DOCSLIB.ORG

Iron Deficiency and Iron Deficiency Anemia: Implications and Impact In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Iron Deficiency and Iron Deficiency Anemia: Implications and Impact In nutrients Review Iron Deficiency and Iron Deficiency Anemia: Implications and Impact in Pregnancy, Fetal Development, and Early Childhood Parameters Robert T. Means 1,2 1 Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA; [email protected]; Tel.: +1-423-439-6499; Fax: +1-423-439-6470 2 Internal Medicine, Building 2/Room 109, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA Received: 26 December 2019; Accepted: 6 February 2020; Published: 11 February 2020 Abstract: A normal pregnancy consumes 500–800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a “physiologic” anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation. Keywords: iron deficiency; pregnancy; iron deficiency anemia; laboratory testing; iron supplementation; iron balance 1. Introduction Anemia with a hemoglobin (Hb) concentration no lower than 10 g/dL at term, occurs in nearly all pregnancies, and in the majority of cases reflects a physiologic process (discussed below) rather than a deficiency state or underlying hematologic disorder [1]. Significant anemia in pregnancy (defined as a Hb concentration <11 g/dL in the first trimester or <10 g/dL in the second and third trimesters) occurs with a prevalence ranging between 2% and 26%, depending upon the population studied [2–4]. Anemia is a major contributor to maternal and fetal morbidity and mortality, particularly in less developed countries [2–6]. Of the pathologic causes of anemia in pregnancy, anemia due to iron deficiency (IDA) is the most common, particularly in more developed countries, where contributions from other anemia-producing disorders such as malaria or hemoglobinopathies are less significant [7–9]. Anemia in pregnancy, and particularly IDA, is both a long-standing scholarly interest and an element of my practice as a hematologist. In preparing for this review, PubMed searches using the terms “pregnancy” and “iron deficiency” were performed. A date range was not specified, but the focus was on papers 2015 and later. Specific searches for subtopics included “hepcidin”, and “guidelines”. Approximately 71 reports, reviews, or studies new to the author were identified through this process. 2. Physiologic Anemia of Pregnancy The effects of ID on red cell production occur in the context of what is usually called the physiologic anemia of pregnancy. This is a phenomenon that is conserved across mammalian species [10,11], and it Nutrients 2020, 12, 447; doi:10.3390/nu12020447 www.mdpi.com/journal/nutrients Nutrients 2020, 12, 447 2 of 16 2. Physiologic Anemia of Pregnancy The effects of ID on red cell production occur in the context of what is usually called the physiologic anemia of pregnancy. This is a phenomenon that is conserved across mammalian species [10,11], and it is hypothesized that the physiologic anemia of pregnancy serves the purpose of enhancing placental perfusion by reducing maternal blood viscosity and facilitating oxygen and nutrient delivery to the fetus by expanding the erythrocyte mass [12]. Beginning approximately the sixth week of pregnancy, the plasma volume increases disproportionately to the erythrocyte mass, Nutrientsreaching2020 a, 12maximum, 447 value at approximately 24 weeks’ gestation. At maximum, the plasma volume2 of 15 is 40%–50% higher than at the start of pregnancy [13]. Since the parameters used to identify anemia in clinical practice (the hematocrit (Hct), the blood isHb hypothesized concentration, that and the physiologicthe circulating anemia erythrocyte of pregnancy count) serves are expressed the purpose as concentrations of enhancing placental based on perfusionwhole blood by reducing volume, maternal the expanded blood viscosityplasma volume and facilitating causes them oxygen to decrease and nutrient and deliveryhence produces to the fetus“anemia”. by expanding While Hb the concentration, erythrocyte mass Hct, [12 and]. Beginning to a lesser approximately degree erythrocyte the sixth count, week are of pregnancy,the anemia theindicators plasma volume used in increases practice, disproportionatelythese parameters are to the only erythrocyte surrogates mass, for the reaching actual adefinition maximum of value anemia: at approximatelya reduction in 24erythrocyte weeks’ gestation. mass per At unit maximum, body weight the plasma [14]. By volume this criterion, is 40–50% the higherphysiologic than anemia at the startof pregnancy of pregnancy is not [13 actually]. anemia: a 15%–25% increase in the erythrocyte mass occurs in pregnancy butSince is concealed the parameters by the dilutional used to identify effect of anemia the increase in clinical in plasma practice volume (the hematocrit [15]. This (Hct), is driven the blood by an Hbincrease concentration, in serum anderythropoietin the circulating concentrations erythrocyte during count) the are late expressed second and as concentrations early third trimesters based on[16] wholeand bloodis facilitated volume, or the potentially expanded plasmalimited volumeby iron causes availability. them to decreasePregnant andwomen hence using produces iron “anemia”.supplementation While Hb have concentration, a greater increase Hct, and in er toythrocyte a lesser degreemass than erythrocyte women not count, using are supplemental the anemia indicatorsiron [1], and used women in practice, with compromised these parameters iron are stores only at surrogates outset of pregnancy for the actual will definition have a limited of anemia: increase a reductionin erythrocyte in erythrocyte mass. The mass upper per limit unit of body erythrocyte weight [ 14mass]. By increase this criterion, in the presence the physiologic of adequate anemia iron of is, pregnancyhowever, isregulated not actually through anemia: erythropoietin a 15–25% increase control in and the is erythrocyte not raised mass by increased occurs in iron pregnancy availability: but ispregnant concealed women by the dilutional in the Bantu effect tribe, of the who increase have in plasmaboth an volume iron-rich [15 ].traditional This is driven diet by and an increasea genetic inpredisposition serum erythropoietin to increased concentrations dietary iron during absorption the late, do second not increase and early Hb third concentration trimesters [or16 Hct] and with is facilitatedsupplementation or potentially [17,18]. limited by iron availability. Pregnant women using iron supplementation have aAs greater a result increase of the in reset erythrocyte balance mass between than womenplasma notvolume using and supplemental erythrocyte iron mass, [1], it and is generally women withconsidered compromised that a Hb iron concentration stores at outset <11 of g/dL pregnancy in the la willte first have trimester a limited and increase <10 g/dL in erythrocyte in the second mass. and Thethird upper trimesters limit of should erythrocyte be investigated mass increase for a in cause the presence other than of adequatethe physiologic iron is, anemia however, of regulatedpregnancy through[19]. Figure erythropoietin 1 shows hemoglobin control and concentrations is not raised by by increased trimester iron based availability: on reports pregnant from Norway women [19], in theJamaica Bantu [20], tribe, and who China have [21]. both an iron-rich traditional diet and a genetic predisposition to increased dietaryMaternal iron absorption, plasma dovolume not increase generally Hb concentrationdecreases during or Hct the with final supplementation weeks of pregnancy, [17,18]. and consequentlyAs a result the of theHct, reset Hb, balance and circulating between plasmaerythrocyte volume count and increase erythrocyte [13]. mass,The maternal it is generally blood consideredvolume generally that a Hb returns concentration to prepregnancy<11 g/dL levels in the wi latethin first one trimester to six weeks and < after10 g/ dLdelivery in the and second maternal and thirderythropoiesis trimesters should increases be investigatedlate in gestation for a causeand re otherturns than to normal the physiologic by about anemia one month of pregnancy after delivery [19]. Figure[22]. 1 shows hemoglobin concentrations by trimester based on reports from Norway [ 19], Jamaica [20], and China [21]. Figure 1. Hemoglobin concentrations of healthy women during pregnancy (mean standard deviation. ± DataFigure combined 1. Hemoglobin from references concentrations [19–21]. of healthy women during pregnancy (mean ± standard deviation. Data combined from references [19–21]. Maternal plasma volume generally decreases during the final weeks of pregnancy, and consequently the Hct, Hb, and circulating erythrocyte count increase [13]. The maternal blood volume generally returns to prepregnancy levels within one to six weeks after delivery and maternal erythropoiesis increases late in gestation and returns to normal by about one month
Load more

Recommended publications
  • Thalassemia Trait As a Cause of Anaemia in ANC Patients
    Volume 5, Issue 11, November – 2020 International Journal of Innovative Science and Research Technology ISSN No:-2456-2165 Thalassemia Trait as a Cause of Anaemia in ANC Patients Lakshmi Rachakonda1 Ankita Balara2 Savita Kadam3 Kritika Agrawal4 1. Professor and HOD, Department of OBGY, MGM Medical College and Research Centre, Aurangabad, Maharashtra, India 2. Junior Resident, Department of OBGY, MGM Medical College and Research Centre, Aurangabad, Maharashtra, India 3. Associate Professor, Department of Anatomy, MGM Medical College and Research Centre, Aurangabad, Maharashtra, India 4. Junior Resident, Department of OBGY, MGM Medical College and Research Centre, Aurangabad, Maharashtra, India Abstract:- Increased prevalence of anemia in pregnancy can occur because of following reasons(1) Introduction-Anaemia is commonest haematological Increased demands of iron disorder that can occur in pregnancy. Thalassemia Diminished intake of iron syndromes are commonly found genetic disorders of the Diminished absorption blood. Beta thalassemia is considered as most common Disturbed metabolism single gene disorder in our country. Detection of Pre-pregnant health status thalassemia is increasing nowadays. If a female with trait marries a person of similar trait, baby can develop THALASSEMIA thalassemia major which is lethal. Failure to differentiate The thalassemia syndromes are the commonly found iron deficiency anemia from thalassemia may lead to iron genetic disorders of the blood. The basic defect is a reduced load which is hazardous to patient. So we conducted this rate of globin chain synthesis so red cells being formed are study to know the proportion of thalassemia trait in our with an inadequate hemoglobin content. (2) Thalassemia is institution so we can add it to our routine ANC profile.
    [Show full text]
  • Approaches to Anemia in Pregnancy
    Research and Reviews Approaches to Anemia in Pregnancy JMAJ 52(4): 214–218, 2009 Shiro KOZUMA*1 Abstract Even in normal pregnancy, the hemoglobin concentration becomes diluted according to the increase in the volume of circulating blood. Since iron and folic acid in amounts necessary for the fetus are preferentially transported to the fetus, the mother is likely to develop iron deficiency anemia and folic acid deficiency anemia. An adult woman has about 2 g of iron in her body. When a woman becomes pregnant, the demand for iron increases, necessitating an additional 1 g. According to the 2005 Dietary Reference Intakes in Japan, the necessary intake of iron in Japanese women is 10.5 mg/day, whereas it is 20 mg during pregnancy. In regard to folic acid, 240␮g is required daily in non-pregnancy and additional 200␮g is needed in pregnancy. No consensus, however, has been reached as to the influences of maternal anemia on pregnancy. In Japan, hemoglobin concentrations of 11.0 g/dl or less and hematocrit of 33.0% or less are considered as anemia in pregnancy, regardless of the timing in the period of pregnancy, and patients should be treated with iron or folic acid therapy. In the West, the prophylactic routine use of iron and folic acid is not uncommon, but its usefulness is not necessarily established. A recent recommendation in Japan is that a daily dose of 0.4 mg of supplementary folic acid be taken during pregnancy for the purpose of preventing impairment of neural tube closures such as spina bifida in fetuses, regardless of whether or not anemia is present.
    [Show full text]
  • Coombs Negative Hemolytic Anemia of Unknown Origin in Pregnancy
    Blood of & al L n y r m u p o h J Dominico et al., J Blood Lymph 2012, 2:2 Journal of Blood & Lymph DOI: 10.4172/2165-7831.1000103 ISSN: 2165-7831 Research Article Open Access Coombs Negative Hemolytic Anemia of Unknown Origin in Pregnancy Sunday Alfred Dominico1*, Mubarakali Janmohamed3, Alex Magesa2, Hyasinta Jaka3, Peter F Rambau4 and Anthony N Massinde1 1Department of Obstetric and Gynaecology, Catholic University of Health and allied Sciences, Tanzania 2Department of Haematology, Muhimbili National Hospital, Tanzania 3Department of Internal Medicine, Catholic University of Health and allied Sciences, Tanzania 4Department of Pathology and Forensic Medicine, Catholic University of Health and allied Sciences, Tanzania Abstract Hemolytic anemia is very common during pregnancy especially in malaria endemic areas and it is usually an autoimmune condition. Coombs negative or idiopathic hemolytic disease during pregnancy is very rare and it has not yet been described in sub-Saharan countries. A 34-year-old grand-multiparous woman was referred at our facility at a gestation age of 22 weeks with features of severe anemia in pregnancy, and a history of receiving a blood transfusion (seven units). Several investigations including a Coomb’s test were done. However, there were hardly any derangements, except for initial low hemoglobin. Coombs negative haemolytic anaemia of unknown origin was the final concluded diagnosis. She was treated with a course of glucorticoids, hematenics and a total of 36 units of blood transfusion. She finally delivered a premature baby at 35 weeks of gestation. She recovered completely during puerperium and was discharged the seventh day postpartum with a hemoglobin of 10g/dl.
    [Show full text]
  • Management of Anaemia in Pregnancy
    14 Management of Anaemia in Pregnancy Ezechi Oliver1 and Kalejaiye Olufunto2 1Chief Research Fellow and Consultant Obstetrician and Gynaecologist Coordinator, Sexual, Reproductive and Childhood Diseases Research Programme Head of Division, Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba Lagos 2Senior Research Fellow and Haematologist Unit Head, Laboratory Services Unit , Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba Lagos Nigeria 1. Introduction Obstetric practice in developing countries is known for unacceptably high maternal morbidity , mortality and perinatal deaths. Factors contributory to these include poor health care delivery system, cultural beliefs, poor nutrition, illiteracy, gender inequality, teenage pregnancies and high parity. Other factors such as infections and infestations ultimately cause anaemia and increase morbidity and mortality in pregnant women and their offspring. Anaemia during pregnancy is a well-known risk for unfavourable pregnancy outcomes. Globally, anaemia has been found to be the most common complication in pregnancy. The World Health Organization (WHO) estimates that more than 40% of non-pregnant and over 50% of pregnant women in developing countries are affected. The majority of the cases occur in sub-Saharan Africa and South East Asia. In 1993, the World Bank ranked anaemia as the 8th leading cause of disease in girls and women in the developing world. Apart from maternal morbidity and mortality, neonatal mortality is high among the babies of anaemic mothers. 2. Hematological changes in pregnancy Pregnancy is associated with normal physiological changes that assist fetal survival and prepares the mother for labour, delivery and breastfeeding. The changes start as early as 4 weeks of gestation and are largely as a result of progesterone and oestrogen.
    [Show full text]
  • BMC OBGYN Anemia in Pregnancy Guideline
    Boston Medical Center Maternity Care Guideline Guideline: IRON DEFFICIENCY ANEMIA Accepted: 04/2015, 11/2019 Updated: 04/2015, 05/2017, 11/2019 Introduction: Normal pregnancies are associated with physiologic decreases in hemoglobin.1 Levels below the Centers for Disease Control and World Health Organization endorsed values for hemoglobin and hematocrit by trimester can be considered anemia and warrants treatment (Table 1).1-3 Iron deficiency anemia is characterized as a microcytic, hypochromic anemia with evidence of depleted iron stores, low serum ferritin levels, low plasma iron levels, and high total iron-binding capacity (Table 2).3,4 Iron deficiency anemia is associated with increased risk of LBW, preterm delivery, perinatal mortality, postpartum depression, and complications with postpartum hemorrhage.3 Treatment to improve iron stores is indicated when laboratory studies indicate anemia in pregnancy. Diagnosis: Iron deficiency anemia is the most common form of anemia. Primary screening is done via complete blood count (CBC). Diagnosis is obtained by abnormal hematocrit, though this may be non-specific for the origin of anemia (Table 1).2 Ferritin <10-15 is diagnostic for iron deficiency anemia (Table 2).3 Reduced mean corpuscular volume (MCV) may be associated with iron deficiency anemia or microcytic anemia of another origin such as thalassemia which is common in ethnically diverse populations such as those at BMC (Table 3; Figure 1).3,5 First trimester – Hemoglobin <11 g/dL (approximately equivalent to a hematocrit <33 percent) Second trimester – Hemoglobin <10.5 g/dL (approximate hematocrit <31 or 32 percent) Third trimester – Hemoglobin level <10.5 to 11 g/dL (approximate hematocrit <33 percent) Postpartum – Hemoglobin 10 g/dL (approximate hematocrit <30 percent) Ref: https://www.uptodate.com/contents/anemia-in-pregnancy Table 2.
    [Show full text]
  • Iron Deficiency Anemia in Pregnancy
    Review Iron deficiency anemia in pregnancy Expert Rev. Obstet. Gynecol. 8(6), 587–596 (2013) Christian Breymann Anemia is a common problem in obstetrics and perinatal care. Any hemoglobin (Hb) below Department of Obstetrics and 10.5 g/dl can be regarded as true anemia regardless of gestational age. Main cause of Gynaecology, University Hospital Zurich, anemia in obstetrics is iron deficiency, which has a worldwide prevalence between estimated Obstetric Research, Feto-Maternal 20 and 80% of especially female population. Stages of iron deficiency are depletion of iron Haematology Research Group, stores, iron-deficient erythropoiesis without anemia and iron-deficiency anemia, the most Schmelzbergstr 12 /PF 125, Zurich, Switzerland pronounced form of iron deficiency. Pregnancy anemia can be aggravated by various [email protected] conditions such as uterine or placental bleedings, gastrointestinal bleedings and peripartum blood loss. Beside the general consequences of anemia, there are specific risks during pregnancy for the mother and the fetus such as intrauterine growth retardation, prematurity, feto-placental miss-ratio and higher risk for peripartum blood transfusion. Beside the importance of prophylaxis of iron deficiency, main therapy options for the treatment of pregnancy anemia are oral iron and intravenous iron preparations. KEYWORDS: anemia • intravenous iron • iron deficiency • iron therapy • pregnancy The review focuses on the clinical, diagnostic requirement during that period [3,4].Ifweextrap- and therapeutic aspects of gestational disorder olate from the high prevalence rates of anemia of in mothers, with its far-reaching consequences pregnancy in developing countries and from the for the intrauterine development of the fetus observed relationship between iron deficiency and neonate.
    [Show full text]
  • Sickle Cell Hemoglobinopathies: Hemoglobinopathies Pathophysiology and Relationship to Pregnancy
    Sickle cell hemoglobinopathies: Hemoglobinopathies Pathophysiology and relationship to pregnancy SHELDON E. BAUM, D.O. Detroit, Michigan The treatment of a patient with (sickle cell anemia) , SA hemoglobin (sickle sickle cell disease requires cell trait), SC hemoglobin (sickle cell C dis- ease) , and STH hemoglobin (sickle cell thalas- consideration of the pathophysiology semia disease). of all its various manifestations. The Varying percentages of S hemoglobin are physician must be aware of the present in the homozygous and heterozygous risks involved when pregnancy is states. In the homozygous state, the abnormal superimposed. In this article the author hemoglobin is generally in excess of 60 per reviews the pathophysiology of sickle cell cent. In the heterozygous state, type S hemo- globin constitutes usually 20 to 40 per cent of disease and its effect on reproduction. the cell hemoglobin, the remainder being nor- While fertility apparently is reduced mal. Sickle cell disease may also exist in in- in sickle cell anemia, this is not so termediate forms in conjunction with other in the other sickle cell diseases. abnormal hemoglobins. The pregnant patient with a sickle cell Adult hemoglobin (type A) is composed of alpha and beta chains of amino acids. Fetal hemoglobinopathy requires close hemoglobin (type F) , is composed of alpha supervision and exacting care during and gamma chains. At birth, F hemoglobin the pregnancy, delivery, and postpartum normally comprises 90 per cent of the blood, period. Two cases are reported. the remainder being type A hemoglobin. Usu- One involved sickle cell anemia ally by 6 to 8 months of age type A hemoglobin associated with pregnancy; delivery predominates in the normal infant, compris- ing 90 to 99 per cent of the blood.
    [Show full text]
  • Magnitude and Factors Associated with Anemia Among Pregnant Women Attending Antenatal Care at St. Paul's Hospital Millennium
    Magnitude and factors associated with anemia among pregnant women attending antenatal care at st. Paul's Hospital Millennium Medical college, Addis Ababa, Ethiopia, July, 2019 Desta Samuel Umuro ( [email protected] ) University College London Hospitals NHS Foundation Trust Yared Lasebew Asres St. Paul's Hospital Millenium Medical College Gezahegn Mamo Muluneh St. Paul's Hospital Millenium Medical College Research article Keywords: Magnitude, Anemia, Pregnant women Posted Date: August 15th, 2019 DOI: https://doi.org/10.21203/rs.2.13046/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/12 Abstract Background: This study aimed to assess magnitude and factors associated with anemia among pregnant women attending antenatal clinic at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: Institution based cross sectional study design was conducted from December 1, 2018 to January 15, 2019 on 405 pregnant women attending antenatal clinic. All pregnant women visiting the Antenatal care clinic during the study period and who fullled the eligibility criteria were included in the study. Secondary data was collected from clients register and personal les on hemoglobin, HIV, stool, and other variables. Descriptive statistics was used to analysis some variables by using SPSS. Logistic regression was carried out to identify factors associated with anemia in pregnancy. Adjusted odds ratio with their 95% of condence interval and p<0.05 are consider to have signicant association. Results: The magnitude of Anemia in pregnant women in this study was 19.8 %, (95% CI 16.00-23.70). HIV infection (AOR=6.12(95% CI 2.19, 17.08) parasitic infestation (AOR= 11.88 (95% CI 5.60, 25.20) and history of not taking fruit after meal during pregnancy (AOR=3.12(95% CI 1.72, 5.67) were the major determinants of anemia.
    [Show full text]
  • International Journal of Medical and Biomedical Studies (IJMBS)
    || ISSN(online): 2589-8698 || ISSN(print): 2589-868X || International Journal of Medical and Biomedical Studies Available Online at www.ijmbs.info PubMed (National Library of Medicine ID: 101738825) Index Copernicus Value 2018: 75.71 Original Research Article Volume 4, Issue 1; January: 2020; Page No. 305-311 CLINICAL EVALUATION OF INTRAVENOUS IRON SUCROSE IN PREGNANT ANEMIC FEMALES Dr. Aakarsh Sinha1, Dr. Kumar Amit2 1Senior Resident, Department of Obstetrics and Gynaecology, Madhubani Medical College and Hospital, Madhubani, Bihar, India. 2Senior Resident, Department of Paediatrics, Darbhanga Medical College and Hospital Laheriasarai, Darbhanga, Bihar, India. Article Info: Received 05 January 2020; Accepted 28 January 2020 DOI: https://doi.org/10.32553/ijmbs.v4i1.1146 Corresponding author: Dr. Aakarsh Sinha Conflict of interest: No conflict of interest. Abstract The standard treatment in majority of the institutions is oral iron (OI), with blood transfusion reserved for severe or emergency cases. However, it is unreliable in the treatment of severe anemia. Blood transfusion has its own hazards, including transfusion of wrong blood and deadly infections like HIV, CMV, hepatitis and anaphylaxis. Thus, there is a need for a safe and effective alternative to OI or blood transfusion in the treatment of anemia. Iron dextran, the first parenteral iron used, lost its popularity due to anaphylaxis. Iron sucrose was then discovered as a parenteral iron that could be safe and effective. Hence based on above findings the present study was planned for Clinical Evaluation of Intravenous Iron Sucrose in Pregnant Anaemic Females. The present study was planned in Department of Obstetrics and Gynaecology, Madhubani Medical College and Hospital, Madhubani, Bihar.
    [Show full text]
  • Anemia in Pregnancy Chowdhury S1, Rahman M2, Moniruddin ABM3
    Review Article Anemia in Pregnancy Chowdhury S1, Rahman M2, Moniruddin ABM3 Abstract Classification of anemia in pregnancy Anemia is the commonest hematological disorder that Grossly classified into two types4: occurs in pregnancy. According to the recent standard laid down by ‘WHO’, anemia is present when the Hemoglobin (A) Pathological anemia in pregnancy. (Hb) concentration in the peripheral blood is 11 gm/dl or less. The most common cause of anemia in pregnancy is (B) Physiological anemia in pregnancy. lack of iron. Less often, it is caused by folic acid deficiency. (A) Pathological Anemia is further sub-classified into In some populations, 80% of pregnant women are anemic. Those most at risk are women from low socio-economic 1. Deficiency Anemia, e. g., groups and teenagers. Anemia is diagnosed by estimating the hemoglobin concentration and examining a peripheral blood -Iron deficiency smear for the characteristic red blood cell changes. Iron -Folic acid deficiency and folate supplementation is indicated during pregnancy to prevent the complications. -B12 deficiency -Protein deficiency Key words : Erythropoiesis, Puerperium, APH, PPH, ANC, LBW, IUD. 2. Hemorrigic: Acute hemorrhagic: Following bleeding in early month of Introduction pregnancy or APH Anemia is a lack of functioning red blood cells (RBCs) that Chronic hemorrhagic: as by hookworm infestation, GI leads to a lack of oxygen-carrying ability, causing unusual (gastrointestinal) bleeding. 1 complications during life time . These RBCs are produced in 1. Hereditary: the bone marrow. They have a life expectancy of about 120 Thalassemias – Haemolobinopathies. days. Among other things, the body needs iron, vitamin B12 & folic acid for erythropoiesis. If there is a lack of one or more Hereditary hemolytic anemia – RBCs defects.
    [Show full text]
  • Download Download
    122 W. ThongpermJournal et al of. AssociatedJournal of Associated Medical Sciences Medical 2018; Sciences 51(3): 2018; 122-127 51(3): 122-127 Thai-Journal Citation Index Centre (TCI) & ASEAN Citation Index (ACI) Journal of Associated Medical Sciences Journal of Associated Medical Sciences Journal homepage: https://www.tci-thaijo.org/index.php/bulletinAMS/index Preliminary study for the prevalence and causes of anemia in pregnant women attending an Antenatal Care Unit in different periods of gestation Wararat Thongperm1 Mantana Chaisen2 Yuttana Chunchom2 Supakit Aueduldecha2 Orawan Sarakul2* 1Department of Medical Technology, Nayong Hospital, Nayong, Trang, Thailand 2School of Allied Health Sciences, Walailak University, Nakhonsithammarat, Thailand ARTICLE INFO ABSTRACT Article history: Background: One of common complications of pregnancy is an anemia which is Received February 2018 effected by various causes. Anemia can develop throughout the pregnancy period Received in revised form March 2018 and increase in severity upon the gestation times. WHO recommends all pregnant Accepted as revised June 2018 women should attend an antenatal care (ANC) unit in the first trimester of gestation Available online August 2018 for healthy promotion and complication prevention during pregnancy and after birth. Keywords: Anemia, pregnancy, iron deficiency, Objectives: The aim of this preliminary study is to find out the prevalence and thalassemia causes of anemia in pregnant women who start attending an ANC program at different time points of gestation. Materials and methods: Cross-sectional study was performed during May 2015 -February 2016. Hematological parameters were examined in all 190 pregnant women attended the ANC unit at Nayong Hospital. Participants were divided into three groups according to period of gestation at the first time of ANC admission.
    [Show full text]
  • Pregnancy Complications in Brazilian Puerperal Women Treated in the Public and Private Health Systems1
    Rev. Latino-Am. Enfermagem Original Article 2017;25:e2949 DOI: 10.1590/1518-8345.2156.2949 www.eerp.usp.br/rlae Pregnancy complications in Brazilian puerperal women treated in the public and private health systems1 Patrícia Louise Rodrigues Varela2 Rosana Rosseto de Oliveira3 Emiliana Cristina Melo4 Thais Aidar de Freitas Mathias5 Objective: to analyze the prevalence of pregnancy complications and sociodemographic profile of puerperal patients with complications, according to the form of financing of the childbirth service. Method: cross-sectional study with interview of 928 puerperal women whose childbirth was financed by the Unified Health System, health plans and private sources (other sources than the Unified Health System). The sample was calculated based on the births registered in the Information System on Live Births, stratified by hospital and form of financing of the childbirth service. Data were analyzed using the chi-square and Fisher’s exact tests. Results: the prevalence was 87.8% for all puerperal women, with an average of 2.4 complications per woman. In the case of deliveries covered by the Unified Health System, urinary tract infection (38.2%), anemia (26.0%) and leucorrhea (23.5%) were more frequent. In turn, vaginal bleeding (26.4%), urinary tract infection (23.9%) and leucorrhoea (23.7%) were prevalent in deliveries that were not covered by the Unified Health System. Puerperal women that had their delivery covered by the Unified Health System reported a greater number of intercurrences related to infectious diseases, while women who used health plans and private sources reported intercurrences related to chronic diseases. A higher frequency of puerperal adolescents, non-white women, and women without partner among those assisted in the Unified Health System (p < 0.001).
    [Show full text]