PREGNANCY DAYS For most pregnant women, carrying a baby to term is largely a mysterious process. This section helps new parents answer some of the most important questions about pregnancy and childbirth.

Anaemia (iron deficiency) in Pregnancy

• what is anaemia?
• What is the cause of anaemia?
• How much iron do I need during pregnancy?
• How much folic acid do I need during pregnancy?
• How much B 12 do I need during pregnancy?
• what can I do to make sure that I have enough iron?
• How can I know if I am anaemic?
• Are some women more prone to anaemia during pregnancy?
• How is anaemia treated?
• How does anaemia affect my baby?
• What is non nutritional anaemia and its cause?

What is anaemia?

Anemia is deficiency of haemoglobin in the blood because of NUTRITIONAL and NON-NUTRITIONAL causes.

What is  the cause of anaemia?

Nutritional anaemia may be caused by the deficiency of Iron, Folic Acid and Vitamin B12.

This deficiency is especially pronounced in the reproductive age in females because of poor nutritional intake,recurrent infections,excessive menstrual blood loss and short birth intervals.

The causes of non-nutritional anaemia may be because of -

• Thalassemias, autoimmune, associated with pre-eclampsia (HELLP syndrome)
• Sickle cell anaemia or bone marrow suppression

How much iron do I need during pregnancy?

Before you conceived, you needed about 15 milligrams (mg) of iron a day. During pregnancy, you need extra iron to help keep you and your baby healthy. If you don't have enough iron to fuel haemoglobin production for both of you, you may develop iron-deficiency anaemia.

The additional Iron requirement during pregnancy is 800 to 1000 mg.

• First trimester 0.8mg/day
• Second/third trimester 6.3/day
  

How much Folic Acid do I need during pregnancy?

Folic acid is recommended in the doses of 0.4 microgram/day for the 3 months PRIOR TO CONCEPTION to avoid  or prevent neural tube defects. Folates are present in liver, dark green vegetables, spinach, broccoli, bananas, sweet potato, mangoes etc. (Rice, Millets and Maize have a very low concentratin of folates).

How much B12 do I need during pregnancy?

This is uncommon in pregnancy and the main source is proteins-meat, fish, eggs, milk etc. Daily B12 requirement is only 1 microgram/day.

What can I do to make sure I have enough iron?

Iron in the body comes from a diet rich in iron.

This means eating lots of dark green leafy vegetables, wholemeal bread, iron-fortified cereals, potatoes, lean red meat, shellfish, raisins, prunes and pulses.

Vitamin C helps your body absorb the iron in your diet, so drinking plenty of orange juice will also help prevent you from becoming anaemic.

Tea and coffee make it difficult for your body to absorb iron, so it's best to cut down on these drinks or avoid them altogether.

Folates are present in liver, dark green vegetables, spinach, broccoli, bananas, sweet potatoes, mangoes etc. and the main source is proteins - meat, fish, eggs, milk.

How will I know if I'm anaemic?

The symptoms of anaemia are not very specific. It may just give us a clue.

There will be vague complaints like fatigue, ill health, constant  breathlessness, palpitation, loss of appetite ,paleness, flat nails etc. Remember that some of these symptoms are seen  in normal pregnancy too especially towards the end or if the baby is large.

It is always better to show a doctor and get yourself investigated.

The routine blood tests you have at the antenatal clinic will check whether your haemoglobin levels are satisfactory. It's normal for the levels to drop a little during pregnancy because there's far more fluid in your blood to dilute the red blood cells.

Peripheral smear can differentiate between iron deficiency and folate or B12 deficiency. In the formal ,there is evidence of microcytosis and in the latter two, there is macrocytosis.

Are some women more likely to become anaemic during pregnancy?

Women who have a diet that is low in iron are likely to become anaemic. So are women who have serious morning sickness to the extent that they are vomiting very frequently - this is known as hyperemesis.

You're also more likely to have iron deficiency anaemia if you've had two or more pregnancies close together, if you're carrying more than one baby, or if you had heavy periods before you became pregnant.

How is anaemia treated?

Your doctor will discuss your diet with you to make sure that you are eating enough of the right kinds of food, and she may prescribe iron supplements.

Iron supplements can cause constipation, so it's important to have plenty of fibre in your diet while you're taking them. Prophylactic iron need not be taken in the first trimester - generally given from the second trimester and the dose is also built up slowly. If need be, one may also have to take Iron injections before delivery. Also if your iron preparation are causing a lot of  gastric problems like constipation, you may have to change the brand of the preparation.

Could my being anaemic affect my baby's health?

You don't need to worry about your baby. Your body will make sure that he gets his quota of iron before you get yours. So you'll be short of iron long before he is. Your baby makes the heaviest demands on your iron supplies in the middle of pregnancy, so this is the time to take extra care of yourself.

NON-NUTRITIONAL ANAEMIA IN PREGNANCY

Sometimes, inspite of all the iron preparations, the haemoglobin of the patient does not change. That is the time your doctor thinks about non-nutritional causes of anaemia.

What is  the cause of  non-nutritional anaemia?

The most common causes are -

1. THALASSEMIAS

It is a condition in which there is a defective haemoglobin in all the red blood cells because of which they get destroyed soon and their life-span is very less.
Transfusion of blood is the treatment for this.but apart from transfusion, one should supplement periconceptional FOLIC ACID.Iron is given only if there is a documented iron deficiency in the blood.

2. SICKLE CELL ANAEMIA

It is again a condition with defective haemoglobin .some amount of care has to be taken in this -

• Periconceptional folic acid is recommended in these patients
• Screening for HIV and Hepatitis is needed in patients with sickle cell anaemia as these patients are likely to have received multiple blood transfusions.
• Iron is given only if there is a documented iron deficiency in the blood.
• Acute pain crisis may be seen in pregnancy.contact your doctor in an emergency.
• EPIDURAL ANALGESIA IS PREFERRED DURING LABOR

3. HELLP SYNDROME

This occurs in a subset of patients with severe pre eclampsia (increased blood pressure).

The only definitive treatment for such patients is termination of pregnancy.