Anaemia is defined as a reduction in circulating haemoglobin mass below the critical level. The normal haemoglobin (Hb) concentration in the body is between 12-14 grams per cent. The World Health Organisation define anaemia in pregnant women as a haemoglobin concentration less than 11.0 g/dL
Degree of Anaemia: Anaemia is often classified as mild (9-11%), moderate (7-9%), severe (4-7%), and very severe (< 4%). It is also classified according to Haematocrit (PCV) %.
Magnitude of the problem: Pregnancy anaemia is one of the important public health problems not only in Nigeria but also in most of the West Africa countries. About 4- 16% of maternal deaths are due to anaemia. It also increases the maternal morbidity, fetal and neonatal mortality and morbidity significantly.
Anaemia in pregnancy is a condition with effects that may be deleterious to mothers and fetuses. Indeed, it is a known risk factor for many maternal and fetal complications.
Maternal risk during the Antenatal period: poor weight gain. Pre-term labour, PIH, placenta previa, accidental Hg, eclampsia, premature rupture of membrane (PROM), etc.
Maternal risk during intranatal period: Dysfunctional labour, intranatal haemorrhage, shock, anaesthesia risk, cardiac failure
Maternal risk during the postnatal period: Postnatal sepsis, subinvolution, embolism
Fetal and Neonatal risk: Complications include prematurity, low birth weight, poor Apgar score, fetal distress, neonatal distress requiring prolonged resuscitation, and neonatal anaemia due to poor reserve. Infants with anaemia have a higher prevalence of failure to thrive, poorer intellectual developmental milestones, and higher rates of morbidities and neonatal mortalities than infants without anaemia. Moreover, babies whose mothers had AIP during their first trimester in utero experienced higher rates of cardiovascular morbidities and mortalities in their adult lives than babies whose mothers did not have AIP.
Causes:
1) Physiological Pregnancy causes a state of hydraemic plethora. There is a disproportionate increase in plasma volume during pregnancy, leading to an apparent reduction in RBC, haemoglobin, and haematocrit values. Hb is consequently reduced to a varying extent, occasionally as low as 80%. The dilution picture is normochromic and normocytic. This is so-called physiological anaemia.
2) Acquired– Nutritional
a) Iron deficiency anaemia (60%),
b) Macrocytic anaemia (10%) due to deficiency of folic acid and/or vitamin B12
c) Dimorphic and protein deficiency anaemia (30%), both due to deficiency of iron and folic acid and /or vitamin B12
d) Protein deficiency due to protein deficiency in extreme malnutrition
Hemolytic or Haemorrhagic (due to acute blood loss, chronic (hookworm, bleeding piles)
Iron and folate deficiency is by far the most important etiological factor. Haemolytic anaemia may be caused by haemoglobinopathies, drug reaction or infestation with malaria parasites.
Risk factors
Sociodemographic factors (age, level of formal education, marital status, areas and cities of residence)
Obstetrical factors (gravidity, parity, history of previous preterm or small-for-gestational-age- age deliveries, plurality of pregnancy, multiple or singleton)
Behavioural factors (smoking or tobacco usage, alcohol usage, utilisation of prenatal care services)
Medical conditions (diabetes, renal or cardio-respiratory diseases, chronic hypertension, AIP anaemia in pregnancy
Symptoms:
To start with, the pregnant woman with anaemia may not have any symptoms as the body system gets adjusted to reduce haemoglobin mass. However, she may present with vague complain of ill health, fatigue, loss of appetite, digestive upset, dyspnoea, palpitation, etc.
Clinical examination may reveal pallor, pale nails, koilonychia, pale tongue, etc. In severe cases, there may also be oedema.
Management:
A pregnant woman requires approximately 2 to 4.8 mg of iron daily. To have it from the dietary sources, she must consume 20-48 mg of dietary iron. The iron store is markedly diminished when there is a fall in Hb values. Therefore, there is a need for routine iron supplementation for all pregnant women.
It is advisable to build up iron stores before a woman marries and becomes pregnant. This can be achieved by
1) Routine screening for anaemia for adolescent girls form school days
2) Encouraging iron-rich foods
3) Fortification of widely consumed food with iron
4) Providing iron supplementation during school days
5) Annual screening for those with risk factors
Iron-rich foods: Pulses, cereals, Beet root, Green leafy vegetables, meat, liver, egg, fish, legumes, Crap, beans, and iron-rich white breads, etc.
