Anaemia in Pregnancy

Anaemia in pregnancy is haemoglobin concentration of < 11 g/dL. It is described as severe if the Hb is < 7 g/dL. Anaemia has adverse effects on the health of the woman and the outcome of the pregnancy. It is associated with an increased rate of miscarriage, preterm delivery, foetal growth restriction, foetal death and increased perinatal loss. It is also associated with ante- and post-partum haemorrhage and an increased maternal mortality rate.
Ideally no woman should go into labour with anaemia. Appropriate measures including blood transfusion may be required to correct the anaemia especially if a woman is close to her expected delivery date.

CAUSES

Physiological (due to blood volume expansion in pregnancy)
Poor dietary intake of iron, folate and vitamin B12
Haemolytic disorders (e.g sickle cell disease, G6PD defect)
Malaria
Infestations with hookworm, ascaris, schistosomes
Chronic infections e.g. TB, UTI, HIV
Bleeding complications in pregnancy e.g. APH

SYMPTOMS

Dizziness
Swelling of the feet
General weakness
Easy fatiguability

SIGNS

Mucosal pallor
Jaundice (may or may not be present)
Hepato-splenomegaly (may or may not be present)
Heart failure in severe cases

INVESTIGATIONS

FBC
Peripheral blood film comment
Blood film for malaria parasites
Sickling and Hb electrophoresis
G6PD activity
Serum iron, total iron binding capacity, ferritin
Stool analysis for hookworm ova
Urinalysis for schistosoma ova and urobilinogen

TREATMENT
Treatment objectives

To relieve symptoms
To correct haemoglobin level before patient reaches term or goes into labour
To identify and treat underlying cause
To recognize and manage the associated complications in mother e.g. cardiac failure, and baby e.g. intrauterine growth restriction

Non-pharmacological treatment

Encourage intake of foods such as red meat, poultry, fish, dark leafy vegetables, shell fish, dried fruits which are rich in iron, folate, vitamins B and C
Avoid tea, coffee, bran, cola and unhealthy habits such as eating of clay, which inhibits iron absorption
Encourage intake of folate and vitamin rich foods including beans, avocado, citrus fruits, spinach and mangoes
Protein rich foods must also be included in the diet
Ensure these anaemic patients are seen more frequently in the antenatal clinic and their response to treatment monitored with haemoglobin level checks.

Pharmacological treatment