Anemia during pregnancy

What does anemia mean during pregnancy?

Anemia during pregnancy is characterized by a decrease in iron levels in the body. This violation poses a danger to the health of the woman herself and her child. Their tissues and organs suffer from hypoxia. By this term, doctors mean oxygen starvation.

Anemia has four levels of severity: mild, moderate, severe, and extremely severe. During pregnancy, iron deficiency, aplastic and hemolytic anemia are more common than others. Moreover, about 90% of all expectant mothers suffer precisely from a lack of iron in the body. This violation can develop both independently and against the background of other pathologies.

If the level of iron in the body decreases, this affects the process of producing hemoglobin. The number of erythrocytes also decreases. This is how iron deficiency anemia develops in pregnant women.

If there is little hemoglobin and red blood cells in the blood, then the internal organs experience hypoxia. Iron in the body is not produced independently, it enters it from the outside, with food.

In the 1st trimester of pregnancy, a woman’s body does not experience an acute need for iron, since her menstruation stops, and the fetus is still too small to take large amounts of this trace element for its own needs. However, starting from the second trimester, the needs of the body of a pregnant woman in iron increase and reach 4 g per day.

Sometimes it happens that a woman had a history of latent iron deficiency anemia even before the time when she conceived a child. Then, starting from the first trimester of gestation, the expectant mother will suffer from a lack of iron. As statistics show, latent iron deficiency is observed in 60-80% of women. Therefore, it is so important to diagnose anemia even before the onset of pregnancy during its planning period. In this case, it will be possible to avoid many negative consequences for the health of the mother and child.

Anemia in pregnant women according to microbial 10

Анемия у беременных по мкб 10 имеет код О99.0. Сюда специалисты относят анемию, которая осложняет течение беременности и родов, а также послеродовой период.

Iron and its role in the human body

Iron is an essential trace element that ensures the vital activity of the whole organism.

The role of iron is difficult to overestimate:

• Iron is an integral part of hemoglobin, which transports oxygen to all organs and tissues.

• Iron is present in myoglobin. This protein is present in muscle tissue.

• Enzymes that are responsible for the synthesis of DNA and ATP contain iron in small doses.

It becomes clear that without iron the body simply cannot exist normally.

Iron during pregnancy: how much does the body consume?

If a woman is not in a position, then every day her body spends about 1 mg of iron. During menstruation, this figure increases to 2-2,5 mg per day.

As for pregnant women, the iron consumption is represented by the following values:

• For the entire period of pregnancy, 220 mg of iron is consumed.

• 450 mg is spent on increasing the number of red blood cells in the body. During pregnancy, the volume of circulating blood increases by about a liter, which requires an increase in the level of all its elements.

• The fetus “takes” about 270 mg of iron for its needs.

• Another 90 mg of iron will be required for the formation of the umbilical cord and placenta.

• During childbirth, natural blood loss occurs. During this period, the body will lose about 200 mg of iron.

Thus, for the entire gestational period, about 1230 mg of iron is needed, so its daily requirement is 4,4 mg per day. If we compare the costs of iron by the body of a pregnant woman, then they increase by 9 times compared to the costs of a woman’s body at normal times.

Symptoms of anemia during pregnancy

Anemia in pregnant women may not manifest itself in any way, but only on condition that it has a mild course. In this case, pathology can be detected only through a clinical blood test.

Common symptoms of anemia during pregnancy include:

• Increased fatigue.

• Frequent dizziness.

• Severe headaches.

• Skin blanching on a permanent basis.

• Increased heart rate, which normally should not be felt.

• Fainting and pre-fainting are possible.

• The woman becomes whiny, nervous, irritable. She constantly wants to sleep.

In addition to the general signs of anemia, this condition is also characterized by sideropenic syndrome.

Its manifestations are as follows:

• The condition of the skin worsens, it begins to peel off. Iron deficiency leads to the formation of cracks in the skin.

• In about 20% of pregnant women, hair begins to fall out, and the nail plates become brittle.

• Blood pressure drops, heart rate increases.

• Shortness of breath can begin to disturb both during physical effort and during periods of rest.

• Seizures in the corners of the mouth are a characteristic sign of anemia. The mucous membrane of the oral cavity becomes inflamed, ulcers may appear on the inner surface of the cheeks and on the gums.

• The mucous membranes of the stomach and intestines suffer, which leads to problems in the functioning of these organs.

• Often in women in position there is a perversion of taste, there is a desire to eat unusual foods, such as chalk or tooth powder. The sense of smell is enhanced, there may be a craving for the smell of acetone, gasoline, paint, etc.

• Immunity is reduced, which becomes the basis for easier penetration of the infection into the body.

• The functioning of the liver is impaired.

If one or more of these symptoms appear, you should consult a doctor and undergo appropriate studies. It is impossible to make a diagnosis on your own.

Causes of anemia during pregnancy

As a rule, anemia in pregnant women develops in the second and third trimester, which is associated with an increase in the volume of circulating blood and growth of the fetus.

Doctors regularly refer women for blood donation, which makes it possible to identify patients at risk. They are being monitored. If hemoglobin continues to decline, then expectant mothers are prescribed prophylactic iron supplementation. Also at risk include women who have chronic diseases of internal organs, such as gastritis, hepatitis, pyelonephritis.

Anemia is a frequent companion of women who adhere to a vegetarian or dietary diet. Also, a decrease in hemoglobin levels can be observed in patients who have previously had abortions, miscarriages or suffer from bleeding.

With multiple pregnancies, the likelihood of developing anemia also increases.

The age of the pregnant woman matters. If a woman is less than 18 years old or more than 32 years old, then she is at risk for developing anemia.

Sometimes it happens that a decrease in hemoglobin and red blood cells occurs for several reasons at once. In this case, anemia will progress quickly and it will be difficult to cope with it.

Pregnant women at risk for developing anemia

There are many reasons that can lead to the development of anemia.

Therefore, special attention should be paid to women at risk:

• Women living in unsatisfactory socio-economic conditions. The worse the nutrition of a pregnant woman, the lower her hemoglobin level.

• Женщины, придерживающиеся принципов вегетарианства.

• Women who have previously been on a diet.

• Women who have had infectious diseases: pyelonephritis, viral hepatitis, dysentery.

• Future mothers with chronic diseases: tonsillitis, rheumatism, pyelonephritis, diabetes mellitus, gastritis.

• Women who often give birth. We are talking about women who have children born more often than 1 time in three years. In this case, the body does not always have time to fully recover. Therefore, the likelihood of developing chronic anemia increases. Completely iron deficiency will be blocked 2 years after birth.

• Women who have suffered anemia during past births.

• Pregnant women under the age of 18.

• Pregnant women whose hemoglobin level drops below 120 g / l already in the first trimester.

• Simultaneous bearing of two or more fetuses.

• Polyhydramnios during pregnancy.

Types of anemia in pregnant women

In pregnant women, physiological (gestational) and true anemia are distinguished. Physiological anemia is also called physiological hemodilution, which is associated with an increase in plasma volume in a woman’s body by 50%, and red blood cells by 11%. Therefore, the red blood cells will be diluted with plasma, which naturally leads to a decrease in hemoglobin levels.

Starting from the 20th week of pregnancy, all women are diagnosed with anemia. Sometimes this condition does not pose a threat to the health of the future mother and the fetus itself, there is no need for treatment. However, the doctor must understand that it is the values ​​of one erythrocyte that should be evaluated: its volume and the content of hemoglobin in it. If these figures begin to decline, then we can talk about true anemia, which requires treatment.

Стоит отметить, что именно истинные анемии диагностируются у 90% все беременных женщин, когда падает уровень гемоглобина внутри каждого эритроцита.

Depending on how much the level of hemoglobin in the blood decreases, there are 3 degrees of anemia in pregnant women:

• The first degree of anemia (mild form) – the level of hemoglobin is 90-110 g / l.

• The second degree of anemia (medium or moderate form of anemia) – the level of hemoglobin is 71-90 g / l.

• The third degree of anemia (severe form) – the hemoglobin level drops to 70 g / l.

Fetal anemia – what is it?

Fetal anemia is a condition in which the fetus lacks oxygen and begins to suffer from hypoxia. Chronic anemia is dangerous with multiple complications. First of all, this concerns intrauterine growth retardation, while every day is important in this period. Fetal growth retardation is observed in 32% of cases precisely because of anemia.

After the birth, the child will also suffer from anemia. This condition is associated with a risk of preterm labor, which is observed in 65% of cases. In the future, the baby will continue to lag behind in both mental and physical development, provided that anemia remains undiagnosed and untreated.

The situation is aggravated by the occurrence of complications during labor, which may be too weak, a woman may experience massive blood loss, and gestosis often develops against the background of anemia.

After childbirth, a woman may not have milk, or it will begin to be produced in insufficient quantities, which will affect the health of the child.

The consequences of anemia of a pregnant woman for the fetus:

• Increased risk of perinatal death.

• Hypoxia of the child’s brain may develop.

• Often there is a delay in the physical and mental development of the fetus.

• In 37% of cases, infectious and inflammatory processes develop in the child’s body after his birth.

• Hypoplasia of tissues with underdevelopment of the amnion and chorion.

• Primary placental insufficiency.

• Asphyxia of a newborn during passage through the birth canal.

After birth, the child will suffer from anemia, which requires treatment. This condition is especially dangerous for premature babies.

Diagnosis of anemia during pregnancy

To establish the fact that a woman has iron deficiency anemia, you will need to donate blood for a general analysis. A decrease in the concentration of hemoglobin in the blood is not always a sign that you should focus on in the first place, since its fall can occur due to an increase in plasma volumes in the blood. However, you need to be concerned if in the first trimester of pregnancy the hemoglobin level is below 110 g / l, and in the second trimester at a level below g / l.

To confirm his assumptions, the doctor will refer the woman to an extended blood test. It is imperative to examine the volume of circulating blood in the body, as well as the content of serum iron and erythrocyte hypochromia. This will make sure that a particular woman actually develops anemia during pregnancy.

Medicines for anemia during pregnancy

Anemia during pregnancy requires long-term and complex treatment. Immediately after the start of taking the drugs, the effect should not be expected, but already on the 9-12th day there should be a jump in reticulocytes in the blood. This will indicate that the treatment is correct. The fact that therapy has a positive effect is not a reason to stop it. It is possible to achieve a steady increase in the level of hemoglobin in the blood only after 1,5-2 months from the start of treatment. Moreover, simply raising the level of hemoglobin is not enough, you need to fill the body’s depot with iron. Therefore, the intake of iron-containing drugs continues for several months. This is not a doctor’s whim and should not scare the expectant mother.

If a woman has an early pregnancy and anemia is already observed, then, most likely, this pathology existed in her even before the moment of conception. In this case, it is strictly forbidden to postpone therapy, since as the fetus grows and the volume of circulating blood increases, anemia will progress.

In addition to iron preparations, pregnant women are prescribed B vitamins, including Folic acid and Cyanocobalamin. Dose selection is carried out on an individual basis.

Proper nutrition is the key to getting rid of anemia, but without taking medicines, recovery is impossible. No more than 2,5 g of iron is absorbed from food per day, while it is required 2 times more.

For the treatment of women in position, the following drugs are used:

• Ferrous salts. The drug from this group is Aktiferrin. It can be purchased in the form of a solution, in the form of capsules and tablets. Analogues of this drug are drugs called Totem and Hemofer.

• Salts of ferrous iron, supplemented with vitamin C. The preparations of this group are: Ferroplex and Hemohelper.

• In the form of a solution, ferric iron succinylate protein can be purchased, this drug is called Ferlatum.

• You can also take ferric iron preparations called Maltofer and Ferrum Lek.

Preparations based on ferrous iron penetrate the body more easily, but give more side effects. First of all, this concerns the violation of the functioning of the organs of the digestive system. Preparations based on ferric iron are absorbed by the body worse, but side effects are much less common.

It is best to take iron supplements by mouth in the form of capsules or tablets. Parenteral administration is practiced only in exceptional cases and in a hospital setting.

With intravenous infusions, the likelihood of developing the following side effects increases:

• An allergic reaction, which can be very serious, up to anaphylactic shock.

• DIC syndrome.

• Problems in the functioning of the digestive system.

• The formation of bruises and infiltrates at the injection site.

Nutrition for anemia in pregnant women

With the development of anemia, pregnant women need to adjust their diet. Meat must be on the menu. The best source of iron is beef, veal, rabbit, chicken and turkey. It is good to eat beef tongue. These products contain heme iron, which has a high bioavailability of 30%. The liver also acts as a valuable source of iron, but pregnant women should eat it with caution. This product has a lot of vitamin A, which can have a toxic effect on the fetus.

In addition, the diet should be diversified with eggs, cheese, cottage cheese, sour-milk drinks. Useful fish, such as pink salmon and cod. Plant foods that are sources of iron are asparagus, apples, black currants, buckwheat, oatmeal. However, non-heme iron, which is found in plant foods, is absorbed by the body only by 3-5%.

In general, the menu of the expectant mother should be varied. Indeed, in order for iron to be fully absorbed in the intestines, it needs other vitamins and microelements, for example, vitamin C. A child needs no less useful substances than a pregnant woman. Without this, its full development is impossible.

Protein is essential for the construction of hemoglobin molecules and muscles. The best source of protein are foods such as: sour cream, cottage cheese, sea fish.

Menu option for a pregnant woman with anemia

Eating properly and balanced should be started immediately after the woman found out about her situation, despite the early gestational age. This will prevent the development of anemia and maintain health. In the first trimester, the daily calorie content of a woman should be equal to 2700 kcal, where proteins and fats account for 80 g each, and carbohydrates – 320 g. In the second half of pregnancy, calorie content can be increased to 3000 kcal. Although specific figures depend on how active the future mother leads.

Prevention

WHO gives all women in position an unequivocal recommendation: in the second half of pregnancy and during lactation, take iron supplements for prophylactic purposes. This will help maintain normal hemoglobin levels in the blood and prevent anemia from developing.

For prophylactic purposes, the same drugs are prescribed as for the treatment of anemia, but in smaller doses. Starting from 12-14 weeks, you will need to take 1-2 tablets of iron-containing preparations. The course is from 14 to 21 days, after which you need to take a two-week break and repeat the course again. For the entire gestational period, a woman will undergo about five such courses.

Also, for the preventive purpose, the woman’s diet is corrected, enriching the menu with products of animal origin, fresh vegetables and fruits.

So, anemia in pregnant women is a condition that develops very often. You shouldn’t be afraid of him. You just need to closely interact with the observing obstetrician-gynecologist, take tests on time, eat right and follow all the doctor’s recommendations. In this case, it will be possible to avoid health problems and endure a strong baby.