Anemia in Pregnancy http://www.dartmouth.edu/~obgyn/mfm/PatientEd/Anemia.

html Description of Condition: Anemia occurs when the number of red blood cells is lower than expected. Red blood cells deliver oxygen to your body. There are many reasons why a person can be anemic. Iron deficiency anemia is the most common. o Iron is needed to make red blood cells. o When women loose blood, they also loose iron. If the iron is lost faster than it is replaced, there is not enough iron to make new red blood cells and iron deficiency anemia occurs. o Iron is replaced by vitamin supplements or in the diet. Other vitamin deficiencies may also cause anemia. Chronic illness Destruction of blood cells Blood loss Abnormally formed blood cells. For example, patients with sickle cell anemia make abnormally shaped blood cells that are easily destroyed. Inherited abnormally low production of hemoglobin o Hemoglobin is the chemical in the red blood cell that actually binds oxygen. o People of certain ethnic backgrounds may not make enough hemoglobin.

Impact on Pregnancy Nature has adapted many ways to protect the developing baby from the effects of anemia. The mother must be severely anemic before adverse effects occur. Patients with severe anemia are more likely to delivery early and have small babies. Women with severe anemia may have symptoms such as: weakness, fatigue, shortness of breath and headaches. If the reason for anemia is an inheritable condition, the baby may also have it.

Pregnancys impact on anemia All pregnant women retain water in their blood vessels, and dont make enough red blood cells to compensate. Therefore, all pregnancy women have a decreased red blood cell count compared to when they are not pregnant. Anemia due to iron deficiency and other causes worsens during pregnancy. Taking a vitamin supplement helps prevent this worsening.

Birth Birth is associated with blood loss. If a woman is anemic, she should take iron for several months after delivery to help the body replace the lost blood cells and iron stores.

Breast feeding women may also need to take iron because iron is lost in breast

milk.

Anemia During Pregnancy

Description
An inadequate level of hemoglobin during pregnancy. Hemoglobin is the protein inside red blood cells that carries oxygen to body tissues. Common anemias in pregnancy include iron deficiency anemia (75 to 85% of cases) and folic acid deficiency. In addition, glucose-6-phosphate dehydrogenase (G6PD) deficiency, thalassemia and sickle cell anemia have genetic implications and should receive special evaluation.

Frequent Signs and Symptoms

Sometimes no symptoms are apparent. Breathlessness. Tiredness, weakness or fainting. Paleness. Infrequent: o Palpitations or an abnormal awareness of the heartbeat. o Inflamed, sore tongue. Nausea. o Headache. o Jaundice.

Causes

Poor diet with inadequate iron. Folic acid deficiency. Loss of blood from bleeding hemorrhoids or gastrointestinal bleeding. Even if iron and folic acid intake are sufficient, a pregnant woman may become anemic because pregnancy alters the digestive process. The unborn child consumes some of the iron or folic acid normally available to the mother's body.

Risk Increases With

Poor nutrition, especially multiple vitamin deficiencies. Excess alcohol consumption, leading to poor nutrition. Medical history of any disorder that reduces absorption of nutrients. Use of anticonvulsant drugs. Previous use of oral contraceptives. G6PD deficiency is more common in persons of Mediterranean, African American and Sephardic Jewish descent. Sickle cell anemia is found in African Americans and in persons of Italian, Middle Eastern and East Indian descent.

Preventive Measures

Eat foods rich in iron, such as liver, beef, whole grain breads and cereals, eggs and dried fruit. Eat foods high in folic acid, such as wheat germ, beans, peanut butter, oatmeal, mushrooms, collards, broccoli, beef liver and asparagus. Eating foods high in vitamin C, such as citrus fruits and fresh, raw vegetables makes iron absorption more efficient. Take prenatal vitamin and mineral supplements, if they are prescribed. Screening for several anemias, e.g., G6PD deficiency and sickle cell disease in high risk women, should be considered prior to any attempt to become pregnant.

Expected Outcome
Usually curable with iron and folic acid supplements by mouth or by injection.

Possible Complications

Premature labor. Intrauterine growth retardation (IUGR). Dangerous anemia from normal blood loss during labor, requiring blood transfusions. Increased susceptibility to maternal infection after childbirth.

Treatment/Post Procedure Care

General Measures

Diagnosis is determined by laboratory blood studies. For most anemias, supplements are prescribed. For G6PD deficiency, treatment is supportive and educational. Sickle cell anemia in pregnant women requires careful medical management; usually done by specialists. If the tongue is red and sore, rinse with warm salt water 3 or 4 times a day. Use 1 teaspoon salt to 8 oz. warm water. Brush teeth with a soft toothbrush.

Medication
Iron, folic acid and other supplements may be prescribed. For better absorption, take iron supplements 1 hour before eating or between meals. Iron will turn bowel movements black, and often causes constipation. Iron sometimes may be taken with meals if it has caused an upset stomach.

Activity
Rest often until the anemia disappears.

Diet
Eat well and take prescribed supplements. Increase fiber and fluid intake to prevent constipation. Notify Your Healthcare Provider If

You have symptoms of anemia during pregnancy. The following occurs during treatment: Diarrhea. Nausea. Abdominal pain. Constipation. Bleeding, however slight, from any source.