General Illness Information Common Name: ANEMIA DURING PREGNANCY Medical Term: None Specified Description: A low level of hemoglobin (less than 10 gm/dl) during pregnancy. Hemoglobin carries oxygen to body tissues via the red blood cells. Anemia in pregnancy is very common and is present in almost 8o% of pregnant women. Because volume of blood increases during pregnancy (hemodilution), a moderate decrease in the concentration of red blood cells and hemoglobin is normal. The hematocrit value (the percentage of red blood cells relative to plasma volume) in non-pregnant women ranges from 38 to 45%. However, in pregnant women because of hemodilution normal values can be much lower, e.g. 34%in single and 30% in twin or multiple pregnancy even with normal stores of iron, folic acid and vitamin B12. This lower range simply reflects "the physiologic hemodilution of pregnancy" and does not indicate a decrease in oxygen carrying capacity or true anemia. Iron deficiency is responsible for 95% of anemia of pregnancy. Causes: Possible causes include: Poor intake of iron in diet; Folic acid deficiency; Loss of blood from bleeding hemorrhoids or gastrointestinal bleeding. Even if iron and folic acid intake are sufficient, a pregnant woman may become anemic because pregnancy alters the digestive process. Also the unborn child consumes some of the iron or folic acid normally available to the mother's body. Prevention: Eat foods rich in iron, such as liver, beef, whole-grain breads and cereals, eggs and dried fruit. Eat foods high in folic acid, such as wheat germ, beans, peanut butter, oatmeal, mushrooms, collards, broccoli, beef liver and asparagus. Eat foods high in vitamin C, such as citrus fruits and fresh, raw vegetables. Vitamin C makes iron absorption more efficient. Take prenatal vitamin and mineral supplements, especially folic acid. Signs & Symptoms Common Symptoms: Tiredness, weakness or fainting. Paleness Breathlessness Occasional Symptoms: Headache Nausea Inflamed, sore tongue Palpitations or an abnormal awareness of the heartbeat Forgetfulness Jaundice (rare) Abdominal pain (rare) Risk Factors Associated with: Twin or multiple pregnancy Poor nutrition, especially multiple vitamin deficiencies Smoking, which reduces absorption of important nutrients Excess alcohol consumption, leading to poor nutrition Any disorder that reduces absorption of nutrients Use of anticonvulsant medications Diagnosis & Treatment General Measures: The diagnosis is based on blood tests which determine the red blood cell count, hemoglobin level ,iron and folic acid levels in the blood. Hematocrit levels less than 33% is considered iron deficient and should be treated. Diet rich in iron and prenatal vitamins. Medications: Iron deficiency anemia is treated with iron tablets, preferably as ferrous sulphate 300 mg, to be taken no more than twice daily. This is because the side effects of iron tablets (stomach upset and constipation) are increased if more than 2 tablets are taken. About 20% of pregnant women fail to ingest or absorb adequate amount of iron and may need to be treated with intra-muscular iron injections. Iron dextran is given every alternate day, in divided doses, for a total of about 1000 mg. over a period of 3 weeks. Iron, folic acid and other supplements may be prescribed. For better absorption, take iron supplements 1 hour before eating, or between meals. Iron will turn bowel movements black, and often causes constipation. It is advisable that most pregnant women should be given supplemental iron (ferrous sulphate 300 to 600mg per day). Even though the hemoglobin is normal at the beginning of pregnancy. This preventive measure prevents depletion of iron reserves and anemia that may occur in case of bleeding or with future pregnancy. Folic acid deficiency anemia is treated with folate tablets. Activity: No restrictions, except rest often until anemia disappears. Diet: Eat well and take prescribed supplements Increase fiber and fluid intake to prevent constipation Possible Complications : Premature labor Dangerous anemia from normal blood loss during labor, requiring blood transfusions Increased susceptibility to infection after childbirth Prognosis Usually curable with iron and folic acid supplements by mouth or injection.