ANEMIA DURING

PREGNANCY

ANEMIA DURING PREGNANCY

Anemia is the commonest medical disorder
in pregnancy.
The WHO definition for diagnosis of anemia in
pregnancy is a Hb concentration of less than
11g/ dl (7.45 mmol/l) and a hematocrit of less
than 0.33.
CDC (Centers for disease control) proposes a
cut- off point 10.5 g /dl during the second
trimester.

ANEMIA DURING PREGNANCY

PREVALENCE OF ANEMIA IN
PREGNANCY
It is estimated that about 51% of pregnant
women worldwide will sufffer some degree of
anemia during pregnnacy. Hb levels of 9-11
g/dl is considered mild anemia.
Pregnancy by itself will aggravate any
already existing anemia.

anemia DURING PREGNANCY

CLASSIFICATION AND TYPES OF
ANEMIA :
A- Physiological anemia :
During pregnancy the plasma volume increases
more than the increase in the R.B.C. volume
resulting in hydraemia and physiological anemia
(blood picture is normal).

ANEMIA DURING PREGNANCY

B- Nutritional anemia :

Iron Deficiency anemia:

It is the commonest nutritional deficiency in pregnancy
followed by folate deficiency anemia. It may either be
due to incresaed iron loss or decreased iron
absorption.
Megaloblastic anemia:
In megaloblastic anemia, DNA replication is affected.
There is derangement of red cell maturation with
production of abnormal precursors known as
megaloblasts which can be due to deficiency of folate
or vitamin B12.

anemia DURING PREGNANCY

C- Haemorrhagic anemia :
Repeated blood loss during pregnancy, as with
antepartum haemorrhage, or GIT bleeding.
D- Haemolytic anemia .
E- Microangiopathic haemolytic anemia:
Occurs in some patients with severe preeclampsia eclampsia, thrombotic
thrombocytopenic purpura and hemolytic
uremic syndrome.

ANEMIA DURING PREGNANCY

F- Acquired immune hemolytic anemia:
Antibodies of the IgG type agienst red cell
antigens are present in collagen vascular
diseases.
G- Hemolytic anemia associated with
haemoglobinopathies: abnormal
hemoglobin synthesis;
Sickle cell anemia
Beta thalassemia.

ANEMIA DURING PREGNANCY

H- Aplastic anemia :
Extremely rare and the mortality rate is
about 30%.

ANEMIA DURING PREGNANCY

Severity of anemia
Category

anemia severity

Hemoglobin
level (g/dl)

Mild

10-10.9

Moderate

7-10

Severe

<7

Decompansated

<4

ANEMIA DURING PREGNANCY

EFFECTS OF ANEMIA ON PREGNANCY
:
A- Maternal Effects :
Mild anemia: No effect on pregnancy and labour.
Mother will have low iron stores.
Moderate anemia: Increased weakness, lack of energy,
fatigue and poor work performance.

Severe anemia: Associated with poor outcome.

Increased incidence of pre-trem labour, preeclampsia and sepsis

ANEMIA DURING PREGNANCY

B- Fetal Effects:
Decreased iron stores due to depletion of
maternal stores.
High risk for an adverse perinatal outcome
(PTL, SGA, and increased perinatal
mortality).

ANEMIA DURING PREGNANCY

Iron requirements in pregnancy :
The requirements are
(i) Basal iron ,280 mg .
(ii) Expansion of red cell mass, 570 mg .
(iii) For transfer to the fetus, 200-350mg .
(iv) For placenta, 50-150 mg .
(v) blood loss at delivery, 100-250mg.

ANEMIA DURING PREGNANCY

After deducting iron conserved by
amenorrhoea (240-480 mg), an additional
500-600 mg of iron is required in
pregnancy or 4-6 mg/day of absorbed iron.
Because absorption is less than 10% at
least 40-60 mg of iron should be available
in the diet, so iron supplementation is a
necessity in all pregnant women.

ANEMIA DURING PREGNANCY

DIAGNOSIS IN PREGNNACY:
Symptoms:
There may be no symptoms, especially in mild and
moderate anemia. Patient may complain of weakness,
exhaustion, loss of appetite, palpitation and dyspnoea.
Rarely, generalised anasarca and congestive heart
failure in severe cases.
Signs:
There may be no signs, especially in mild and moderate
cases. Pallor, glossitis and stomatitis may be persent. In
severe cases oedema and systolic murmur can be
found.

ANEMIA DURING PREGNANCY

Investigations:

Complete blood picture including Hb% and

haematocrit value (Ht).
Serum ferritin; better picture of stored iron;
levels below 30 ug/l are diagnostic of iron
deficiency.
Investigations for detection of the cause :

Serum iron
Peripheral blood smear
HB electrophoresis; for diagnosis of inherited
anemia

ANEMIA DURING PREGNANCY

MANAGEMENT OF anemia :
During pregnancy :
Prevention: Proper antenatal care. Iron
supplementation using oral iron preparations.
Proper diet rich in iron and vitamin C.
Treatment:
Oral iron therapy: In mid trimester or early 3rd
trimester. Hemoglobin rises from 0.3 to 1.0 g per
week, and this is reflected in a significant
elevation in Hb/Ht values 2 to 3 weeks after
initiation of treatment.

ANEMIA DURING PREGNANCY

Parentral iron therapy: For women with severe
anemia in late 3rd trimester or those with poor
compliance for oral therapy. Iron dextran is
used.
Blood transfusion (Packed cells are preferred):
Very rarely required in patients with severe
anemia beyond 36 weeks, associated infection,
to compensate blood loss due to antepartum
haemorrhage and in patients not responding to
iron therapy.

ANEMIA DURING PREGNANCY

During labour :

First stage: Oxygen should be ready if dyspnoea

develops. Antibiotic prophylaxis.
Second stage: Shortened if necessary to avoid
maternal exhaustion.
Third stage: Active management should be done
excpet in very severe anemia for fear of cardiac
failure (any post partum haemorrhage must be
treated as these patients tolerate bleeding very
poorly).

anemia DURING PREGNANCY

During Puerperium:
Adequate rest, iron and folate therapy for at
least 3 months.
Any infection should be promptly treated.

ANEMIA DURING PREGNANCY

Molecular
iron content
(mg)

Elemental iron
content (mg)

Ferrous sulfate

300

60

Ferrous gluconate

200

36

Ferrous fumarate

300

66