Anaemia in pregnancy

Anaemia in pregnancy

Anaemia in pregnancy is defined as a haemoglobin level of less than 11 g/dL in early pregnancy and less than 10.5 g/dL in the second and third trimesters. Mild anaemia is defined as haemoglobin 8–11 g/dL, while severe anaemia is defined as haemoglobin less than 7 g/dL.

Iron deficiency anaemia during pregnancy is associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality.

Clinical presentation

• Tiredness, weakness, palpitations, and dyspnoea

• Exercise intolerance

• Pallor of the skin and mucous membranes

• Dizziness, faintness, and headache

• Intermittent claudication (ache, cramp, numbness, or a sense of fatigue)

Note

• Some patients with anaemia in pregnancy may be asymptomatic

Investigations

• Full blood count and blood cross-match, including red cell morphology

• Red blood cell electrophoresis if haemoglobinopathies are suspected

• Blood smear for malaria

• Stool and urine analysis

• HIV test

Non-pharmacological treatment

• Encourage an iron-rich diet (fish, eggs, fruits, vegetables, etc.)

• Prevent and treat malaria early

• Investigate and treat associated worm infestations

Pharmacological treatment

Prophylaxis during antenatal care

• Ferrous sulfate (PO) 200 mg every 8–12 hours

AND

• Folic acid (PO) 5 mg every 24 hours

Note

• Ferrous sulfate should be taken on a full stomach and should not be taken with tea or coffee

• If vomiting occurs, reduce the dosage to a tolerable level

Management of severe anaemia in the first and second trimesters (Hb <7 g/dL)

• Ferrous sulfate + folic acid (FDC) (PO) 1 tablet every 12 hours for 4 weeks

AND

• Vitamin B (PO) every 12 hours for 4 weeks

Management of severe anaemia in the third trimester (Hb <7 g/dL) or in the presence of signs of severe anaemia

Signs of severe anaemia include features of heart failure.

• Refer or admit the patient for blood transfusion with at least 2 units of packed red blood cells (RBCs

• Continue ferrous sulfate and folic acid supplementation after blood transfusion as outlined above.