Pregnancy and Anaemia (Iron Deficiency Anaemia)
Anaemia is the most common nutritional deficiency in the world. Prevalence of anaemia in developed & developing countries is more than 50%. In India incidence of anaemia is highest in the world. It is higher in pregnant women and pre-school going children. It has been observed that even in higher income & educated groups about 50% of population of children, adolescent girls and pregnant women are anaemic. It is due to improper dietary iron and poor bioavailability of dietary iron.
Increased requirement of iron during growth, pregnancy and chronic blood loss (due to menstruation) may leads to higher ratio of anaemia in this specific group. There are many fold increase in maternal mortality rate (MMR) when haemoglobin falls below 5gm/dL.Early diagnosis and management of anaemia in pregnancy can reduce maternal mortality rate. Maternal anaemia leads to poor intra-uterine growth and increased risk of pre-mature delivery and low birth weight rates resulting-
1. Higher perinatal morbidity & mortality.
2. Higher infant mortality rate.
When Hb% is less than 8gm% it may give rise to-
• Low birth weight rate.
• Increased perinatal mortality rate
Signs and symptoms of iron deficiency anaemia :
Signs and symptoms of anaemia is as follows-
• Fatigue (is most common sign)
• Pale skin
• Brittle nails
• Unusual thirst and food craving
Blood test is the best method of diagnosis of anaemia.
Tenth Plan Strategy to prevent anaemia in Pregnant Females :
Tenth five year plan strategy for preventing anaemia in pregnant women is effective if followed. Tenth Plan strategy is as follows-
1. Fortification of common food items like salt with iron is affective to improve the Hb percentage of whole population including girls & women before pregnancy. Nutritional education also improves the iron and folate intake.
2. Screening of all pregnant women for anaemia is required.
3. Oral iron folate is given to prevent anaemia of all non-anaemic pregnant females.
4. Oral iron folate therapy is given to a maximum tolerable dose throughout the pregnancy with haemoglobin level between 8-11g/dl.
5. Parenteral iron is given with Hb level between 5-8g/dl if they don't have any obstetric or systemic complication.
6. Hospitalisation and intensive care is required for women with Hb less than 5g/dl.
7. Screening and proper management of obstetric & systemic problems in all anaemic pregnant females;
8. Improvement in health care delivery systems and health education to the community to promote the utilization of available health facilities.
Prophylaxis of iron deficiency anaemia :
Prophylaxis of iron deficiency anaemia in women is based mainly on two principles-
1. Balanced diet containing iron rich food.
2. Periodic intake of supplementary iron during pregnancy, lactation, and excess menstruation.
Amount of Iron required during pregnancy :
Normally about 15mg of iron is needed a day in normal female. During pregnancy extra iron is needed which is double the iron before you conceive i.e. 30mg iron a day keeps you and your baby healthy. Less intake of iron leads to iron deficiency anaemia in you and your offspring's.
Sources of iron :
• Consumption of food rich in iron alone may not be a solution to improve haemoglobin levels.
• Consumption of iron & protein particularly animal protein is essential to increase the iron reserves like Lean red meat, Chicken and Fish are rich in iron.
• In vegetarians: Dal along with green leafy vegetables can compensate the iron.
• Spinach (Palak), Fenugreek (Menthe), Mustard (Sarson), Bathua, Coriander (Dania), and Mint (Pudina) are richest source of iron.
• Soya protein, whole meal bread and flour, fortified cereals with iron, potatoes, raisins, prunes and pulses.
• Fruits: Bananas, plums and black grapes, apricots, pomegranates (dried or semidried), Amla, amla juice and its murabba is rich in vitamin C & iron.
• Groundnuts, Jaggery (un-refined brown sugar).
• Vitamin C helps your body to absorb the iron in your diet.
Complications of Iron Deficiency Anaemia :
Moderate anaemia may cause-
• Increased maternal mortality rate.
• More prone to infection with prolonged recovery from infection.
• Premature birth of baby.
• Deliver child with low birth weight.
• Increased perinatal mortality in babies.
• Maternal death due to ante-partum and post partum haemorrhage.
• Pregnancy induced hypertension and sepsis.
Severe anaemia may cause-
• Circulatory failure
• Pulmonary oedema
Prevention of anaemia in pregnancy :
• Monthly screening as a routine in all pregnant female in ante natal care clinic is important.
• Proper and quick management of severe anaemia prevents the maternal and perinatal deaths.
Treatment of iron deficiency anaemia :
In pregnant women iron deficiency anaemia is treated by diet and with medicinal iron (iron pills). Always avoid iron pills with milk, coffee, antacids and food rich in fibres.
When haemoglobin is below5g/100ml it is advisable to keep patient in bed and decision for blood transfusion is made on the basis of clinical state of patient instead of haemoglobin level.
Parenteral iron therapy of commercial preparation of iron can be given intra-muscularly or intravenously. This route of administration of iron is advisable to those patients who are generally unable to take iron by mouth because of pain in abdomen, vomiting and diarrhoea or who are unable to absorb iron because of malabsorption syndrome of gastrointestinal tract. Injectable iron therapy is also given in following conditions:
• Anaemia in rheumatoid arthritis
• Severe anaemia correction in late stage of pregnancy
• Following major operations
Prognosis of iron deficiency anaemia :
Prognosis of iron deficiency anaemia depends on the cause, its severity and age of patient. It is good in young but poor in elder ones. Young people tolerate anaemia better than elders