Signs of anaemia in pregnancy

IN pregnancy the changes to the body are numerous. As it prepares itself to accommodate a baby, the body produces up to 50 per cent more than its regular blood supply to nourish the foetus and placenta. But, according to obstetrician-gynaecologist Dr Keisha Buchanan of ICON Medical Centre, this new demand could result in anaemia in the absence of iron and other essential vitamins.

“Anaemia is one of the commonest complications in pregnancy. It develops when the blood haemoglobin levels are low. Haemoglobin carries oxygen to tissues, so a lack of haemoglobin results in anaemic symptoms such as weakness, tiredness, shortness of breath, palpitations, easy fatigue, dizziness and fainting. Severe anaemia can cause heart failure, with swelling of the feet and shortness of breath on lying down,” Dr Buchanan explained.

She pointed out that while mild anaemia may not cause any problems in the pregnancy, moderate to severe anaemia may be associated with low birth weight and premature delivery.

“The commonest cause of anaemia is iron deficiency. However, anaemia may be pre-existing; for example, due to heavy periods from fibroids, nutritional deficiencies due to an unhealthy diet, or poor appetite due to nausea and vomiting in the early part of the pregnancy. Also, non-compliance to the prenatal vitamins will almost certainly lead to anaemia, as it is very difficult to maintain a normal haemoglobin in pregnancy with just diet alone,” Dr Buchanan continued.

She said that there are a number of other factors that could cause anaemia, including:

• Persistent vaginal bleeding due to a low-lying placenta or a threatened miscarriage.

• Women with sickle cell anaemia — a genetic condition that results in early destruction of red blood cells as a result of the cells sickling and breaking down.

•There is also the possibility of vitamin deficiency — for example, Vitamin B or folic acid deficiency. Dr Buchanan notes that Vitamin B deficiency could be a direct result of malabsorption syndromes where the intestines fail to absorb adequate vitamins in the body, as is commonly seen in vegetarians.

• Autoimmune disorders such as lupus can cause anaemia due to the destruction of red blood cells by antibodies that the body creates against them.

•Other underlying longstanding medical conditions such as thyroid disease, kidney disease, liver disease and cancers.

• Infectious diseases such as HIV, Hepatitis B and C, malaria, hookworm infestation.

• Medications such as some antibiotics, chemotherapy drugs, HIV medications. Anaemia in this case is temporary and stops when use of the drug ceases.

•Excessive consumption of alcohol.

In the case of women with pre-existing anaemia, she warns that it worsens as a result of blood loss during delivery and through the passage of the lochia (blood, tissues and mucus passed vaginally) for the first few weeks following delivery.

In terms of treatment, Dr Buchanan said this could be both medicinal and non-medicinal depending on the cause as well as the severity of the anaemia. Below she explores a few:

•Treatment of iron deficiency anaemia includes improved diet and iron supplementation which is usually oral (in tablet or liquid form). Intravenous (injectable) treatment may be needed in more severe cases.

•Vaginal bleeding during pregnancy may be decreased by bed rest. Abstinence from sex and use of progesterone supplementation (which helps to prevent premature contractions) may decrease blood loss from a low-lying placenta.

• Treating conditions that encourage sickling of the red blood cells can help to prevent worsening of sickle cell anaemia. This can be done by keeping hydrated, and by early treatment of infections — such as bladder infections, treating colds, flu, and early treatment of lung infections. Avoiding cold or hot weather and early blood transfusions are at times essential to prevent deterioration of this condition.

• Supplementation of additional B12 vitamins and improving the dietary intake of meats and dairy products will treat vitamin B12 deficiency. For those whose intestines do not absorb Vitamin B12 well, they may need the vitamin in an injectable form.

• Improvement in the dietary intake of folic acid by having more green leafy vegetables and folic acid-enriched foods like cereals and extra folic acid (as much as 5 mg) will help to treat the anaemia.

•Treating underlying immunological disorders such as lupus will help to prevent red cell destruction seen in these conditions. During pregnancy, most immunological disorders do improve naturally, but may get worse after delivery and hence will need to be closely monitored thereafter.

•Iron supplementation and at times blood transfusions may also be needed to treat anaemia. For anaemia due to kidney disease, an additional use of a substance called Erythropoietin may improve the condition.

• The World Health Organization recommends that a de-worming treatment should be taken by adults once or twice per year to prevent worm infestation. Treatment of worms during pregnancy is usually reserved for the more moderate to severe cases. Antiviral treatments for Hepatitis A and B will help to combat anaemia.

• Cessation of alcohol consumption, improved nutrition and iron supplementation will help to improve anaemia. In fact, doctors recommend that pregnant women should abstain from alcohol completely in order to avoid the risk of Foetal Alcohol Syndrome, which can cause abnormal facial features and developmental disorders in babies.

Anaemia in pregnancy is a very common and treatable condition, and most causes of anaemia can be successfully treated. Compliance with prenatal vitamins and proper nutrition will help to prevent anaemia.