

-Vomit a lot because of morning sickness -Are a pregnant teenager

-No enough iron in the nutrition. -Had anemia before the pregnancy

Risk Factors for Anemia in Pregnancy

- Anemia caused by decreased in red blood cell production • Iron-deficiency anemia • Folate-deficiency anemia • Vitamin B12 deficiency

- Anemia caused by destruction of red blood cells • Hemolytic diseases

- Anemia caused by blood cell loss • Hemorrhage (Bleeding)

Types of anemia during pregnancy:

Iron-Deficiency AnemiaIron deficiency is the most common cause of anemia in pregnancy. It is about 75 – 95% of the cases of anemia in pregnant women.

This type of anemia occurs when the body doesn't have enough iron to produce hemoglobin; so the blood cannot carry enough oxygen to tissues throughout the body.

Total body iron requirement is increased by 1000mg in pregnancy:- 300 gm for fetus and placenta.- 250 gm lost at delivery.- 450 gm to increase red blood cell mass.

Management of Iron-deficiency:

- Pregnant without anemia should take a dosage of 30 – 65mg of iron once daily (Just one time per a day to prevent constipation).

- Anemic pregnant should take 120 – 240 mg per day- Iron Supplements: • Parenteral Fe • Oral Fe- Blood transfusion; if the anemia is severe.- Diet: red meat, liver, egg, dark green and leafy vegetables, dried fruits,

nuts, cauliflower, Broccoli.- Additionally; vitamin C helps the body absorb iron, the Fe tablets

should be taken with a source of vitamin C, like a glass of orange juice.

Iron supplement side effects:

• Oral therapy- Constipation- Diarrhea- Nausea and vomiting

• Parenteral therapy- Skin discoloration- Local abscess- Allergic reaction- Fe over loaded

Folate-Deficiency Anemia- Not very common as Iron-deficiency anemia.

- Folic acid (folate) is a type of B vitamin (B9) and is needed to make new cells in the body, including red blood cells.

- It is very important for the health of the baby’s brain and spinal cord.

- The usual cause is not eating enough foods which contain folic acid. It is treated easily by taking folic acid tablets.

Management of Folate-deficiency:

- The daily folic acid requirements for not anemic pregnant is 0.4 mg

- Anemic pregnant should have 4 mg.

- Folate Supplements (folic acid oral tablets)

- Diet: fresh vegetables and fruits without cooking, cauliflower, Broccoli, Nuts.