Anemia in Pregnancy

Abstract

Anemia is considered a severe public health problem by World Health Organization as its prevalence is greater than 40%. It has major consequences for human health as well as social and economic development and is responsible for 20% of maternal deaths. Anemia is the reduction in circulating hemoglobin mass below the critical level. Faulty dietetic habit, faulty absorption mechanism, iron loss through excessive sweating, hookworm infestation, chronic malaria, bleeding piles and dysentery are the pre pregnancy causes. During pregnancy, the causes are increased demands of iron, diminished intake of iron, diminished absorption, disturbed metabolism, presence of infection, pre pregnant health status and excess demand. Risk Factors may be socio demographic, obstetrical, behavioral ormedical conditions. Anemia is classified as physiological anemia and pathological anemia. Further, pathological anemia is classified as nutritional / deficiency anemia (iron, folic acid, vitamin B12 or protein deficiency), hemorrhagic, hereditary, bone marrow insufficiency, hemolytic and anemia of chronic diseases. About 1–1.5 mg of iron is being lost daily through urine, vaginal fluid, sweat, feces and tears. Signs and symptoms of anemia are ill health, fatigue, loss of appetite, digestive upset, dyspnea, anorexia, nausea, vomiting, restlessness, drowsiness, abdominal discomfort, palpitation, headache, paleness, feelings of weakness, dysphagia, general malaise, poor concentration, angina and intermittent claudication of the legs. On examination, there will be pallor – pale skin, mucosal linings, conjunctiva and nail buds, brittle nails, brittle hair, atrophy of papilla in tongue, spoon shaped nails, jaundice, bone deformities and leg ulcers. In severe anemia, there will be tachycardia, bounding pulse, flow murmurs, cardiac hypertrophy, signs of heart failure and pica (persistent eating of substances that have no nutritional value). Treatment can be oral therapy, parenteral therapy, blood transfusion and nutrition. Anemia leads to pre-eclampsia, inter current infection, heart failure, preterm labor, low birth weight baby, neural tube defects, poor weight gain, PIH, abortion, dysmaturity, placenta previa, abruption placenta, accidental hemorrhage, PROM, fetal malformation in pregnancy & puerperal sepsis, sub involution, poor lactation, puerperal venous thrombosis and pulmonary embolism in postnatal period and may cause intrauterine death, increased perinatal death, cardiovascular morbidity and mortality, poor APGAR score, fetal distress, neonatal distress and neonatal anemia in baby. It can be prevented by prophylactic dose of iron and folic acid in pregnancy, iron and vitamin C rich diet, decreasing intake of coffee, tea, alcohol, phosphates, antacids, oxalates and phytates.