Anemia during pregnancy: risk assessment for mother and baby25.05.2022
Anemia is a disease characterized by a drop in the level of red blood cells and hemoglobin below certain values, as a result of which oxygen starvation develops in all organs and tissues of the body without exception.
Most often, pathology develops due to iron deficiency, since it is it that is the basis on which hemoglobin is built. This anemia is called iron deficiency.
Why does the body need iron?
- The most important task is to form hemoglobin (an iron-protein complex), which binds and delivers oxygen to all organs and tissues, providing tissue respiration.
- The second task is to form myoglobin, a complex that provides oxygen transport in working muscles.
- The third task is to participate in the synthesis of iron-containing enzymes necessary for the functioning of the endocrine and immune systems.
How iron enters the body
- Iron enters the body with food.
- With the help of special proteins it is absorbed in the intestine.
- In the body, iron binds to the transporter transferrin. It is in this form that iron is transported in the body.
Part of the iron is stored in the body (deposited) in the form of ferritin and hemosiderin, and part is spent on urgent needs of the body (hemoglobin, myoglobin, iron-containing enzymes).
Why does iron deficiency occur in the body
Iron deficiency can occur for a variety of reasons, but all of them are associated either with a lack of iron intake in the body, or with its excessive consumption. One of the conditions in which the need for iron increases many times over is the period of pregnancy, and here’s why:
- The first point: iron is required for adequate growth and development of the fetus, as well as to increase the total number of red blood cells circulating in the blood of the expectant mother.
- The second point: during pregnancy, a woman’s volume of circulating blood increases sharply – after all, she forms a third (fetoplacental) circle of blood circulation. The rate of formation of blood cells (in particular, erythrocytes) lags significantly behind the rate of increase in plasma volume. There is a so-called physiological hemodilution.
It is because of physiological hemodilution that the “red blood” values in pregnant women differ from those in non-pregnant women. The lower limit of normal hemoglobin in expectant mothers is 110 g/l, in non-pregnant women – 120 g/l
The situation is further complicated in the presence of early and late toxicosis, as well as liver damage (pregnancy hepatosis).
Let’s be honest, chronic anemia does not develop overnight. Before the fall in hemoglobin levels and the development of clinical manifestations, several stages pass:
- iron (ferritin) stores are depleted first,
- then the amount of the transport form of iron (transferrin) decreases,
- lastly, hemoglobin levels decrease.
To avoid the development of anemia, you need to do tests on the level of ferritin and transferrin on time. This is how you can suspect iron deficiency even before the development of clinical manifestations.
Classification of iron deficiency anemia in pregnant women
- I degree (mild) – hemoglobin level 110 – 90 g / l
- II degree (moderate severity) – hemoglobin level 90 – 70 g / l
- III degree (severe) – hemoglobin level below 70 g / l
Mild degree usually does not give pronounced symptoms. The clinical picture unfolds anemia of moderate severity and its severe forms.
Clinically, anemia is manifested by two syndromes:
- Hypoxic (oxygen deficiency), which is expressed by general weakness, dizziness up to loss of consciousness, lowering blood pressure, tinnitus, poor exercise tolerance, palpitations, pain and discomfort in the heart area, increased drowsiness or, conversely, insomnia, memory impairment and attention, pallor or even in severe cases, cyanosis of the skin and mucous membranes.
- Sideropenic (iron deficiency in tissues), which is manifested by a perverted taste (desire to eat inedible things such as plaster, chalk, clay, sand, etc.), thickening and increased fragility of the nail plates, dry skin and hair loss, muscle weakness. Many patients complain of painful cracks (“zaeds”) in the corners of the mouth and stomatitis. In severe cases, urine leakage can be expected due to a weakened bladder sphincter, as well as itching and burning in the vulva.
If proper correction is not carried out by the time of delivery, then in women suffering from anemia in childbirth, one can expect persistent weakness of labor, hypotonic bleeding, as well as an increased risk of developing purulent-septic complications.
The fetus also suffers from hypoxia: weight gain slows down, development is inhibited. Such children are often born with hypoxia, and in severe cases, with asphyxia. After birth, babies gain weight worse, lag behind their peers in acquiring new skills and abilities, and often suffer from infectious diseases.
Diagnosis and treatment
Diagnosis of anemia with severe clinical manifestations usually does not cause problems. A routine clinical blood test is done, which shows the number of red blood cells and the level of hemoglobin. It is much more difficult to assume the development of iron deficiency before the onset of characteristic symptoms.
Often, the first signs of anemia are disguised as ordinary overwork, and, unfortunately, expectant mothers have plenty of reasons to overwork. They often ignore their needs: they work full-time, they don’t get enough outdoors, they don’t have time for sufficient physical activity, they deny themselves good nutrition. In such a situation, you can’t let everything take its course – you definitely need to see a doctor.
Treatment of anemia consists of two stages
- Elimination of oxygen starvation both in the woman herself and in the fetus. For this, drugs are prescribed that improve peripheral circulation and cardiac activity, angioprotectors, antioxidants, antispasmodics.
- Elimination of iron deficiency and raising the level of hemoglobin. Iron preparations are prescribed in an easily digestible form. In order not to harm the digestive system, gastroprotectors are prescribed in parallel with iron. Iron is best absorbed in combination with ascorbic acid (vitamin C). The duration of the course of treatment is determined by the doctor, but we can say with confidence that it will be at least 4 weeks.
It is very important to carry out appropriate medical correction before the moment of delivery, because physiological blood loss (natural for any childbirth) will further increase the severity of anemia.
A huge role in the prevention and treatment of anemia is given to dietary nutrition. The presence of iron-rich foods in the diet allows you to largely meet the body’s needs for a much-needed substance.
Iron is best absorbed from animal products, which include:
- meat (beef, veal, rabbit, horse meat)
- low-fat cottage cheese
- low-fat fish and seafood acceptable for expectant mothers
There is also a lot of iron in plant products, but it is more difficult to absorb than from animal products. These include:
- black currant
- rose hip
- dried apricots
- cherry and sweet cherry
- sea kale
But there are substances that impair the absorption of iron in the body. At the time of treatment of anemia, their use is better to limit. These substances include:
- corn and dishes from it
- tea and coffee
The same principle should be adhered to when choosing a medical treatment for iron deficiency. It is important to know that calcium preparations, which are also often prescribed to expectant mothers, largely bind the iron entering the body and prevent it from being fully absorbed.
That is why calcium supplements and iron supplements are taken strictly separately with an interval of at least 2 hours.
It is impossible to overestimate the role of iron in the work of the body of expectant mothers. It directly depends on this important element whether a woman and her unborn baby will have enough oxygen for normal development and physiological childbirth, or not. Do not neglect the directions for the study of the level of ferritin and serum iron. Correcting latent iron deficiency is much faster and easier than curing anemia itself.
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