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All your pregnancy questions answered

Anaemia in pregnancy

A patient is diagnosed as having anaemia if her haemoglobin level is less than 11g%. There are a number of causes of anaemia the commonest being iron deficiency. Haemoglobin [Hb] is a substance which is present in the red blood cells [RBCs] in the blood which carries out the critical function of carrying and delivering oxygen from our lungs to all parts of the body.

Why is iron so important in pregnancy?

The biggest reason is that iron helps your body make new blood to carry the oxygen and nutrients to the baby during pregnancy. By the end of pregnancy you will have almost twice as much blood in your body than when you began the pregnancy. Your need for iron will increase 100% over your requirements pre-pregnancy. Towards the end of pregnancy your baby will also be storing iron for his or her first six months of life. Babies generally do not get much iron from their mother's diets during this time and depend upon their own stores of iron. Hence the most common cause of anaemia in pregnancy is iron deficiency and that will be discussed at length.

In addition most Indian women have low haemoglobin to start pregnancy with, have a vegetarian diet which is also lower in iron and hence are very prone to anaemia.

Anaemia is the cause of about 1/3rd the maternal deaths in India. This is because if your haemoglobin is low it is more difficult to withstand any excessive blood loss at the time of delivery or abortion.

Types and causes of anaemia:

• Microcytic hypochromic anaemia:

1. Iron deficiency

2. Thalassaemia

3. Chronic illnesses

• Normocytic normochromic anaemia

1. Blood loss

2. Haemolysis-destruction of the red blood cells

• Macrocytic

1. Vitamin B12 deficiency

2. Folic acid deficiency

Who is at an extra risk for anaemia?

If you fall into any of the following categories you are at high risk for anaemia

• If your pregnancies are closer than two years apart

• If you don't eat foods high in iron

• If you have been dieting

• If you have been suffering from menorrhagia [heavy bleeding during your periods]

• If you have any chronic blood loss such as piles

When will you be tested for anaemia?

You will need to be tested twice, the first Hb being done at the time of registration and the second at about 28 weeks of pregnancy.

What can you do about your diet?

The following foods are either rich in iron or help the body to absorb the iron:

• Green leafy vegetables such as spinach, broccoli and other greens

• Red meats

• Beans of all types

• Eggs

Is diet alone enough?

NO, Diet changes alone are not enough in pregnancy. You will need to take a iron supplement which will be prescribed by your doctor. This is probably the most important supplement that you need to take in pregnancy.

What are the symptoms of anaemia?

Your body will be able to compensate enough for early anaemia and symptoms usually appear late with advanced anaemia. This is why it is important too check for anaemia with a Hb test rather than wait for symptoms. When you do develop symptoms they will be:

• Easy fatigue and loss of energy
• Unusually rapid heart beat, particularly with exercise
• Shortness of breath and headache, particularly with exercise
• Difficulty concentrating
• Dizziness
• Pale skin
• Leg cramps

Treatment

You will be given oral iron supplements and if that is unsuitable you may be asked to take injectable iron. If the anaemia is severe and late in pregnancy you may need a blood transfusion. This is because for the iron supplement to work it takes atleast 4 weeks.