Women who become pregnant may be at risk of having an iron deficiency, called anemia. It is more elaborately explained as a deficiency of red blood cells that cannot provide oxygen to the body’s tissues. To have a clearer view of the condition; Hemodilution which is termed as hydremia of pregnancy increases the inconsistent plasma volume and red blood cell mass as a result hematocrit (the number of red blood cells in the blood) decreases. Hematocrit in healthy women is reduced from thirty-eight percent to forty-five percent, drops to thirty-four percent in a late single pregnancy, and thirty percent in a multi-fetal pregnancy. Usually, women with the consequent hemodilution (a reduction in red blood cells) are treated prophylactically during pregnancy as there is a chance of having a Hb level of less than ten. However, oxygen capacity remains standard in the condition and hematocrit escalates right after delivery.
Types of Anemia in Pregnancy
Two major types of anemia can occur during pregnancy. Firstly, there is iron deficiency anemia which includes iron-deficient patients. Secondly, there is anemia of pregnancy in which hemoglobin is condensed to unwanted levels. Thirdly, inadequate dietary intake results in vitamin B12 deficiency. Lastly, folate deficiency can be initiated by anti-folate drugs, resulting in hemolysis and folic acid malabsorption. Sometimes the baby does not grow to proper weight (premature), which could also cause anemia. A good nutritional diet is the best way to reduce anemia and increase hematocrit in the body.
Treatment of Anemia in Pregnancy
Treatment is determined by age, symptoms, condition, and health. The first step towards a cure is increasing the intake of iron supplements, including oranges, and carrots, and eating green vegetables like leafy greens of the cabbage family, which comprises broccoli, kale, turnip greens, and collards. There may be some distress after ingesting iron supplements such as nausea, stools becoming dark greenish or black, and can lead to constipation as well. The doctor usually recommends ferrous sulfate 325 mg daily in mid-morning; the percentage intake will be less because one dose may block absorption of the next dose and supplemental oral iron is, at times, not absorbed enough by twenty percent of pregnant women. Dextran 100 mg daily is also an effective dosage for iron deficiency. Mothers of Neonates having iron deficiency anemia usually have a normal Hct but diminished iron levels.
Prevention of Anemia in Pregnancy
Proper nutrition intake during pre-pregnancy results in preventing anemia. Consumption of healthy, balanced food during pre and post-pregnancy improves iron and other significant nutrients for a growing baby. Iron food sources comprise meat which includes pork, lamb, liver, and beef. Poultry includes; duck, chicken, turkey, and dark meat. Lastly, seafood involves; oysters, mussels, clams, and shellfish. FDA recommends for pregnant women, consume eight to twelve ounces per week of fish that have lower levels of mercury, such as:
- Tuna (light canned)
Women who are pregnant should avoid the intake of fish with high levels of mercury. Legumes are also in line for considering it as healthy which involves; dry beans, black-eyed peas, and canned baked beans. Pregnant women must also consider iron-enriched products such as white bread, pasta, rice, and cereals,
Anemia During Pregnancy
The body assimilates iron to create hemoglobin and red blood cells, which help to carry oxygen to tissues by a protein. Pregnant women need a double amount of iron dosage compared to non-pregnant women. For an adequate supply of oxygen to the baby, the body requires iron to make blood; otherwise, this will result in iron deficiency anemia.
Anemia During the Trimester of Pregnancy
CDC is defined Hb level as less than 11g/dL. Hematocrit of less than thirty-three percent causes anemia during the third trimester of pregnancy. This condition is due to the less advanced socioeconomic status, fewer follow-ups during pregnancy, and improper iron replacement therapy. There is an extended stay in the hospital after delivery in severe third-trimester anemia. Stay is usually for postpartum anemia treatment, such as transfusion or intravenous iron supplementation. Causes behind anemia that occurs in up to one-third of women during the 3rd trimester are iron deficiency and folate deficiency.
Iron Deficiency Anemia in Pregnancy
The risk of premature birth is calculated by the severity of iron-deficient anemia during pregnancy. Women who have two closely spaced pregnancies or pregnant women with more than one baby are at a higher risk of anemia Symptoms of iron-deficiency anemia during pregnancy are; fatigue, weaknesses, pale or yellowish skin, and irregular heartbeats.
While best practice includes preventing anemia or early identification and antenatal treatment, some women enter labor with iron deficiency anemia. As for all women, active measures to minimize blood loss at birth must be planned. Efforts should be made to maximize pre‐delivery Haemoglobin with an induction planned according to the usual obstetric indications. Iron deficient anemia should not impact the intentional mode of birth, and choices should be made according to obstetric indications. Many risk factors might affect the probability of hemorrhage and also include previous cases of fibroid uterus, multiple pregnancies, the severity of anemia, and whether blood components will be accepted or not. Women with Hb levels less than 100 g/l with imminent birth must follow a precise individualized diet plan, the third stage of labor, and the management of the anemia of pregnancy with doctor follow-ups.
Following are the recommendations for anemic pregnant women; the mode and timing of delivery (2D) should not be influenced by iron deficiency anemia. Delivery should be in an obstetrician‐led unit (1D) for women with a Hb level of less than 100g/l. Women with iron deficiency anemia with a Hb of <100 g/l should have active management of the third stage of labor (1D). Active management of the third stage of labor (1D) of women who have iron-deficient anemia is critical.
Women should eat folate-enriched food, citrus fruits and juices, and berries as a dietary precaution. Anemia can also result in premature birth or a baby with a lower body weight than usual. Prevention largely depends on a healthy nutritional balanced diet and active routine. Only a few know how to control this situation, and we are sure that once you are done reading this discussion, you have joined that club!