ANEMIA IN PREGNANCY

In pregnancy need higher oxygen to trigger increased production of

erythropoietin. As a result, increased plasma volume and red blood cells
(erythrocytes) increases. However, the increase in plasma volume occurs in a
proportion greater than the increase in erythrocytes resulting in decreased
concentration of hemoglobin (Hb) due to hemodilution.
Plasma volume expansion began in the 6th week of pregnancy and reaches a
maximum at the 24th week of pregnancy, but may continue to rise until the 37th
week. At its zenith, the plasma volume approximately 40% higher in pregnant women
than women who are not pregnant. Decrease in hematocrit, hemoglobin concentration,
and erythrocyte count usually appear in week 7 to all 8 of pregnancy and continued to
decline until week 16 to 22 when the point of balance is reached.
A study shows the change in Hb concentration in accordance with increasing
gestational age. In the first trimester, Hb concentration appears to have declined,
except in women who have had low hemoglobin levels (<11.5 g / dl). The lowest
concentration found in the third trimester there was a slight increase in Hb, except in
women who already have high hemoglobin levels (> 14.6 g / dl) in the first
inspection.

Picture 1. Hemoglobin concentration during pregnancy

 The cause of anemia is the most common nutrient deficiency. Often multiple
deficiency is accompanied with clinical manifestations of infection, malnutrition, or
hereditary disorders such as hemoglobinopathies. However, the underlying causes of
anemia include nutritional intake is insufficient, inadequate absorption, increasing the
missing nutrients, excessive requirements, and lack of utilization of haemopoietic
nutrients. Approximately 75% of anemia in pregnancy is caused by an iron deficiency
that shows a picture of microcytic hypochromic erythrocytes in the peripheral blood
smear. The second commonest cause is a megaloblastic anemia caused by a deficiency
of folic acid and vitamin B12 deficiency. Other causes of anemia are rarely found
among other hemoglobinopathies, inflammation, toxicity of chemicals, and
malignancy.

Reference :
Ilmu Kandungan.2009.Jakarta:PT.Bina Pustaka Sarwono
Prawirohardjo.page 775