Women's Health
Anemia and Pregnancy

​​​Overview: 

Pregnant women experience several psychological and physical changes, as well as medical conditions. The most common of such conditions is anemia, which may develop owing to iron deficiency. Iron is the main component of hemoglobin, which carries oxygen to the brain and other body cells, and is therefore essential for the body to conduct its vital functions. Anemia, as such, endangers the health of both the mother and fetus. That is because, during pregnancy, the body produces an extra amount of blood (around 4 liters). A pregnant woman who suffers anemia should seek medical attention immediately, to receive proper treatment, and learn about the symptoms and potential complications. Iron deficiency can affect the fetus (since iron is essential for fetal development; the fetus consumes relatively large amounts of iron, and preserves them up to 6 months after birth)

Causes of anemia:
  • Severe bleeding (during previous deliveries or accidents)
  • Menstrual or internal bleeding
  • Blood donation in large quantities
  • Pregnancy
  • Malnutrition
  • Hereditary diseases
Risk factors of anemia during pregnancy:
  • Pre-pregnancy iron deficiency or low iron intake
  • ​Diseases that trigger anemia (e.g. sickle cells)
  • Disorder in the digesting system hampering absorption of iron and other nutrients
  • Multiple pregnancy (two or more twins), in which case the need for iron supply becomes even greater
  • Suffering anemia in a previous pregnancy
  • Successive pregnancies (with only one year in between)
Anemia diagnosis during pregnancy:
  • During the first weeks of pregnancy, a blood test is conducted to make sure that the hemoglobin level is 110 g/L during the first trimester, and 105 g/L during the second and third trimesters. The test should be repeated 2-4 weeks afterwards, to ensure effectiveness of the prescribed treatment.
  • Another blood test should be conducted during the 28th week of pregnancy, to measure the level of ferritin (the intercellular protein responsible for iron storage and release). During pregnancy, the ferritin level increases, and then gradually decreases. By the 32nd week of pregnancy, the ferritin level becomes less than the half. If the test results show that the ferritin level is >30µg, drug treatments should be considered.
Blood transfusion:
The early treatment of anemia (depending on medications) is meant to curb the need for blood transfusion, given the risks associated with it. In some cases, however, blood transfusion would be the only effective treatment method. Such cases include:
  • Severe bleeding;
  • Worsening anemia, or ineffective medications.
Complications of anemia:
  • Adverse effects on the functions and endurance of muscles
  • Inability to exercise
  • Low birth weight
  • Iron deficiency in children
  • Weak milk production of delivery
Iron:
Iron deficiency is the most common cause of anemia. Iron is essential for the production of hemoglobin, which is responsible for carrying oxygen to the body cells. Iron deficiency, as such, leads to deficiency of hemoglobin, and the development of a medical condition called: iron-deficiency anemia. It is difficult for the person suffering this kind of anemia to make for such deficiency through food only. A medical intervention should be considered, which usually takes the form of iron supplements (tablets/ syrup) prescribed by the doctor. The extent and speed of recovery vary according to the body's responsiveness to treatment, which commonly take several months.

Stopping the intake of iron:
In some cases (e.g. before undergoing a colon endoscopy procedure, or after surgeries), the doctor may recommend stopping the intake of iron for a specific period of time. The patient should ask the doctor when to resume the iron therapy.
 Iron supplements: guidelines
  • Make sure to take the dose prescribed by the doctor, and follow the guidelines;
  • Don’t grind or chew iron tablets, and seek the doctor's advice if you're unable to swallow them;
  • Iron is best absorbed when taken on an empty stomach (one hour before or two hours after meals), with a cup of water or fruit juice (rich in Vitamin C), which is necessary for accelerating the absorption of iron;
  • Avoid tea, coffee, milk and chocolate after administering iron, since the affect or hamper its absorption;
  • Avoid mixing iron supplements with other medications (e.g. calcium, antacids, antibiotics, and some medications of osteoporosis, thyroid disorders and Parkinson’s disease); Ask the doctor about the interval between taking iron supplements and other medications;
  • If you take over-the-counter medications, seek your doctor’s advice to avoid drug interaction.
Intravenous infusion of iron:
If anemia is detected after the 36th week of pregnancy, iron will most likely be infused directly into the blood through intravenous injection, given the few weeks remaining before delivery. This will also be the case if the drug therapy proves ineffective in making for the iron deficiency and raising the hemoglobin level. Intravenous infusion of iron is also recommended for patients with heart of kidney diseases. Regarded as the fastest method for raising the hemoglobin level, intravenous infusion of blood is usually conducted in sessions (one or two sessions, as needed), with a one-week interval between sessions.

Side effects of intravenous infusion of iron:
The side effects of intravenous infusion of iron are often temporary and transient. They include: headache, vomiting, nausea, pains in muscles and joints, taste changes, metallic taste, pulse and hear-rate abnormalities, and discolored skin patches in the injection area owing to iron deposits (a rare side effect). Sometimes these side effects do not appear immediately, but take one or two days to appear, and then gradual recover usually takes place.

When to see a doctor?
If you the following symptoms begin to develop: chest pain, difficulty breathing, swallowing neck or mouth.

Treatment of anemia:
Following a healthy, balanced diet is the best treatment for most cases of deficiency of vitamins and minerals, with an emphasis on the foods rich in iron, such as:
  • Iron: The foods rich in iron include beef and liver, as well as plant-based sources of iron (e.g. lentils and black raisins), and leafy vegetables (e.g. spinach).
  • Folic acid: e.g. avocado, leafy vegetables, broccoli, lentils and beet).
  • Vitamin B12: (e.g. eggs, meat, sea-food)
  • Besides, iron supplements may be taken as prescribed by the doctor.
Side effects of iron pills:
The common side effects associated with iron pills include nausea, headache, metallic taste, gas, diarrhea or constipation and black stool. Stop taking the iron supplements and seek the doctor’s advice immediately:
  • If you suffer stomachache;
  • If the stool becomes bloody or takes the appearance of tar.
Prevention:
  • Check the hemoglobin level every now and then;
  • Make sure your diet is healthy and balanced;
  • Increase the intake of Vitamin C, since it improved the iron absorption;
  • Avoid the triggers of anemia (e.g. internal or external bleeding), and some infectious diseases (e.g. malaria and viral infections) that weaken the red blood cells.

Clinical Education General Department
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