ANEMIA IN PREGNANCY

Asheber Gaym M.D.

January 2009
 Outline

 Definition and epidemiology of anemia in

pregnancy
 Describe iron demand during pregnancy
 Discuss causes of anemia in pregnancy
 Discuss diagnostic approach to anemia in
pregnancy
 Outline complications of anemia in pregnancy
 Outline management of anemia in pregnancy

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 Definition and Epidemiology of Anemia in
Pregnancy
 WHO definition- Anemia in pregnancy is a
hemoglobin level of less than 11g/dl. This is to make
adjustments for the physiological hydremia of
pregnancy
 The commonest medical complication of pregnancy
– WHO- upto 50-65% of pregnant women in low-
resource countries
 More common among multifetal gestations; poor
women; malnourished societies; high parity;
adolescent mothers; inter- pregnancy intervals less
than two years and women with obstetric
hemmorhage during current pregnancy
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 Iron Demand of Pregnancy

 Total iron demand for a singleton pregnancy is around 1 gram

 This demand is shared for the formation of fetal structures; fetal
blood; placenta; maternal red cells increase; myoglobin in the
uterus and cytochrome enzyme systems increase
 The demand is much more for multifetal gestations
 Total iron content of an adult female is around 2.5 grams- about 1.5
grams is in the form of hemoglobin and much of the rest is in the
cytochrome enzyme system of each cell and myoglobin of muscle
cells
 Only a small amount is in the storage forms of ferritin and
hemosiderin which can be mobilized to meet the iron demand of
pregnancy
 This implies that the iron demand of pregnancy must be met by the
diet- if that is lacking the mother rapidly slides to a state of anemia

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 Etiology of anemia during pregnancy

 All causes of anemia are potentially possible during

pregnancy
 But the majority are due to:
 Nutritional deficiencies
 Iron deficiency anemia
 Folate/B12 deficiency anemia
 Parasitic illnesses
 Hookworm infections
 Other intestinal parasites
 Malaria
 Hemmorhage during pregnancy
 Abortion
 Antepartum hemmorhage
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Diagnostic approach to anemia in pregnancy
– Steps
 Routine Hemoglobin check at first ANC visit
 If anemia is diagnosed
 Follow up with peripheral blood smear
 If microcytic hypochromic picture is found then a
provisional diagnosis of nutritional anemia can be
made after ruling out intestinal parasites and malaria
by stool exam and blood film exam
 Additional workup for anemia that is often not
required during pregnancy include:
 Red cell indices; serum iron; total iron binding capacity;
serum and bone marrow ferritin levels
 Bone marrow studies..etc
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Complications of anemia during pregnancy

 Severity of complications depends on severity

of anemia
 Maternal complications
 Congestive high output heart failure
 Intolerance to hemmorhage such as PPH
 High infection rates including puerperal sepsis
 Fetal complications
 Fetal growth restriction
 Preterm labor and prematurity

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 Management outline of anemia during
pregnancy
 Depends on the specific cause
 Nutritional anemia:
 Management depends on:
 Anemia severity
 Gestational age and proximity to delivery
 Presence of complications such as heart failure
 Iron supplementation
 Oral – 300 mg of ferrous sulphate or fumarate t.i.d
 Parenteral – If oral intake is not tolerated IM iron dextran
or sorbitol monthly injections
 If gestational age is not near term or labor; anemia is mild
or moderate and no hemodynamic instability
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 Management – Continued

 Blood transfusion – Indications

 Severe anemia (hemoglobin <7 g/dl) with
hemodynamic effects including congestive heart
failure
 Severe anemia in labor
 Severe anemia at term or near term and iron
supplementation may not correct anemia in a
reasonable period of time
 Severe or moderate anemia with hemorrhagic
complications such as antepartum hemmorhage

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 Prevention and Prophylaxis

 Adequate and balance diet

 Interpregnancy intervals at least three years
 Routine(?) iron supplementation
 Oral iron 300 mg once daily throughout pregnancy
 Particularly for multifetal gestations and in high
anemia prevalence areas
 Reduction of adolescent pregnancies by
supplying family planning to those who need it

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