What is anemia in pregnancy? Diagnosis and treatment

What is anemia in pregnancy?

Anemia is called a condition in which the amount of hemoglobin in the blood and/or the number of erythrocytes is reduced. The WHO definition of anemia is: Anemia is a condition in which there is a decrease in hemoglobin, red blood cell count and hematocrit below the reference values for the population. Its direct effect is to reduce oxygen transport to the tissues. In pregnancy, the most common cause of anemia, accounting for about 75% of its cases, is iron deficiency. This is known as “iron deficiency. Microcytic anemia. During pregnancy, iron requirements increase-especially in the 3rd trimester-by about 7.5 mg per day. It is estimated that the additional need for iron is due to increasing red blood cell mass, the needs of the placenta and fetus, and, at the end of pregnancy, also to protect against perinatal blood loss.

Anemia in pregnancy: Symptoms

Pregnant women with anemia develop general symptoms such as fatigue, headaches, decreased activity, shortness of breath during exertion, and heart palpitations. In addition, they complain of pallor, acrimony and hair loss and splitting.

Anemia in pregnancy – diagnosis

Iron deficiency anemia during pregnancy is diagnosed with a hemoglobin concentration – 11 g/dl (6.8 mmol/l). It is also important to evaluate erythrocyte indicators such as. MCV, which determines the average volume of a red blood cell. If the MCV value is less than 80fl then we are dealing with  microcytic anemia, where erythrocytes are too small. If, on the other hand, the MCV value is greater than 95 fl, this indicates anemia of a macrocytic nature, resulting, for example, from folic acid or vitamin B12 deficiency. Most cases of anemia in pregnancy, however, are microcytic anemia due to iron deficiency.

Additional tests to help diagnose anemia are:

• Ferritin concentration (which determines the body’s iron stores)
• Iron concentration
• Iron saturation of transferrin
• Total iron binding capacity (TIBC)

Anemia in pregnancy. What to eat to prevent anemia during pregnancy?

To predict the onset of anemia during pregnancy, ferritin levels can be tested in the first trimester. If its value is less than 60ug/l, this is an indication to start taking oral iron preparations in low doses from 16. One week of pregnancy. 

The prevention of anemia from iron deficiency involves a well-balanced diet and, according to WHO recommendations, oral supplementation with iron preparations in 30-60 mg throughout pregnancy. However, the PTGiP recommends taking iron preparations only in cases of diagnosed anemia, as it has been shown to have adverse effects when iron is in excess in the body.

Easily absorbed (trivalent) iron is found in meat and fish, among other things, and sources of divalent iron are vegetables such as parsley, spinach, beets and broad beans.

Note that iron absorption can be increased or decreased by other products. Vitamin C, present in orange juices, for example, increases its absorption from the gastrointestinal tract, while substances in tea or bran reduce it.

Anemia in pregnancy – When to the hospital? Treatment of anemia in pregnancy

When an expectant mother is diagnosed with microcytic anemia during pregnancy, she should take oral iron preparations in higher doses-100-300 mg per day. Once normal hemoglobin values are achieved, treatment is maintained for about 3 months to replenish the element. In extreme situations, intravenous treatment or even blood transfusions are used.

Anemia in pregnancy: what is the risk? Iron deficiency in pregnancy effects on the baby

Anemia can adversely affect not only the course of pregnancy and childbirth, but also the fetus or newborn. There is an increased risk of miscarriage, preterm labor and IUGR- intrauterine growth restriction of the fetus. in extreme cases, there may even be intrauterine fetal demise…. It also happens that after delivery, uterine contraction is impaired.

Read also: Hypotrophy – what is it? What are the causes and effects?

In turn, lower Apgar scores and prematurity are observed among newborns, and they may be more likely to develop anemia in later development. Note that anemia present in a pregnant woman is not a contraindication to collecting cord blood during delivery. For more information, see our Q&A page.

Bibliography:

• Clinical situations in obstetrics. Editor. G.H. Bręborowicz
• Obstetrics and Gynecology Volume 1. G.H. Brębrowicz
• Recommendations of the Polish Society of Gynecologists and Obstetricians on supplementation in pregnant women