Anemia in pregnancy

Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to our body's tissues. Anemia is the commonest problem in women of reproductive age. According to WHO the prevalence of anemia in reproductive women aged 15-49 years is 29.9%, anemia contributes to 20% of maternal deaths across the globe making it the most important condition to be addressed during the pregnancy.

In pregnancy, Anemia is classified into two types one

1. Physiological anemia
2. Pathological anemia
   

Physiological anaemia

In pregnancy there is an increase in blood volume (plasma volume) by 40-60% and red blood cells volume increases by 20%. This leads to relative decrease in blood haemoglobin and hematocrit content, called physiological anemia. In order to maintain haemoglobin concentration within normal limits, the body requires additional iron and other vitamins to make more red cells. The foetus depends on maternal stores of vitamins and minerals for its growth, resulting in the increased demand. So it is essential for the mother to ensure adequate intake through diet and nutritional supplements. physiological anemia is a very common phenomenon which occurs in pregnant women due to the changes that occur in the women’s blood during pregnancy.

Pathological anaemia

The most common causes are:

1. Iron deficiency anaemia
2. Vitamin B12 deficiency
3. Folate deficiency

Other causes of anemia are

1.Aplastic anemia
2.Hemoglobinopathies
3.Infections

Iron deficiency anemia

Our body requires more iron to make red blood cells and haemoglobin which carries oxygen to the tissues. During pregnancy the iron requirement increases as our body needs this iron to make more haemoglobin to supply oxygen to the baby.

The causes of increased prevalence of iron deficiency anemia:

Before pregnancy:

1. Taking iron rich foods along with phosphates and phytates rich foods like brown rice, peanuts, chickpeas results in decreased iron absorption
2. High prevalence of intestinal worm infestation resulting in malabsorption of iron.
3. Multiple pregnancies at short intervals.
4. Excessive blood loss during menstruation

During pregnancy:

1. Twin pregnancies leading to increased demand
2. Presence of infection interferes with erythropoiesis (production of red blood cells)
3. Intake of famotidine, ranitidine, pantoprazole, rabeprazole, aluminum hydroxide gel, inhibit iron absorption leading to anemia
4. Excessive vomiting due to morning sickness
5. Inadequate dietary intake of iron

Vitamin B12 deficiency:

Vitamin b12 is an important vitamin required for the synthesis of red blood cells. The daily requirement of Vit B12 in non-pregnant condition is 2 µg and during pregnancy is 3 µg.This vitamin deficiency is more commonly seen in women who are predominantly vegetarian, as the main sources of vitamin B12 is from animal products like milk, eggs, poultry. The causes of vitamin B12 deficiency are:

1.Lack of intrinsic factor which is needed to absorb vitamin B12.

2.Inadequate dietary intake

3.Surgery that removes or bypass the end of small intestine

4.Gastritis

5.Drugs like metformin, Pantoprazole, rabeprazole

6.Crohn’s or celiac disease

Folic acid deficiency:

Folic acid is a water soluble vitamin. During pregnancy the demand for folate increases as it is required for the growth and development of foetus. Hence women are advised to start folic acid 3 months prior to planning a family.

Causes of folic acid deficiency :

1. Increased demand
2. Excessive vomiting
3. Abnormal demand due to infection, peptic ulcer, hemorrhoids,
4. Hepatic disorders
5. Intestinal malabsorption
6. Iron deficiency anemia
   

Symptoms of anemia:

1. Lassitude and fatigue
2. Pale skin, lips ,nails, palms
3. Increased heart rate
4. Ulceration in mouth and tongue
5. Shortness of breath
6. Lightheadedness
   

Complications of anemia in pregnancy:

The anemia is the most common indirect cause of maternal death. There are many complications because of anemia in pregnancy like preeclampsia,preterm labour, flaring up of existing infections,hemorrhage, shock, cardiac failure,poor lactation,puerperal sepsis, subinvolution.foetal complications include low birth weight,intrauterine growth restriction and high prevalence of failure to thrive.

How to prevent anemia during pregnancy?

The answer for this is a very simple one - a healthy and balanced diet.

1. A realistic balanced diet, rich in iron and protein, should be prescribed which should be within the reach of the patient and should be easily digestible.
2. Iron rich foods include meat, beans, iron fortified foods, dark green leafy vegetables and dried fruit. For home made iron rich snacks/recipes click on the this link https://anemiamuktbharat.info/wp-content/uploads/2019/09/recipe-booklet_iron-rich_single_Final.pdf
3. Folic acid can be found in fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread, cereal, pasta and rice.
4. The main source of vitamin B12 is animal products like meet, eggs,poultry and dairy products
5. If your doctor advises and prescribes, kindly take Adequate treatment for hookworm infestation, dysentery, malaria, bleeding piles, and/or urinary tract infection.
6. Foods rich in vitamin c like amla, guavas,fresh fruits and green leafy vegetables help increase iron absorption.
7. The Indian government has introduced a national programme”ANEMIA MUKT BHARAT" with a goal to make India anemia free . Under this program the recommendations for iron and folic acid supplements for pregnant and non pregnant women are as follows
   

Under this program the government has implemented mandatory provision of iron and folic acid fortified food in government funded health programmes like integrated child development services and mid day meal schemes to address the micronutrient deficiencies.

Anemia is one of the major preventable causes of complications in pregnancy. Let’s work together make yourself anemia free by ensuring proper nutrition

It's easy to manage and maintain your health during pregnancy. Just follow your doctor's instructions for taking a prenatal vitamin that contains a sufficient amount of iron and folic acid and any other advice he/she prescribes.

Author : Dr. Chaitanya

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