Effect of iron deficiency anaemia during pregnancy: A Review

By
Samreen Munawar
(2019-GCUF-302636)
(B.S Hons) HND

Submitted to partial fulfilment course requirements for the degree

of
Bachelor of Science (Hones
In
Human Nutrition & Dietetics

DEPARTMENT OF HUMAN NUTRITION & DIETETICS

FACULTY OF ALLIED HEALTH SCIENCESTHE PHYSIO
COLLEGE MULTAN
2023
Abstract:
Anemia in pregnancy is a global health problem affecting approximately half of pregnant women
worldwide. High fetal iron requirements are considered the most common cause of anemia
during pregnancy. Human pathogens such as hookworms, malaria parasites, and human
immunodeficiency virus are major causes of anemia during pregnancy in certain geographic
populations. Hemoglobin apathies, sickle cell disease and thalassemia are different causes of
anemia in pregnancy that require special attention. Aplastic anemia is a rare pathogenic anemia
in pregnancy that is managed by transport until the end of pregnancy. .Every pregnant woman is
at risk of developing anemia during pregnancy. The prevalence of anemia in pregnant women
remains high. Anemia is a common problem in reproductive medicine and gynecology. Any
hemoglobin below 10 g/dL can be considered true anemia, regardless of gestational age. The
main causes of anemia in pregnancy are malnutrition, parasitic and bacterial diseases and
congenital red blood cell diseases such as thalassemia. The worldwide prevalence of iron
deficiency is estimated between 20% and 80%, especially in the female population. Among the
stages of iron deficiency, the most prominent forms are iron depletion, non-iron-deficiency
erythropoietic anemia, and iron-deficiency anemia. There is a shortage of steel. Anemia during
pregnancy can be aggravated by various conditions such as uterine or placental bleeding,
menstrual bleeding, and postpartum anemia. In addition to the general consequences of anemia,
there are specific risks to the mother and fetus during pregnancy, such as intrauterine growth
restriction, premature birth, fetoplacental insufficiency, and increased risk of blood transfusions.
In addition to the importance of preventing iron deficiency, the main treatment options for
anemia in pregnancy are oral and intravenous preparations containing iron. The prevalence of
anemia during pregnancy is 53-61% in developing countries and 44-53% in Africa. 0.17% to
31% in Southeast Asia, Europe and North America. Iron and folic acid deficiency are thought to
be the most common cause of this condition. Anemia during pregnancy is not only common but
often severe in these countries. It is estimated that 20% of pregnant women have a hemoglobin
level < 8 g/dL and iron deficiency of 2% can affect the overall health of the mother and lead to
fatigue and reduced ability to work. It can also cause paleness, shortness of breath, palpitations,
headaches, dizziness and irritability. There is evidence of a significant association between the
severity of anaemia, preterm birth and low birth weight, intrauterine growth retardation, low
neonatal iron status, preeclampsia and post haemorrhage. -partum. This happens with other
pregnancy-related disorders. Anemia in pregnant women is affected by many factors. The results
showed family factors, lack of prenatal care, nutritional status including micro and macronutrient
deficiency such as iron folate and infectious diseases.

Key points:

Anemia, iron deficiency anemia, pregnant women, blood hemoglobin level, gastrointestinal
bleeding, dizziness, prenatal care.

Introduction:

The definition of iron deficiency anemia (IDA) in pregnancy is incorrect because pregnancy
results in changes in plasma volume and hematocrit, differences in hemoglobin (hb)
concentration during trimesters, Iron deficiency anemia is the most common known disorder
affecting one third of the world's population. There are many findings, especially in pregnant
women, that suggest that overall physiological adaptations are not sufficient to meet nutritional
needs. The definition of pregnancy in women is the state between conception (fertilization of an
egg by a sperm) and childbirth, in which the fertilized egg develops in the uterus. Human
pregnancy usually lasts about 40 weeks, or a little over 9 months, from the last period to
delivery. The average age at the time of childbirth for women is 12 to 51 years. Health
professionals refer to the three parts of pregnancy as trimesters. Below are the key events of each
quarter. First trimester (weeks 1 to 12) Second trimester (weeks 13 to 28) Third trimester (weeks
29 to 40). Anemia is a disease process in which red blood cell hemoglobin (hb), hematocrit (ht),
and red blood cell volume are abnormally lower than the blood parameters of a reference
population. In normal individuals, hematocrit and hemoglobin levels vary according to
individual developmental stage and hormonal stimulation, environmental partial pressure of
oxygen, age and gender1 Iron deficiency anemia The World Health Organization (WHO) defines
hemoglobin as the amount of iron in the amount of iron in the blood. body varies according to
body weight, gender, hemoglobin level and iron level in the body. Storage 2. Iron deficiency is
defined as a decrease in ferritin levels, usually due to insufficient dietary iron bioavailability or
increased iron requirements during periods of acute growth. A decrease in ferritin levels during
pregnancy, adolescence and childhood can also be the result of massive blood loss, either as part
of bleeding or occult bleeding, or in inflammatory processes caused by various chronic diseases.
After. Five leading causes of disability in men and one of the leading causes of disability in
women. Although it is considered a public health problem affecting mainly growing children,
premenopausal women and pregnant women, it is also recognized as a medical condition
affecting patients with different clinical and surgical characteristics. especially people with
chronic diseases and the elderly. New evidence continues to accumulate on the role of IDA in
altering clinical outcomes, necessitating careful consideration of the diagnosis and treatment of
IDA in international practice guidelines. However, the multiple etiologies of IDA and the
nonspecific nature of symptoms can make diagnosis difficult. Additionally, the availability of
different formulations of iron supplementation can complicate treatment decisions. These aspects
are discussed in this review using the best available evidence and the authors' experience. A poor
diet and lack of iron, micronutrients and vitamins leads to deficiencies of nutrients such as iron,
folic acid, vitamin A, vitamin B12 and vitamin D29.

Risk factors:

Risk factors:

1. Use of drugs and foods that inhibit iron absorption, including antioxidants, aspirin, no
steroidal anti-inflammatory drugs, and excessive consumption of folic acid, phosphates, oxalates,
and tannins.

2. Overweight and obesity. The prevalence of overweight and obesity is significantly increased
in pregnant women whose iron deficiency is associated with a poor caloric diet, micronutrients,
overweight, genetic predisposition and/or iron deficiency. In addition, overweight and obesity
may also appear. It causes a persistent inflammatory process, accelerates blood loss and
interferes with treatment.

3. Malnutrition, in addition to dietary insufficiency, other possible associated conditions such as

malabsorption syndrome and/or iron overload. In this case, these patients also have a flattened or
atrophied intestine, which prevents the absorption of micronutrients.

4. All pregnant women are at risk of anemia. This is because they need more iron and folic acid
than usual.

5. But if you are at high risk:

6. Pregnant with multiple children (several children)

7. The time of two pregnancies is very close. 8. Morning sickness causing profuse vomiting.

9. She is a pregnant teenager.

10. Avoid foods rich in iron.

11. You were anemic before pregnancy.

Microcytic anemia:

Microcytic anemia: Thalassemia. Mature Hb consists mainly of HbA, which consists of α- and
β-globin. Mature Hb also contains small amounts of HbA2 (α2δ2) and HbF (α2γ2). Thalassemia
refers to a reduction in the production of alpha- and/or beta-globin chains due to mutations in the
alpha- and/or beta-globin genes. Recommended laboratory parameters for thalassemia include
hypochromic microcytic anemia in ethnic populations at increased risk for thalassemia, such as
those in Africa, the Middle East, the Mediterranean, Southeast Asia, the Caribbean, South
America, and the Western Pacific. Ethnic pregnant patients with thalassemia should be screened
for hemoglobinopathies if they have hypochromic microcytic anemia. Iron deficiency. Because
the demand for iron increases dramatically during pregnancy, iron deficiency in pregnancy is
very common, accounting for 18% of pregnancies, up to 7% in the first trimester, and up to 30%
in the third trimester. 1,9,10 The total iron requirement during pregnancy is approximately 1.2 g,
with the highest requirements during the third trimester, up to 7.5 mg per day. Dietary iron is
considered insufficient to meet iron needs during pregnancy. Assuming 25% bioavailability, iron
requirements are met during pregnancy. That equates to about 1.5 pounds of cooked beef and 4.5
pounds of cooked chicken, which is hard to include in your daily diet. Prenatal multivitamins are
recommended for all healthy pregnant women. and a mineral supplement containing 16 to 20 mg
of iron per day to cover the daily iron requirement. Symptoms of iron deficiency in pregnancy
are non-specific. Pica cannot be used to indicate iron deficiency during pregnancy because pica
is more common in pregnant women, regardless of their iron status. A ferritin concentration
below 30 μg/L is diagnostic of iron deficiency in pregnancy, although soluble transferrin
receptor (another sensitive marker of iron status) is not widely used. Consecutive pregnancies are
separated by 1 year. Complete blood count at 12 and 28 weeks of pregnancy and oral iron testing
in asymptomatic patients with first-trimester Hb concentrations > 110 g/l and 105 g/l due to the
high incidence of iron deficiency anemia Q2 (with normocytic or microcytic anemia in the
absence of hemoglobinopathies ), then check the answers after 2 weeks.

Table 1

Common Iron Preparations

Preparation Dosage Form Elemental Iron, mg

Ferrous gluconate Tablet 35

Ferrous sulfate Tablet 65

Ferrous fumarate Capsule/tablet 100

Polysaccharide-iron complex Capsule/powder150

Heme-iron polypeptide Tablet 11

Prenatal vitamin Tablet 27–35

Absence of anemia:

Oral iron supplementation increases Hb concentrations by approximately 20 g/L over 3 to 4

weeks without continued losses or increased requirements. Intermittent oral iron supplementation
is a viable alternative that may have fewer side effects than daily oral therapy. Non-anemic
parenteral iron should be considered if oral iron is ineffective, in iron intolerance, severe anemia,
or recent pregnancy.3 Parenteral iron has been shown to cause faster increases in Hb levels and
fewer gastrointestinal side effects than oral therapy, but the effect on neonatal outcomes remain
limited. In early pregnancy or in case of severe or allergic reaction to parenteral iron.

Microangiopathic hemolytic anemia:

Microangiopathic hemolytic anemia (microangiopathic hemolytic anemia, MAHA) is caused by

mechanical fragmentation of red blood cells in blood vessels with splitting and
thrombocytopenia on the peripheral blood film, accompanied by organ dysfunction.
Microangiopathic hemolytic anemia can occur during pregnancy for a variety of reasons, which
can arise from predetermined reasons. Preeclampsia is a systemic disorder that usually occurs
after 20 weeks of gestation with new-onset hypertension (≥140/90 mmHg) and new-onset
proteinuria (defined as ≥0 to 24 hours). Urine collection 3 g/day. or ≥30 mg/ml urethral
creatinine (urethral protein/pregnancy creatinine)25). It is now recognized that the absence of
proteinuria does not rule out the disease. In these patients, preeclampsia may be described as
hypertension and organ damage such as renal failure, liver disease (hypertransferamine and/or
acute right upper quadrant pain or epigastric pain), neurological disease (lacerations).
[eclampsia], persistent visual impairment, stroke) and/or blood disorders (thrombocytopathy,
disseminated intravascular coagulation), pulmonary edema and/or fetal complications including
intrauterine growth restriction or stillbirth. Hemolytic anemia, elevated liver enzymes, and
decreased platelets (Hellp) are the most common causes of MAHA in pregnancy and are a
serious manifestation of preeclampsia. 10% to 20% of patients with preeclampsia may have
Hellp syndrome, often accompanied by right upper quadrant pain or epigastric pain, while
hypertension and proteinuria may be mild or absent. HELLP takes place mainly in the third
semester. However, 30% of women may present within 48 hours of delivery.

Sickle cell disease:

SS syndrome includes HBSS, HBSC, and HBSβ0. Structurally, HBS results from the production
of abnormal β-globin chains that aggregate in deoxygenated areas of the circulation, leading to
microvascular and acute and chronic organ inhibition. Sometimes women with SS do not become
pregnant because of chronic complications such as recurrent painful attacks associated with
blood vessels, repeated need for red blood cell transfusions, and osteopenia. In addition, pregnant
women with SS disorders have an increased incidence of maternal, fetal, and neonatal
complications, increased risk of infection, vaso-occlusive crisis, thrombosis, and maternal death,
and preterm birth, including high birth rate, preeclampsia, and disease. . For children of
gestational age. Red blood cell transfusions have been shown to reduce some complications such
as stroke and pre- and post-operative acute chest syndrome in non-pregnant SS patients.
However, the role of red blood cells in SS during pregnancy has not been elucidated, as the risk
of aloe immunization may increase not only with vascular occlusion but also with pregnancy. SS
disease. A recent systematic review concluded that protective red blood cells may improve
maternal and fetal outcomes, although this finding was hampered by small study size and a lack
of high-quality data from randomized clinical trials in pregnancy. Red blood cell transfusions
during pregnancy should take into account the limitations of the available evidence regarding
owl immune risks. Since the growth of abnormal bodies in patients with SS tends to grow, if red
blood cell transfusion is necessary, if the patient is not immune to aloe vera in the presence of the
digestive tract and he n There is no long-term agreement whether red blood cells are
incorporated and must be mixed for nail antigens. Of the 2 antihypertensives commonly used
during pregnancy, folic acid is recommended for all SS patients. However, iron supplementation
may not be necessary because the patient's iron overload may be high. Iron supplementation
should only be used in patients with laboratory evidence of iron deficiency. If you did not take
folic acid (the standard folic acid for all pregnant women) before pregnancy, you should take
folic acid at a dose of 5 mg per day during pregnancy. Mortality was 7% and 34%. Preeclampsia
and HELLP disappear within days to several months after birth. .Midwife syndrome can be
treated with assisted platelet transfusion if necessary. Corticosteroids have not been shown to
improve clinical outcomes. An alternative diagnosis such as primary thrombotic
microangiopathy (MAT) should be considered if HELLP does not improve or worsens after 3
days postpartum, if HELLP persists beyond 7 days postpartum, or is associated with persistent or
worsening neurological or renal damage.

Complications of iron deficiency anemia in pregnancy:

Iron deficiency anemia in pregnancy can lead to complications for the mother and fetus.
Pregnant women may have an increased risk of preterm birth, cesarean delivery, postpartum
hemorrhage, and maternal death. Fetal infection, pre-eclampsia, haemorrhage, hospitalization
after delivery and the person may also experience cognitive impairment, behavioral problems
and problems with milk production.

Stages of iron deficiency:

It takes place in three stages Stage 1: Iron stores are depleted. Stage 2: When iron stores are low,
the normal way red blood cells are made changes. Stage 3: Iron deficiency anemia occurs when
red blood cells do not have enough iron to make hemoglobin.

Why do you need iron during pregnancy?

Before you get pregnant, your body needs iron for several reasons: It is important to make
hemoglobin (a protein in red blood cells that carries oxygen to other cells), collagen (a protein in
bones).

How Much Iron Should You Take?

Recommended Dietary Allowance (RDA) category

14-18 years 15 mg/day

19-50 years 18 mg/day

51 years and older 8 mg/day

Pregnant 27 mg/day

Iron metabolism in pregnancy:

Transport regulatory fiber from maternal plasma to fetal circulation during pregnancy. When
fesidinone levels are low, the rate of iron entry into plasma iron increases. When ferritin levels
are high, iron is sequestered in intestinal cells, macrophages, and hepatocytes. When pre-
regulated levels are high, ferroportin is internalized. The minimum daily requirement of external
iron remains 1 to 8 mg. However, an additional external supply of iron is necessary to balance
the increasing need for iron, especially during growth, pregnancy and lactation. This significant
increase in iron requirements is essential for fetal and placental growth and maternal blood
volume. In addition, pregnant women suffer from iron deficiency before and after childbirth. In
total, about 1000 mg of iron is lost during pregnancy and breastfeeding. Therefore, pregnant
women should consume 27 mg of iron per day, rather than the 8 mg that non-pregnant adults
should consume. For breastfeeding, the necessary dose is 10 mg per day.

Pathophysiology of iron deficiency anemia in pregnancy:

Physical or wasting anemia of pregnancy is observed in healthy pregnant women due to a 30-
40% increase in plasma volume compared to 20-40-25% volume of hb mass and This results in a
slight decrease in hb levels in erythrocytes, which leads to a hypoadhesive state, which facilitates
the supply of oxygen to the placenta and fetus. Pregnancy dramatically increases iron
requirements to compensate for increased hematocrit, growth of fetoplacental units, and body
needs lost during labor and lactation. Institute of Medicine (IOM) estimates.

Role of Hepcidin:

Systemic iron homeostasis is controlled by a peptide hormone produced mainly in the liver and
released by the kidneys. Hepcidin works by modulating the activity of ferroportin, a mammalian
iron transporter. Ferroportin provides stored, dietary, or recycled plasma iron and is expressed at
all sites involved in plasma iron exchange, including duodenal enterocytes, macrophages, the
basolateral membrane of hepatocytes, and the placenta. These sites in the lower layer of the
trophoblast cause the denaturation of intracellular hepcidin. iron transporters and thus prevent the
export of iron into the plasma. Changes in hepcedin levels can lead to rapid fluctuations in
plasma iron levels.
Diagnosis:

Iron deficiency is suspected, other tests may be present such as: serum iron, total iron binding
capacity (tibc), saturation plasma or serum transferrin and ferritin. It is important to be aware of
the limitations of the citations, as these values are often not the same. A promising lady. Also,
laboratory values in pregnancy often change during a woman's pregnancy. For example, what is
the hemoglobin reference value for anemia varies from person to person. Trimester First
trimester hemoglobin <11 g/dl Second trimester hemoglobin <10.5 g/dl Third trimester
hemoglobin <11 g/dl Postpartum hemoglobin <10 g/dl 4 Possible pregnancy abnormality at
diagnosis4 Hemoglobin levels below 10 g/dl dl can be diagnostic and are associated with
increased risk of fetal weight, low birth weight, and preterm birth, as well as maternal morbidity
and mortality (levy et al., 2007)., 2005) At 6-12 weeks of gestation, maternal plasma volume
increases by 10-15% and persists for 34 weeks.

During a successful pregnancy, plasma volume increases by about 50%. If a woman maintains
her iron levels, red blood cell volume increases by 20 to 30% toward the end of pregnancy.
Diagnostic tests to distinguish iron deficiency anemia include serum ferritin, serum iron
concentration, transferrin saturation, total iron binding capacity, and total binding capacity. blood
count. Serum ferritin concentration is the best known diagnostic test.

Formula for iron deficiency anemia in pregnant women:

Required dose of iron (mg) = (2.4 × (target Hb-current H6) × pre-pregnancy weight (kg)) + 1000
mg for replenishment

Non-anemic iron deficiency:

Anemia is the final manifestation of id because erythropoiesis is usually preserved until late
stages of id. Thus, in pregnant women, most of the burden of ID would not go unnoticed unless
there was anemia considered appropriate for iron storage. Iron deficiency not associated with
anemia (naid) is quickly recognized as a condition, but medical compatibility in pregnancy is not
clear. . A recent study of 102 non-anemic pregnant women found that 42% had evidence of

identity, such as ferritin below 30 per/L or transferrin saturation below 20%, but information on
maternal and infant outcomes was lacking.

Supplement:

A recent systematic review of iron supplementation in healthy nonpregnant women with naïe
showed that participants seeking iron reported lower levels of mental fatigue. However, objective
measures of physical performance such as time trials, fatigue test times or maximal oxygen
consumption did not improve. In addition, the overall quality of the evidence was rated as low to
moderate. Small studies of patients undergoing elective colorectal and cardiac surgery have
shown that untreated patients have worse postoperative outcomes than iron-supplemented
patients. pregnant woman. be reminded More research is needed into the diagnosis of naid and
its impact on maternal and infant outcomes. Systematic screening of pregnant women using
serum ferritin is recommended. However, cost implications and the lack of well-designed studies
to support this approach mean that a more targeted approach to identifying and treating women
at risk is currently recommended.

Risk factors:

During pregnancy, a person may be at increased risk of iron deficiency anemia if: The interval
between pregnancies is not long. Multiple pregnancy Nausea causing frequent vomiting. Heavy
menstrual flow before pregnancy History of anemia before pregnancy Taking low doses of iron.
People with anemia are at increased risk of death and health complications in the baby at birth
Miscarriage Premature birth Stillbirth Low birth weight (LBW) Early pregnancy (SG) High
blood pressure problems.

Diet therapy for iron deficiency anemia in pregnancy:

Authentic sources from the World Health Organization (WHO) Credibility sources are high. The
World Health Organization recommends that pregnant women consume 30 to 60 mm of iron per
day. When it comes to diet and pregnancy, the list goes on. But you have a list of what you eat.
Before you get pregnant, you need to increase your intake of calories and certain minerals and
vitamins. During pregnancy, you have an increased level of iron, an important mineral. Your
body does not make iron naturally. Iron can only be obtained through diet or supplements.
Therefore, it may be important to filter the amount of nutrients, especially during pregnancy.
Consider meat, chicken, fish, eggs, dried legumes and whole grains as iron-rich foods. Iron
format in meat products (so-called ham) is absorbed more than iron in vegetables

Why is iron important?

Pregnancy increases blood supply by 50%. Here comes the iron. The body uses red blood cells to
make them. Higher blood pressure means you need more red blood cells and more iron to make
blood cells. Blood loss is the most common blood disorder in pregnant women.

Types of iron:

Iron is associated with animal protein, but if the thought of meat makes you sick (morning
sickness) or if you are a vegetarian, iron can be found in a variety of foods. There are two types
of irons: Hame and Non Hame.

Ham Iron:

You can get this type of meat, fish and other sources of protein. Your body digests it quickly.
Non Ham Iron:

It's found in grains, legumes, vegetables, fruits, nuts, and seeds, and it takes longer for your body
to convert it into something it can use. Foods suitable for pregnancy rich in non-heme. If you
don't eat meat or can't stomach it, there are plenty of iron sources you can try. Keep in mind that
raw iron is poorly absorbed in your body and takes longer to satisfy your metabolism. If your
main source of iron is iron other than ham, talk to your doctor about adding an iron supplement.

Foods rich in iron;

Beans and Lentils:

Beans and lentils are rich in fiber and protein and contain almost no iron. White beans are such a
reliable source in any cup, all cooked. If you want to start including it in your diet, eat a lot of
beans and legumes and sprinkle them in salads or heat them a lot as a side dish.

Spinach And Kale:

Spinach and kale are also high in antioxidants, vitamins and iron. A cup of boiled cabbage is a
reliable source of 1 mg of iron, and spring is better than 6.4 mg 6.5 ml of Daoyuan. This
vegetable is versatile. Some can be mixed with a salad, cut into an omelet or fried in a Sawan
pan. You can also mix them into a long-lasting treat.

Broccoli:

Broccoli may be a favorite food for kids, but this vegetable is easy to prepare and packed with
many pregnancy-friendly nutrients. This common vegetable contains more than 1 mg of iron per
cup. As a bonus, broccoli is rich in vitamin C, which aids iron absorption. Broccoli is also high
in fiber, making it an excellent source of nutrition. Since pregnancy can slow down your
digestive system (bloating and constipation), adding a good source of fiber to your diet can help
ease these painful symptoms. Try roasting it on your head with olive oil and sea salt or steaming
broccoli and keeping it on hand for breakfast. As a bonus, broccoli is a great vegetable to have in
a parent's arsenal because it's easy to prepare and often enjoyed by toddlers. Broccoli can be very
spicy when cooked, so be careful. You are very disgusted by morning sickness or a strong
unpleasant smell.

Salmon:

Salmon is rich in iron. 1.6 mg per half pound of wild Atlantic salmon fillet. Salmon is safe
during pregnancy as long as it is thoroughly cooked to an internal temperature of 145°F
(62.8°C). This contributes to a healthy pregnancy. Salmon also has lower levels of mercury than
some types of salmon. Salmon is relatively high in iron – 1.6 mg of iron per pound of wild
Atlantic salmon fillet is a reliable source. Salmon is safe during pregnancy as long as it is
thoroughly cooked to an internal temperature of 145°F (62.8°C). In addition to being a source of
heme iron, salmon also contains omega-3 fatty acids and other nutrients that support a healthy
pregnancy.

Distribution of vegetables for pregnant women:

Most of the 4444 women come from poor families and eat mainly vegetables every day. About
70.2% of women eat 2-3 servings of vegetables a day. 15.5% eat 1-2 portions of vegetables per
day, 8.8% eat 3-4 portions per day, and 5.5% eat 3-4 portions per week.

Breakdown of fruit intake:

Since pregnancy, women eat mainly seasonal fruits such as apples, guavas and pomegranates
every day. According to the study, 63.2% of women consumed 1-2 servings, 18.8% ate 2-3
servings a day, 8% ate 3-4 servings a day, and 10% only ate 1-2 servings a day. Serve pulp and
its substitutes once a week.

Distribution of meat and its substitutes:

Our results showed that 55.8% of pregnant women consumed 1-2 servings of meat or meat
alternatives, especially eggs, beans, pulses and legumes. 25.5% consume 1-2 servings per week
because they are weak or unwilling.

Distribution of physical activity:

Physical activity was an important factor. It is divided into sedentary, light and active. The
largest number of women belong to the sedentary group, namely 74.6%. It therefore follows that
there is no statistical correlation between the level of physical activity and the level of
hemoglobin. Our results suggest that it doesn't matter if you are physically active or not.
However, it really depends on your food choices as well as your body's physiology.

How to increase iron absorption?

In addition to eating iron-rich foods, you can help your body get out by adding foods that help
you absorb more iron, such as foods rich in vitamin C. Eating sour fruits, tomatoes, red or yellow
bell peppers, or broccoli or cauliflower along with iron sources can help your your body to more
efficiently absorb the iron you use.

Avoid burns:

If you suffer a lot from heartburn related to pregnancy, you can look to vegetarian sources of
vitamin C instead of lemons, which increase breast irritation.

Warning signs of an iron overdose include:

Diarrhea and stomach pain

Vomiting of blood

Shallow, quick breaths

Yellow, flat hands

Weakness and fatigue

If you experience these symptoms and are pregnant, contact your healthcare provider
immediately. You may need emergency treatment.

Prevention:

The key to preventing iron deficiency anemia in pregnancy is to ensure that pregnant women
consume enough iron to meet their needs. They should eat a healthy, varied diet and take iron
supplements to prevent iron storage. Many pregnant women do not get enough iron from their
diet, even through fortified foods and supplements. For example, some studies show that 40% of
women between the ages of 19 and 34 depend on the person's symptoms and overall health.
Doctors can also tailor treatment depending on the severity of the anemia.

Treatment of iron deficiency anemia in pregnancy:

Oral iron supplementation:

Oral iron supplements are the first line of treatment for iron deficiency anemia. These
supplements should contain 40 to 100 mg of elemental iron. A person usually takes iron
supplements one or more times a day. Although iron is constantly replenished, the body absorbs
it poorly. To maximize iron absorption, people should take a vitamin C supplement, such as
orange juice, on an empty stomach. In addition, people should take iron supplements 1 hour
before or 2 hours after eating certain foods, including: tea, coffee, milk, soy products, eggs, enoic
acid, calcium, proton pump inhibitors, and trixin. In addition, people should take iron
supplements 1 hour before or 2 hours after eating certain foods, including:

Tea

Coffee

Milk

Soy products

Egg

Antacid

Calcium
Proton pump inhibitors

Thyroxin

Intravenous versus oral iron therapy in pregnancy:

Depending on the level, IV iron (including iron sucrose) has been used in randomized controlled
trials and may improve efficacy when used alone or in combination with IV iron. An increased
incidence of thrombosis was associated with a single intravenous dose of iron sucrose. In
contrast, six small intravenous doses of iron sucrose over three weeks did not cause infusion-
related thrombosis and were well tolerated when given in five daily doses to 45 pregnant women.
During the study, there were no significant changes in Hb levels between IV ferrous sucrose and
oral ferrous sulfate on days 8, 15, 21, and 30 and the use of IV ferrous sucrose at delivery.
However, when Hb levels were assessed using six small doses of iron sucrose at two and four
weeks after IV iron administration and at delivery, there was a significant difference in the IV
iron-sucrose group. However, both studies showed that the patient's increased effort during the
six infections came at the expense of the immediate need to go to the hospital, the administration
of iv iron sucrose, according to the data of 79% of women receiving iron orally compared to
4.5% of women receiving iron iv at birth (p 0.001) In in the oral iron group, 29% of pregnant
women had Hb levels below 116 g/L versus 16% in the intravenous iron group (p = 0.04).

During and after childbirth:

Despite the high disease prevalence and burden associated with IDA, a comprehensive meta-
analysis revealed a paucity of high-quality studies examining the maternal and neonatal clinical
effects of iron treatment in women with IDA. . Only prospective randomized trials comparing
intravenous iron with oral iron for IDA in pregnancy met the strict requirements of an
independent review. The recommended daily dose is 40 to 80 mg of iron, which is high in iron.
Women who need immediate correction of symptomatic anemia or who cannot tolerate oral iron
should use imported iron. A recent systematic review showed that these women improved by an
average of 9 G/L (95% CI: 4-13 G/L) within 60 days of oral iron maintenance therapy. Iron is
0.6%.

Side Effects of IV Iron:

Avoidance of blood transfusions during pregnancy is unknown, but a recent experiment

comparing IDA therapy during pregnancy with oral iron versus intravenous iron found no
transfusions to control blood loss during pregnancy. However, two subjects (0.9%) in the oral
iron group required blood transfusions during the postpartum period. For optimal therapeutic
effect, it is important to use safe, effective, high and infrequent doses in different medical
conditions. The primary goals of these technologies include reducing overall costs, relieving
overburdened healthcare systems, improving patient comfort, increasing compliance,
maintaining access to Venus, and reducing.
Avoiding blood transfusions:

Blood transfusion has traditionally been an effective treatment for anemia in patients with severe
IDA, especially in cases where patients have not responded to dietary iron therapy or when rapid
correction of anemia is clinically necessary. Avoidance of blood transfusions during pregnancy
is not well understood, however, a recent experience comparing treatment of IDA with oral and
intravenous iron in pregnancy showed that no blood transfusions were found to control blood
loss during pregnancy. However, in the postnatal stage, two people (0.9%) in the oral iron group
required a blood transfusion. To achieve the best treatment results, it is important to use safe,
effective, large and infrequent doses for different medical conditions. The main goals of these
techniques include reducing overall costs, providing relief to overburdened healthcare systems,
increasing patient comfort, increasing compliance, maintaining access to Venus, and minimizing
blood transfusions.

Other causes of anemia in pregnancy;

Folic acid and vitamin B12 deficiency:

The prevalence of folate deficiency in pregnancy ranges from 15% to approximately 49% and is
higher in economically disadvantaged areas of the world. Several studies have shown that the
incidence of folate and cobalamin deficiencies increases with advancing pregnancy. Folate and
cobalamin participate in tetrahydrofolate metabolism and are essential for DNA synthesis in fetal
development and maternal tissue development. Dietary folic acid is absorbed in the jejunum.
Malnutrition, intestinal disease, and increased fetal growth needs can lead to folate deficiency.
Cobalamin is present in animal proteins and is absorbed in the terminal ileum. Protein R
(haptocorrin) secreted by the salivary gland binds to cobalamin in the stomach and transports
cobalamin to the duodenum, where trypsin cleaves protein R. Cobalamin is then released and
binds to intrinsic factor secreted by the parietal cells. The cobalamin-intrinsic factor complex
then binds to ileal enterocyte receptors. Atrophic gastritis, proton pump inhibitors and
malabsorption increase the risk of cobalamin deficiency. Bariatric surgery in the United States
increased by 800% between 1998 and 2005, and women accounted for 83% of procedures in the
18-45 age group. In a retrospective study, 17% of patients undergoing bariatric surgery had
anemia, 15% had low ferritin, 11% had low cobalamin, and 12% had low red blood cell folate.
Folate is a naturally occurring vitamin in certain foods, such as the B vitamin found in green
leafy vegetables, that the body needs to make new cells, including healthy red blood cells.
Women need extra folic acid during pregnancy. However, sometimes they don't have enough
food. When this happens, the body cannot produce enough red blood cells to supply oxygen to
all the tissues in the body. Human folic acid supplements are called folic acid. Folic acid
deficiency can directly lead to certain types of birth defects, such as neural tube defects (spina
bifida) and low birth weight. Vitamin B12 produces healthy red blood cells If a pregnant woman
does not get enough vitamin B12 in her diet, her body cannot produce enough healthy red blood
cells. Women who avoid meat, poultry, dairy and eggs are at higher risk of vitamin B12
deficiency, which can lead to birth defects such as neural tube defects and lead to premature
birth. Anemia during and after childbirth can also cause anemia.

Signs and symptoms:

Common symptoms include headache, fatigue, lethargy, tachycardia, dyspnea, paresthesia,

pallor, glossitis, and cheilitis. Acute symptoms include heart failure, placenta previa, placenta
previa, and operative delivery.

Literature review:

More than 2 billion women worldwide suffer from iron deficiency, especially pregnant women
who suffer from nutritional iron deficiency, the most common form of iron deficiency.
According to the World Health Organization (WHO), iron deficiency anemia (IDA) is a serious
problem. in pregnancy worldwide, with an average prevalence of 14% to 56% among pregnant
women in industrialized countries. In developing countries (range 35-75%). In addition, IDA is
considered the only nutritional deficiency that exists in both developed and developing countries,
affecting both mothers and children. Since more than 2 billion people in different parts of the
world or more than 30% of the world's population suffer from iron deficiency with different
frequency, distribution and causes, the number of patients with ID and IDA is amazing. Women
are more susceptible to iron deficiency than any other disease, creating a public health epidemic.
Despite numerous warnings and awareness campaigns, it usually presents with mild symptoms
and should be considered a chronic and progressive disease that is often overlooked and
neglected worldwide. Due to the high frequency of IDA in women, it has serious health impacts
and subsequent socioeconomic risks, such as adverse pregnancy outcomes, poor school
performance and ability to work and reduced productivity. Several international nutrition
conferences have focused on this topic with the aim of reducing the incidence of iron deficiency
in women of childbearing age, but due to the severity and consequences of iron deficiency
anemia, especially in women of childbearing age, without much success. Several studies have
been conducted on the effects of IDA. However, there is a paucity of data on its impact on
patient health, but according to the 2016 World Disease Study, iron deficiency is one of the top 5
causes of disabling anemia, ranking first in men/dL, 12 g/dL (women, 11 g/dL /dl) during
pregnancy, a global survey showed that in 2010, anemia still affected a third of the population
and almost half of the cases were caused by iron deficiency. The assumption is this: 1.24 billion
people suffer from iron deficiency anemia, although this varies widely among low-income
countries. .This problem becomes even more relevant when considering functional iron
deficiency, which occurs when iron is strongly consolidated from stores, such as in chronic
swelling/infection, or when iron is necessary for extrinsic or endogenous red blood cell
expansion (recommended increase ). The full amount of their diet is used and the excess energy
helps them meet the increased need for iron, which is estimated at 27 mg per day during
pregnancy. This excess iron and energy requirement during pregnancy can be observed for the
effectiveness of research interventions, as the absorption of non-heme iron during pregnancy
increases as pregnancy progresses, consistent with the increase in maternal red blood cells and
their rapid growth. . Placenta and fetus, given that interventions during pregnancy may be more
effective than in non-pregnant women. Daily iron supplementation is currently recommended as
part of prenatal care to reduce the risk of maternal anemia and low birth weight. However, it has
been found that adequate adherence to iron supplementation by pregnant women can be difficult,
as was the case in the study by Fouelifack et al. 56% of these women were found to be iron
deficient and the main reasons for non-adherence were side effects, forgetfulness and lack of
access to iron supplements. A promising opportunity to improve iron status in pregnant women
is useful in the presented systematic review. Three key nutritional strategies have been identified
to overcome anemia and improve iron quality in pregnant women. The first is food modification,
which aims to increase iron levels by choosing iron-rich foods such as meat and fish, legumes
and green leafy vegetables. Since grain products can provide significant amounts of iron in
young women's diets, their intake should also be increased. However, efforts should also be
made to increase the bioavailability of iron to ensure adequate amounts of foods such as vitamin
C and meat, and iron inhibitors such as plant cells, polyphenols and small amounts of calcium to
increase iron absorption. This approach is commonly used in research, as the majority of studies
reviewed in this systematic review found all dietary interventions evaluated to be effective in
preventing and treating anemia in pregnant women. Regarding the risk of bias, most of the
included studies were described as having a moderate risk of bias, but some studies showed a
high risk of bias due to the randomization process, due to the bias of the expected intervention,
reported results Many studies evaluated dietary interventions in prevention and treatment
effectiveness if it's blood loss in pregnant women like studies done in non-pregnant women in
pregnant women. Studies done include increasing iron intake. Improving the bioavailability of
iron increases the intake of iron and simultaneously increases the intake and absorption of other
nutrients. However, the results obtained were not as unusual as the studies included in this
systematic review. Although all studies in this review focused on the prevention and prevention
of blood loss in pregnant women, some dietary interventions were insufficient to improve iron
quality in non-pregnant women. Pregnancy is a fast time. Since one of the most important health
problems of pregnant women is blood loss [38], special attention should be paid to a balanced
diet.

Summary:

Iron deficiency anemia is a global health problem that particularly affects pregnant women. Iron
deficiency anemia in pregnancy is associated with increased maternal and maternal morbidity
and mortality. Maternal iron deficiency may also be associated with neurological deficits in
newborns. The need for iron increases during pregnancy and is influenced by the master
regulator of iron homeostasis, Fethinone. The overall consistent burden of maternal anemia
suggests that currently used iron supplementation strategies are the best. For rapid correction of
maternal anemia, iron supplementation appears to be a safe treatment, but patient outcome and
cost-effectiveness studies are needed. Future studies should be sufficiently powered to assess
relevant outcomes for pregnant women. Prevalence of iron deficiency anemia in developed and
developing countries. IDA is the most common nutritional deficiency in the world, with
approximately 32 million pregnant women classified as anemic and approximately 750,000
pregnant women classified as severe. Prevalence of IDA approximately 18.0%. Iron deficiency
in the third trimester of pregnancy can be observed from 6.9% to 14.3% at 28.4%. Analysis of
representative data on Hb and prevalence of severe anemia from 1995 to 2011 revealed a
prevalence of anemia in pregnancy of 14.0% in high-income areas and 23.0% in Central and
Eastern Europe. In contrast to these developed countries, about 53.0% of pregnant women in
South Asia are diagnosed with anaemia, of which 3.8% were severely anemic. More than 70.0%
of them had iron deficiency anemia. 11 Inadequate consumption of iron-containing foods, poor
hygiene, safe water, parasite burden due to iron deficiency (e.g. malaria or intestinal worms),
anemia in young people, teenage pregnancy and frequent pregnancy in low-resource countries
are the main reasons for the disproportionate increase in incidence IDA during pregnancy.
Regarding the prevention of iron deficiency anemia in pregnancy, Malaysia follows a prevention
program that recommends routine iron supplementation to all pregnant women as in most
developing countries. Despite iron overload, the incidence of anemia in pregnancy did not
improve much. The biggest obstacle to solving this problem is poor adherence to iron
supplementation. Adherence is essential to ensure good iron storage and to ensure better
maternal iron status. It is a personal choice of each clinic or hospital to provide complementary
foods to mothers without proper supervision of their adherence to protocols. However, almost
half of pregnant women in Malaysia do not take iron supplements due to the legendary fear of
forgetting, intolerance to the side effects of iron pills, and the legendary fear of being fat. child
due to taking iron pills. However, other causes of nutritional anemia such as folic acid and
vitamin B12 deficiency should be considered to prevent anemia in pregnancy. Iron deficiency in
pregnancy has significant adverse effects on maternal and fetal outcomes, including low birth
weight, premature death, increased risk of maternal infection, as well as anemia and infection.
Including low tolerance also affects the child's immediate and long-term neurological
development. Low maternal iron intake has been shown to be associated with an increased risk
of autism, schizophrenia and structural brain abnormalities in offspring. One review reports the
results of several cross-sectional studies indicating that the prevalence of iron deficiency in
pregnant Canadian women and pregnant teenagers ranges from 3% to 66%. Given the adverse
effects of iron deficiency on maternal and infant health, uncertainty remains as to whether
screening for iron deficiency anemia in pregnancy should be part of routine care and which type
of test (eg, Hb or ferritin) is most effective for improvement And child health outcomes.

Conclusion:

It is useful to consider a global and comprehensive management algorithm that offers multiple
evidence-based treatment options and focuses on regional problems. However, lack of resources
is a common problem in poor countries where IDAs are important. Therefore, it is necessary to
design a functional scheme for the successful use of locally available resources. The key to the
effectiveness and sustainability of these programs may lie in making IDA treatment a top priority
and raising community awareness of this persistent and serious disease. The successful
elimination of IDA will undoubtedly have a large positive impact on productivity and
community health, saving significant health costs in developing and wealthy countries. This
condition can have devastating effects on an entire population, and if neglected and improperly
treated, can have serious consequences. Therefore, IV iron therapy should be considered as a
quick, effective, and safe treatment alternative for certain medical conditions. Based on several
prospective randomized trials, it is suggested that one approach to the treatment of iron
deficiency anemia during pregnancy and the postpartum period is more frequent intravenous iron
administration to avoid or reduce the need for transfusions. blood and quickly replenish iron
levels. When considering treatment options for IDA, the recent development of intravenous iron
preparations, considered a milestone in the treatment of IDA, should be kept in mind. Therefore,
it is necessary to design a functional program for the successful use of available local resources.
The key to the effectiveness and sustainability of these programs may lie in making the treatment
of IDA a top priority and increasing community awareness of this persistent and serious disease.
The successful removal of IDA will undoubtedly have a significant positive impact on
productivity and the community. health, which translates into significant health care cost savings
in both developing and wealthy countries.

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