Written by : Dr.M.D.Mazumdar, MD

The term ‘anemia’ is used when the level of haemoglobin in the blood falls to less than 10 gm %. It is very commonly encountered in pregnancy because of the increased requirements of all the vitamins and minerals, especially iron, at this time.

Causes of Anemia:

• Iron deficiency: the most common reason for anemia during pregnancy.

• Folic Acid and/or Vit B12 deficiency: Anemia due to folic acid or Vit B12 is less common but not unknown.

• Combination of both the above.

• Vit C deficiency: Rare.

Only iron deficiency anemia will be discussed on this page.

Iron deficiency anemia is graded according to the haemoglobin level in the blood.

• Mild Anemia: Hb level between 8.0gm % to 10.0gm%
• Moderate Anemia: Hb level between 5.0gm% to less than 8.0gm%
• Severe Anemia: Hb level less than 5.0 gm%.

Signs and Symptoms of Anemia

• Mild Anemia: The patient has no complaints specific to anaemia. Diagnosis is made on routine blood examination.

• Moderate Anemia: The patient may complain of:
  • There is pallor of the sclera of the eyes, lips and the nail bed.
  • Excessive tiredness
  • Palpitation
  • Occasional breathlessness, especially during exertion such as on climbing stairs

• Severe Anemia: The patient with severe anemia has acute signs and symptoms:
  • She looks ill and exhausted
  • There is breathlessness and palpitation even on resting
  • Some patients prefer to sleep in a propped up position rather than lying down, to decrease breathlessness.
  • Ulcers of the lips and gums may occur.
  • Edema all over the body (anasarca).
  • Enlargement of the heart and cardiac murmurs due to severe anemia may lead to congestive cardiac failure.

Treatment of Anemia in Pregnancy:

Anemia is usually diagnosed at the first antenatal visit of a woman when the blood is routinely examined for haemoglobin level. Pregnant women can also use home test kits for self-diagnosis of anemia, but it is better to get a proper laboratory test done for accuracy.

• Diet advice: Diet advice to increase iron consumption is given. Foods rich in iron are liver, meat, egg, fish and milk.

  For a vegetarian diet – green, leafy vegetables, beans, peas, whole wheat, legumes, and raisins are advisable. Sprouting grams are a very rich source of Vit B12. Food containing Vitamin C like lemon, lime and oranges should be also taken as Vit C helps in absorption of iron.

Iron Supplementation: Where adequate diet cannot be ensured, prophylactic iron should be prescribed. An iron preparation containing 200-400 mg of elemental iron should be given in divided doses in the form of Ferrous sulphate, ferrous fumarate, or ferrous gluconate.

Vitamin C 500mg tablets should be prescribed to increase the absorbtion of iron from the gut.

Folic Acid and Vitamin B Complex can be given daily to treat anaemia due to deficiency of Vitamin B or Folic Acid. .

If anemia is severe: If the anemia is severe, it cannot be treated by oral supplementation alone.

The patient has to be admitted in a hospital and investigated thoroughly for other causes of anemia. She should be kept at complete bed rest with adequate high protein diet, supplementary injections of Vit B12, Folic Acid and Vit C if necessary should be given.

Injections of iron preparations are rarely used nowadays as severe local reactions at the site of the injection can occur. Blood transfusion using only the red blood cells (packed cell transfusion) is a better form of replacing the deficient iron.

• During labor: During labor and childebirth, the patient should be closely monitored to prevent complications like shock and heart failure.

Supplementary Vitamins to be taken in pregnancy:

• Iron tablets
• Folic Acid tablets
• High strength Multivitamin Capsules
• Calcium tablets.
• Psyllium Husk, a natural fibre, if there is constipation.

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OTHER TOPICS IN COMPLICATED PREGNANCY:

• Bleeding in early pregnancy
  (Abortion, Implantation Bleeding, Ectopic Pregnancy, Molar Pregnancy, Cervical Erosion, Cervical Polyp).
• Placenta Previa
• Placental Abruption
• Multiple Pregnancies (twins, triplets etc.)
  
• Pre-eclamptic toxemia
  
• Rh-ve (Rh Negative) Pregnancy
  
• Anemia in Pregnancy
  
• Diabetes in Pregnancy
  

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