ANAEMIA IN
PREGNANCY
BY DR. NGWIRA

ANAEMIA IN PREGNANCY
DEFINITION
 Hb < 11 g/d1 in 1st trimester, < 10.5 in 2nd 3rd and <10 immediately
postpartum.
 WHO- lower limit should be 2 SD below the normal population
GRADES
 Mild <11 – 9
 Moderate 8.9- 7
 Severe < 7
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TYPES AND CAUSES
 Commonest type is Iron deficiency anaemia due to:
 Haemodilution – Physiological Anaemia due to disproportionate
increase in plasma volume (30%-40%) Vs. Red cell volume
increase (25%).
o May not be apparent in pre-eclampsia
 Iron utilisation increases as is required for fetal growth and
development as well as maternal erythropoiesis.
o Demand worsens as pregnancy advances. (2nd and 3rd term)
o requirement per day in 1st trimester is 3-4mg/day and 6-7
mg/day in 2nd
o Demand more in multiple pregnancies
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 Nutritional
 Infestations (E.g. Hookworm)
 Previous pregnancies – multipara, miscarriages
 Menstrual disorders - menorrhagia.
 GIT bleeding
OTHER CAUSES
 Hemoglobinopathies – HBS, thalassemias
 Hemolysis – Malaria, SCD
 Hemorrhage- APH
 Chronic illness – TB, HIV
 Poor diet
 Malabsorption
 Drugs- Anticonvulsants, ARVs.
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Complications
 Increased maternal and Foetal morbidity and mortality.
 Maternal:
■ Cardiac failure
■ Sepsis (infections)
■ Unable to withstand even minor acute blood loss.
■ PPH
■ Increased risk of maternal mortality ( Hb< 7)
o Foetal :
■ Hypoxia
■ Preterm labour
■ IUFD
■ Low birth weight
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Diagnosis
 History.
o Dyspnoea (breathlessness)
o Weakness, fatigue.
o Headache.
o Palpitations.
o Pica
o Others due to the cause:
■ Malaria – fever
■ Bleeding in pregnancy.
 Examination
■ Pallor/ jaundice/ petechiae
■ Tachycardia.
■ Dyspnoea.
■ Organomegaly 6

Diagnosis
 Investigation.
o Aim to establish :
• Severity
• Type
• Cause.
o Severity.
• Hb- mild, moderate, severe
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Diagnosis cont…
o Type.
• FBC
• Microcytic (MCV < 80)
• Normocytic (MCV 80 -100)
• Macrocytic (MCV > 100)
o Cause.
• Stool
• Urine
• MP slide
• Bone marrow
• Serum ferritin
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Management
 Depends on:
o Severity
o Cause
o Gestational age
o Mild
• Haematinics – orally
• Hb will rise by 0.8 – 1.0g/dl per week.
• Ferrous formulations better than ferric
• Fumerate, sulphate and gluconate formulations
• Multivits have insufficient iron to correct anaemia
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• Amount of elemental iron is what’s important
• 200mg Sulphate( 65mg), 300mg gluconate (35mg), 210mg
fumerate (65mg)
• Previously Recommended dose of elemental iron for
treatment is 100- 200mg , now 40mg- 80mg daily
• Should be taken in the morning and on an empty stomach
taken with water or a vitamin c source.
• Vit C enhances absorption and tannins in tea and coffee
inhibit it.
• Avoid taking with other meds such as antiacids, multivits.
• Check Hb at 2-4 weeks after treatment
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• Iron salts may cause gastric irritation – nausea, vomiting,
abdominal pains.
• Change formulation or reduce the dose in case of adverse
effects.
 IV formulations ( Iron sucrose, iron dextran)
• By-passes gastric absorption
• Less side effects
• Faster absorption, quicker HB improvement
• Indicated in patients with malabsorption, intolerance,
poor compliance and need for rapid Hb boost.
• C.I : anaphylaxis, 1st trimester, active bacteremia and
decompensated liver disease.
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o Moderate
• 1st and 2nd trimester. Orally
• 3rd trimester, term, labour Transfuse.
o Severe
. Transfuse irrespective of gestation age but be careful it
may precipitate cardiac failure if the transfusion is rapid
and massive.
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 Therefore:
i. Use packed cells
ii. Give fast acting diuretic eg frusemide before
transfusion starts.
iii. Slow transfusion.
 Deal with the cause.
o Malaria.
o Infestations – H/worm
o Stop bleeding.
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Prophylaxis
o Diet-haem iron from meat is absorbed 2- to 3- times more readily than non
haem iron.
o Meat also contains organic compounds that promote absorption
o Iron and Folic acid supplements
o Antimalarials eg Fansidar.
o Deworming
o Pre-pregnancy correction of anaemia.
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■ INTRAPARTUM MANAGEMENT
 Actively prevent blood loss- AMTSL
 Maximize pre-delivery HB
 Women with Hb < 10 should be delivered at a center with an
obstetrician
 Should not determine the mode of delivery.
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