Anemia during pregnancy

Iron deficiency anemia is a common diagnosis during childbearing. Without treatment and elimination of risk factors can lead to serious consequences. Therefore, it is very important to timely identify pathologies and start therapy.

What is anemia in pregnancy

Blood anemia during pregnancy (gestational) is a disorder in which hemoglobin decreases. It is designated in analyzes as Hb. Hemoglobin is a protein found in red blood cells – red blood cells. The function is to bind with oxygen and deliver it to organs and tissues. In the capillaries of the lungs, hemoglobin binds to oxygen. Then the erythrocytes with the blood flow are carried throughout the body. After that, oxygen is released from the connection with hemoglobin and enters the tissues, where it is consumed for oxidative processes. Free hemoglobin picks up carbon dioxide in the tissues and “carries” it to the lungs.

When the concentration of hemoglobin decreases, the function is also impaired: providing the body with oxygen and removing carbon dioxide.

Causes of anemia during pregnancy

During pregnancy, the development of anemia is most likely as a result of the following factors:

1. Increased iron intake in the second half of pregnancy by the growing fetus and placenta. If iron deficiency was also before pregnancy, the disease develops earlier;
2. Hemodilution is a natural condition caused by an increase in the volume of circulating blood.

Other factors are also at play. For example, microcytic anemia develops due to:

• chronic diseases – diabetes mellitus, gastric ulcer and duodenal ulcer, rheumatism, gastritis, long-term infectious diseases;
• thalassemias – disorders of the synthesis of hemoglobin of a hereditary nature;
• disorders of the absorption of iron by the bone marrow;
• iron deficiency as a result of meat deficiency and the predominance of foods with non-heme forms of the trace element in the diet.

Another form of anemia is normocytic, accompanied by a reduced content of normal red blood cells. It develops after bleeding with pathology of the placenta, hypothyroidism, renal failure, autoimmune hemolytic anemia (erythrocytes are destroyed by their own immune cells), inhibition of the formation of erythrocytes in the bone marrow, hypothalamic-pituitary insufficiency.

Factors that lead to macrocytic anemia with an increase in the volume of red blood cells are a deficiency of folic acid, vitamin B12, liver disease, an increase in the content of immature forms of red blood cells, a violation of hematopoiesis in the bone marrow.

Additional risk factors for the development of anemia during pregnancy: low material standard of living in the family, multiple pregnancies, frequent childbirth, long-term breastfeeding, pregnancy pathologies (toxicosis, gestosis).

Classification of anemia in pregnancy

In practice, doctors use a classification that takes into account the concentration of hemoglobin:

• mild anemia during pregnancy – Hb 90-109 g / l;
• severe anemia during pregnancy – Hb 70 – 89 g / l;
• average anemia during pregnancy – Hb less than 70 g / l.

The second criterion is the substance, the deficiency of which became the cause of the disease. Depending on this, there are:

• Iron-deficiency anemia;
• folic acid deficiency;
• B12 deficiency.

The stages of the disease also matter. There is pre-latent, latent, and manifest iron deficiency. Pre-latent and latent deficits are not clinically apparent. Pathology is diagnosed only at the stage of manifest deficiency.

Symptoms and signs of anemia during pregnancy

The manifestations of the disease depend on the severity. Mild anemia during pregnancy is asymptomatic. When the hemoglobin level drops below 90 g / l, hypoxia develops – oxygen starvation of tissues. It is manifested by dizziness, weakness, pain in the region of the heart, rapid pulse, tinnitus, shortness of breath during exertion. Characteristic pallor of the sclera and skin.

The course of pregnancy with anemia is complicated by changes in the emotional background: irritability, impairment of memory and attention, poor appetite.

Manifestations of iron deficiency in anemia during pregnancy are perverted taste – a woman is drawn to chalk, plaster, clay, sand, raw meat. The nail plates thicken – they become brittle. Hair falls out and breaks. Muscles become weak, flabby, the sphincter apparatus is weakened.

Cracks in the corners of the mouth, inflammation of the oral mucosa may occur. Itching of the mucous membrane of the external genital organs is possible.

In moderate to severe chronic anemia, the palms and nasolabial triangle turn yellow. This is due to impaired metabolism of carotene in iron deficiency. Also there is a “blue” sclera due to mucosal degeneration.

Complications of pregnancy with anemia

The likelihood of complications depends on the duration of the disease and on what kind of anemia during pregnancy is diagnosed in the patient. Anemia complicating pregnancy is one that began before conception. In this case, already in the 1st trimester, there is a high probability of placental insufficiency, placenta previa, miscarriage, hypoplasia of the membranes, and frozen pregnancy.

In the 2nd and 3rd trimesters, the risk of preeclampsia, eclampsia, premature birth and late miscarriages, placental abruption increases.

The development of severe anemia during pregnancy is accompanied by problems with the cardiovascular system. Perhaps the development of myocardial dystrophy, a decrease in the ability of the myocardium to contract. The disorders caused by iron deficiency in the tissues are joined by problems due to insufficient blood flow in the organs. This is expressed in organ dysfunction.

The consequences will be during childbirth. A woman in labor has a weakness of labor forces, possibly bleeding due to hypotonia of the uterus. In the postpartum period, a woman and a baby develop purulent processes. The woman’s milk production decreases.

The consequences of anemia during pregnancy for a child can develop already in the prenatal period. These include fetoplacental insufficiency, which results in fetal hypoxia, hypoxic brain damage, developmental delay, asphyxia in childbirth. Also, anomalies in the development of the nervous system and the spine are possible due to a lack of vitamin B12, folic acid. After childbirth, these children develop respiratory failure. In the future, there may be a discrepancy between the neuropsychic and physical development of age norms, frequent infectious diseases as a result of reduced immunity.

Pregnancy management

According to the order of the Ministry of Health of the Russian Federation, the management of pregnancy with anemia includes:

• clinical blood test – monthly;
• blood chemistry;
• studies prescribed by a general practitioner;
• consultation of a therapist or hematologist and further observation with a frequency of 1 – 2 times a month;
• ECG – 3 times during the entire pregnancy;
• bone marrow puncture (if indicated);
• cardiotocography and dopplerometry in dynamics.

How can you prevent anemia? If a woman has a history of prolonged and heavy menstruation, a diet, regular medical supervision, and blood tests are recommended. When there is a short interval between pregnancies, the woman has been breastfeeding for a long time after the previous birth, during the second pregnancy, anemia can be prevented by special nutrition and taking iron supplements in a prophylactic dosage.

Treating anemia during pregnancy

The goal of therapy for gestational anemia is to correct iron deficiency, prevent hypoxia or eliminate its symptoms, and normalize metabolic processes and hemodynamics. In severe pathology with significant metabolic disorders, support for adequate placental blood flow is shown.

Treatment includes special nutrition and the use of drugs to meet the need for iron, vitamins, and eliminate metabolic disorders. It is preceded by diagnostics: determination of the level of hemoglobin, hematocrit, determination of the concentration of serum iron and ferritin. The diagnostic task is also to exclude indications for termination of pregnancy – in some cases, this procedure may be advisable.

Nutrition and diet

What to eat for anemia during pregnancy? Special nutrition consists in increasing the content in the diet of foods that contain a lot of iron: beef, veal, liver, fish. Bread, bran, soybeans, tea and coffee, milk, mineral water (phosphate, hydrocarbonate), corn reduce the absorption of iron, so their amount in the menu should be reduced. Medicines containing calcium and magnesium salts, as well as almagel, tetracyclines contribute to the progression of the disease.

The diet should contain enough vegetables, fruits, herbs: they provide the body with vitamins.

Drugs for treatment

What should women take to restore hemoglobin? The administration of preparations containing a bivalent or trivalent form of iron is shown. The dosage and the specific medicine are selected individually, depending on the severity of the disease, the existing complications:

1. Ferrous iron preparations are easier to digest, but can cause side effects;
2. Ferric iron tablets and capsules are absorbed more slowly, and the likelihood of side effects is lower.

When a woman has difficulty taking tablets or capsules, absorption through the mucous membrane of the digestive tract is impaired, there is an intolerance to a trace element or there is a stomach ulcer, 12 duodenal ulcer, parenteral agents are prescribed.

The simultaneous intake of vitamin C can improve the absorption of iron. It is also recommended to take folic acid if the disease is associated with a deficiency of this substance. Vitamin B12 is prescribed when a woman has a cyanocobalamin deficiency.

Forecast

With a mild degree of anemia, it is possible to quickly correct the condition – it does not pose a danger to the baby and the expectant mother. With moderate and severe forms of the disease, adequate and timely therapy will help improve blood counts and prevent the development of negative consequences.

Conclusion

At first glance, anemia is a common disease that is diagnosed in most women in a position. However, if you do not diagnose it in time, do not start a correction, it can lead to very serious complications. Undergo mandatory examination methods, take blood tests. This is the only way you can prevent this pathology or detect it early before complications develop.