Anemia in Pregnancy

Introduction

Anemia is defined as a hemoglobin level below 11g/dl during the first and third trimester and below 10.5 g/dl during the second trimester. Pregnancy aggravates pre-existing anemia due, for example, to nutritional deficiency or malaria. Anemia increases the risk of intrauterine growth retardation and preterm birth. It increases vulnerability in the event of hemorrhage, particularly postpartum hemorrhage.

Diagnosis

• Pallor of the conjunctivae, mucous membrane, palms and the soles of the feet; fatigue, dizziness, tachycardia, heart murmur.
• Signs of serious illness: intense pallor lethargy, dyspnea, hemoglobin below 7g/dl.
• Measure Hb level.

Treatment

• Tab Ferrous sulfate/ folic acid (co formulated tablet containing 200mg ferrous sulfate equivalent to 65 mg elemental iron + 400 micrograms folic acid) PO 2-3 tabs per day in divided doses until Hb level rises to normal, then change to preventive treatment (200mg ferrous sulfate (65mg elemental iron) + 400 micrograms folic acid tablet may be replaced by 185 gm ferrous fumarate (60 mg elemental iron) + 400 micrograms folic acid tablets).
• Addition of vitamin-C PO 500mg/day improves iron absorption.

For severe anemia in the third trimester

• Arrange for delivery in an established facility.
• Ensure active management of third stage of labor and if required, uterine exploration / manual removal in case of postpartum hemorrhage, or possible transfusion.
• Given the risk of hemorrhage and rapid decompensation during delivery, be prepared for transfusion for any woman whose hemoglobin is below 7 g / dl, even if anemia is relatively well - tolerated.

Note

The World Health Organization recommends 30 to 60 mg of elemental iron daily however, a dose of 60 mg of elemental iron daily is preferred over a dose of 30 mg daily in settings where prevalence of anemia in pregnant women is high (≥ 40 %).