 Body pain (insufficient O2 and
Folic Acid Deficiency Anemia
 Lack of folic acid in blood
 Folic acid, a B vitamin, helps in
making RBCs
 Can cause megaloblastic anemia
Megaloblastic Anemia
 RBC larger in size than in normal
 Fewer of these cells, oval-shaped,
not round
 Sometimes these RBCs don’t live as
long as normal RBC (N: 120 days)
Cause:
 Diet low in folic acid
 Too much alcohol (affects stomach
lining)
 Disease in lower digestive tract
 Medicines (anti ambot)
 Pregnancy
S&S:
 Pale skin
 Decrease in appetite
 To grouchy (irritable)
 Lack of energy or tiring easily
 Diarrhea
 Smooth and tender tongue
Management:
 Folic acid (400mcg)
 Folacin-rich foods (green
vegetables, orange, and
beans)
Sickle Cell Anemia
 Recessively inherited hemolytic caused
by abnormal amino acid in the beta
chain of hemoglobin
 RBCs that are irregular or sickle shaped
can’t carry as much Hgb as normally
shaped RBCs can
nutrients delivered)
 Prone to hemolysis
Assessment:
 Hemoglobin: 6-8mg/100mL
 Rise in indirect bilirubin level (due to
hemolysis)
 Clean catch urine sample collected
periodically during pregnancy
 Monitor diet
 Fluid intake should also be carefully
monitored
 Assess a woman’s lower extremities
for varicosities or rooting or blood in
leg vein
 Fetal health is monitored
 Ultrasound exam at 30 weeks
Management:
 Pediatric exchange transferrin
through pregnancy
 Controlling pain, administering
oxygen as needed (sickle cells crisis)
 Increasing the fluid volume of the
circulatory system to lower blood
viscosity
 Fluid administered is hypotonic (0.45
saline) [so RBC will not lyse]
 As a rule, women with sickle cell
disease are not given an iron
supplement during pregnancy
 Need folic acid supplement (to
prevent neural tube defect)
 Keep a woman well hydrated in labor
leafy
dried
Substance Dependent
Substance abuse: the inability to meet the
major role obligations an increase in legal
problems or risk-taking behavior, or
exposure to hazardous situations because of
an addicting substance
Substance Dependence: When a woman - Tends to leave the maternal
has withdrawal symptoms following circulation and concentrate in
discontinuation of the substance, combined fetal cells, so it may be
with abandonment of important activities, particularly injurious to a fetus
spending increased time in activities related
to substance abuse, using substances for a
longer time than planned, or continued use III. Amphetamine
despite worsening problems because of - Methamphetamine (speed): has
substances a pharmacologic effect similar to
cocaine
- Ice, a rock type of meth that is
Marks of a substance dependent woman: smoked, can produce high
concentrations of drug in the
1. Late in pregnancy for prenatal care
maternal circulation
2. Difficulty following prenatal
- NB show jitteriness and poor
instructions for proper nutrition
feeding at birth and may be
growth restricted
COMMON SUBSTANCESN ABUSED
DURING PREGNANCY
IV. Marijuana and Hashish
I. Cocaine - Obtained from the hemp plant,
- Derived from Erythroxylum coca cannabis
- Grown almost exclusively in - When smoked, they produce
South America tachycardia and a sense of well-
- Absorbed across the mucous being (euphoria)
membranes to affect the CNS - Associated with loss of short-term
- Vasoconstriction: respiratory and memory and an increased
cardiac arrest incidence of respiratory infection
in adult
- Reduced milk production
Effects of Cocaine
 Vasoconstriction (respiratory
and cardiac arrest, placenta V. Narcotic Antagonists
abruptio, preterm labor, fetal - Used for treatment of pain (e.g.
death) morphine or meperidine
 Fof NB: intracranial [Demerol] and cough suppression
hemorrhage, withdrawal [codeine] )
syndrome of tremulousness, - Potent analgesic and euphoric
irritability, and muscle rigidity effect
- Heroin: inactive until it crosses
the blood-brain barrier
II. Phencyclidine : administered ID (skin
- An animal tranquilizer that is a popping), through inhalation
frequently used street drug in (snorting), or IV (shooting)
polydrug abuse
- Causes increased cardiac output
and a sense of euphoria Heroin abuse
- Potential for causing long-term  Can result in fetal opiate dependence
hallucinations (flashback and severe withdrawal symptoms in
episodes) the infant after birth
  Small for gestational age and have an
increased incidence of fetal distress
and meconium aspiration
 Fetal liver is forced to mature faster
than normally
 Women receiving methadone may
need stronger prescriptions for pain
relief in labor or postpartum than
others

Inhalation
 Refers to “sniffing” or “huffing” of
aerosol drugs
 Lead to severe respiratory and
cardiac irregularities
 Have effects similar to alcohol abuse
during pregnancy

Alcohol abuse
 Can cause fetal alcohol syndrome, a
syndrome with significant facial
features, possible cognitive
challenges and memory defects