Anemia in pregnant women by degrees. Should you panic if you have anemia? Treatment of anemia in pregnant women

During the physiological course of pregnancy, blood volume gradually increases. Although the mass of red blood cells in the blood increases, the volume of the liquid component, or plasma, increases to a greater extent. This leads to a relative dilution of the contents of the bloodstream.

Gestational anemia, or hydremia, is characterized by physiologically decreased hemoglobin and hematocrit levels, but the mean erythrocyte volume (MCV) and shape do not change. This value (MCV) is determined by automatic interpretation of blood test results.

Some pregnant women experience pathological anemia, which in 75-95% of cases is associated with iron deficiency.

Physiological reasons

In any pregnant woman, plasma volume increases to a greater extent than red blood cell mass. As a result, blood thinning, or hemodilution, occurs. This condition is not morbid anemia in the true meaning of the term.

Hemodilution has a physiological meaning:

• more liquid blood penetrates better through the placental vessels and nourishes the embryo;
• During childbirth, the absolute number of lost red blood cells decreases.

Therefore, a decrease in hemoglobin concentration to 100-110 g/l in pregnant women is normal in many cases. With such numbers, iron supplements are sometimes not prescribed; it is enough to follow the correct diet. This condition is not accompanied by pathological symptoms. 1-2 weeks after birth, blood counts return to normal.

Pathological causes

Anemia in pregnant women can be caused by a variety of reasons. Depending on the MCV value, it is classified into three groups:

1. MCV less than 80 fL – microcytic, erythrocyte volume is reduced.
2. MCV 80 - 100 fL - normocytic, the average volume of erythrocytes is normal.
3. MCV more than 100 fL - macrocytic, red blood cells are larger than normal, but poor in hemoglobin.

Causes of low MCV anemia:

• iron deficiency;
• thalassemia;
• chronic diseases of a pregnant woman;
• sideroblastic anemia;
• copper deficiency;
• lead poisoning, for example, in hazardous industries.

The normocytic form in pregnant women can be caused by the following reasons:

• blood loss;
• physiological anemia;
• minor iron deficiency;
• chronic diseases;
• inhibition of hematopoiesis in the bone marrow;
• chronic renal failure;
• autoimmune hemolytic form;
• hypothyroidism (thyroid dysfunction) or hypopituitarism (hypothalamic dysfunction).

The macrocytic variant of the pathology occurs in the following cases:

• folate deficiency anemia;
• B12 is deficient;
• pathology caused by medication;
• reticulocytosis;
• liver disease and alcoholism;
• acute myelodysplastic syndrome.

Factors contributing to the development of anemia:

• consecutive pregnancies;
• teenage pregnancy;
• low iron content in food products;
• anemia that existed before gestation;
• intense vomiting due to;
• previous pyelonephritis, hepatitis A;
• chronic diseases - gastritis, tonsillitis, pyelonephritis, rheumatic heart defects, diabetes;
• intense menstrual or uterine bleeding observed before pregnancy;
• hemoglobin in the 1st trimester is less than 120 g/l;
• pregnancy occurs during breastfeeding previous child;
• vegetarianism;
• or threat of interruption of gestation.

Prevalence

A decrease in hemoglobin concentration to 100 g/l or less, associated with iron deficiency, is diagnosed in 20-80% of pregnant women. The level of this microelement in serum is reduced in 50-100% of women. In Russia, the frequency of iron deficiency in pregnant women ranges from 30 to 40%. This is an average; in European countries the incidence of this disease is lower.

Another fifth of pregnant women have hidden iron deficiency, which persists even after the birth of the child.

Why does anemia develop:

• the need for this microelement by the 3rd trimester reaches 12-18 mg/day;
• about 400 mg of it circulates in the fetal bloodstream;
• 500 mg of this substance is spent on increasing a woman’s blood volume;
• During childbirth, up to 170 mg of iron is lost, and during lactation – another 420 mg of iron.

Therefore, by the end of breastfeeding, iron deficiency can reach 1400 mg.

The most common forms of pathology

In pregnant women, a decrease in hemoglobin levels is most often recorded, caused by a deficiency of iron, folic acid or vitamin B12. This condition occurs much more often in the 2nd-3rd trimesters of gestation.

Iron-deficiency anemia

This form occurs when there is a lack of iron, which is required for the formation of hemoglobin. This is a protein found in red blood cells that carries oxygen to tissues. With this form of pathology, a lack of oxygen develops in the cells of the woman and the fetus. This is the most common reason anemia in pregnant women.

Folate deficiency form

Folic acid is found in leafy greens and some other foods. It is necessary for the formation of new cells, including red blood cells. During pregnancy, a woman needs more folic acid. However, it is often not enough in the diet. This can lead to abnormalities in the child, such as neural tube abnormalities (spina bifida) or low weight. Therefore, supplements with folic acid necessary for every pregnant woman.

B12-deficient form

If there is insufficient intake of vitamin B12 into the body of a pregnant woman, her Bone marrow cannot synthesize normally functioning red blood cells. The greatest risk of developing this variant is in women who follow a vegetarian diet and do not eat meat, poultry, milk, or eggs. Vitamin B12 deficiency can cause abnormalities in the formation of the fetal nervous system and premature birth.

Severity

Depending on the level of hemoglobin (Hb), the following degrees of anemia are distinguished:

Lower limits of normal:

• hemoglobin – 100 – 110 g/l;
• hematocrit 0.32;
• red blood cells 3.5 x 1012/l.

The WHO classification includes the following gradation of the severity of pathology:

• mild degree – Hb 90-110 g/l;
• 2 degrees (moderate) – 70-89 g/l;
• heavy – below 70 g/l.

Signs

Symptoms of anemia during pregnancy:

• pallor of the skin, lips, nails, mucous membranes;
• constant fatigue;
• dizziness;
• dyspnea;
• rapid heartbeat;
• difficulties with mental and physical work;
• sometimes unusual taste preferences - a desire to eat chalk, plaster, clay or other inedible substances;
• difficulty swallowing with a feeling of a “lump in the throat.”

Anemia of the 1st degree may practically not manifest itself externally. Often its symptoms resemble weakness and deterioration of health common to pregnancy. However, this condition can harm the woman and child. Therefore, all pregnant women should undergo blood tests as prescribed by their doctor.

How does it appear upon external examination:

• pallor of the skin and mucous membranes;
• dry and cracked skin;
• “jams”, cracks in the corners of the lips;
• there may be slight yellowing of the area above the upper lip, the skin of the hands, caused by a violation of vitamin A metabolism due to iron deficiency;
• muscle weakness;
• brittleness and striation of nails;
• hair loss, brittle ends;
• burning in the area of ​​the external genitalia.

Signs of anemia during pregnancy, both clinical and laboratory only, should be a reason to begin treatment.

Possible consequences

If iron deficiency is severe, the consequences of anemia for the child include:

• prematurity or low birth weight;
• low hemoglobin content in a child;
• lagging child in mental and physical development.

With iron deficiency, the risk of the following complications increases significantly:

• OPG-gestosis;
• premature birth;
• untimely outpouring of water;
• weakness of labor;
• increased blood loss during childbirth;
• postpartum septic (infectious) complications;
• – lack of breast milk.

What are the dangers of anemia caused by a lack of folic acid during pregnancy?

• prematurity, low birth weight;
• formation of heavy birth defect spine, spinal cord or brain.

Untreated vitamin B12 deficiency can also lead to the formation of a neural tube defect in the fetus.

Diagnostics

At the first appointment with a gynecologist, a woman is given a referral for a general blood test, and this is repeated in the future. This simple test makes it possible to diagnose anemia of any severity and suggest its cause. A blood test determines the level of hemoglobin, red blood cells, and hematocrit.

If iron deficiency is suspected, a determination of total serum iron binding capacity (TIBC), transferrin saturation with iron and serum iron may be additionally prescribed.

Criteria to suspect iron deficiency anemia:

• hemoglobin less than 100 g/l;
• decrease in color index to 0.85 or less (hypochromia);
• microcytosis, anisocytosis - reduction in the size and change in the shape of red blood cells;
• decrease in erythrocyte diameter less than 6.5 microns;
• THC more than 64.4 µmol/l;
• Serum Fe up to 12.6 µmol/l;
• transferrin saturation with iron up to 16%;
• the most informative indicator is serum ferritin up to 12 mcg/l.

To identify a lack of folic acid, its content in serum and red blood cells is determined. A deficiency of vitamin B12 is confirmed by a blood and urine test for the concentration of cyanocobalamin.

Treatment

Mild anemia is treated by prescribing iron and. A woman is recommended to take complex vitamins for pregnant women, which include the required amount of all microelements. It is necessary to understand that with this disease, diet alone will not be enough.

In the macrocytic form of the disease caused by vitamin B12 deficiency, it may be necessary to administer this substance in the form of injections. Treatment of anemia in pregnant women in this case necessarily includes a nutritious diet including meat, eggs, and dairy products.

Drugs prescribed for anemia in pregnant women

During pregnancy, drugs are prescribed only by a doctor; therapy should begin when the hemoglobin level decreases to 110 g/l. It is better to use tablets containing, in addition to iron, ascorbic acid, for example, Sorbifer Durules. While taking medications, blood tests are repeated every 10 days, therapy continues until the end of pregnancy, regardless of improvement in blood counts.

Clinical recommendations based on WHO data include the use of Fe supplements in all pregnant women in the 2nd-3rd trimesters and in the first six months of breastfeeding, even in the absence of signs of low hemoglobin. However, in each case, the decision to prescribe these funds is made individually.

Anemia of the 3rd degree requires hospitalization in a hospital. With such low hemoglobin levels, the woman is prescribed a red blood cell transfusion. However, this procedure is dangerous due to the risk of contracting infectious diseases. Therefore, it is better to detect and begin treatment of pathology at an early stage.

Of the Fe preparations, preference should be given to:

• tablet rather than injectable forms;
• products containing divalent iron;
• ferrous sulfate derivative.

Effective medicines:

• Actiferrin drops, syrup or capsules;
• Biofer (chewable tablets with folic acid);
• Gyno-tardiferon (long-acting tablets with folic and ascorbic acid);
• Totema (solution for oral use with copper and manganese);
• Fenyuls (ferrous sulfate and ascorbic acid);
• Feroglobin B12 (combination of Fe and multivitamins).

Injectable medications are prescribed to pregnant women only in special cases:

• severe diseases of the small intestine (enteritis, consequences of intestinal operations);
• nausea or vomiting that occurs when taking any iron preparations orally, regardless of the form (drops, syrups, etc.);
• necessity quick recovery Fe levels in the body, for example, if a pregnant woman requires surgery;
• additional use of erythropoietin, which without a sufficient supply of this trace element in the body will be ineffective.

Such restrictions are due to the fact that with an increased intake of Fe into the blood and a lack of transferrin that carries it, severe allergic reactions are possible. Trivalent drugs are used in combination with plasma-substituting solutions. Calculation of the course dose for injection: body weight (kg) x hemoglobin level (1 g/100 ml) x 2.5.

After a course of injections, medications are prescribed in tablets. Your doctor should determine the duration and dosage of iron intake. Excess of this trace element can be deposited in the liver, lungs and other organs, disrupting their function. On the other hand, a maximum of 300 mg of iron can be absorbed per day, so exceeding this figure is not advisable.

Side effects of iron supplements

In some patients, taking iron-containing drugs causes quite pronounced side effects– nausea and vomiting, abdominal pain, constipation or diarrhea. Their likelihood increases with increasing dosage of the drug. Sometimes they cause the cancellation of tablet forms and the need for injection.

When taking the tablets, the stool turns black.

Less common side effects include:

• formation of esophageal ulcers;
• skin rash and itching;
• dizziness and headache;
• weakness, increased body temperature.

Prevention

Prevention of anemia in pregnant women is required if there is a high risk of developing this pathology:

• a previous decrease in hemoglobin;
• chronic infections or internal diseases;
• repeated births;
• hemoglobin in the 1st trimester is less than 120 g/l;
• multiple births;
• before pregnancy, the duration of menstruation is more than 5 days.

For prevention, a diet and iron-containing medications are prescribed. Medicines should be taken in low dosage, starting from the 12th week, for six months.

The heme form is part of hemoglobin. It is found in animal products that initially contain this protein. These are red meat, fish and poultry. This form is quite well absorbed in the intestines.

Non-heme iron has been found in plant products, its absorption is much worse. Therefore, of course, vegetables and fruits should be part of a pregnant woman’s menu, but there is no need to count on them as a means of preventing and treating anemia. This, in particular, applies to such popular products as apples and pomegranates.

• beef, pork, chicken liver;
• sardines, preserved in oil;
• halibut, sea bass, salmon;
• veal, beef;
• low-fat natural ham.

• lentils, beans, spinach;
• tofu cheese;
• pumpkin seeds, sesame seeds, sunflower seeds;
• pistachios, peanuts, cashews, walnuts, toasted almonds;
• apricots, raisins, peaches, prunes;
• baked potato;
• egg noodles;
• sprouted wheat grains;
• boiled peas;
• brown rice;
• whole grain or bran bread.

Some foods promote the absorption of iron from food, while others interfere with this.

To improve the absorption of the microelement, it is recommended to give up strong coffee and tea, and use more calcium-rich foods, such as milk.

To improve absorption, you should add sources of vitamin C to the menu - broccoli, rosehip decoction.

Approximate daily menu:

The list of foods useful for anemia includes citrus fruits, strawberries, oysters and shrimp, eggs, but pregnant women are not recommended to eat them due to their high allergenicity, as well as chocolate, mushrooms and raspberries.

Due to the significant risk of developing anemia, doctors recommend that you approach pregnancy planning very responsibly. If necessary, the expectant mother undergoes additional treatment to increase hemoglobin levels.

While pregnant, you need to take measures to prevent anemia. Particular attention should be paid to diet. It must include meat dishes. This is where a person gets iron from. For the sake of the health of the unborn child, vegetarians are advised to at least temporarily reconsider their diet.

To prevent blood pathologies, iron-containing medications are used as prescribed by a doctor. It is usually recommended to take them daily for six months, starting from 14-16 weeks of pregnancy. The daily dose of iron should be about 60 mg, and folic acid - 250 mg.

The lack of hemoglobin in a woman’s blood quite often goes unnoticed, without causing any symptoms. However, the consequences of anemia during pregnancy for the child can be fatal, which causes Special attention to the blood parameters of gynecologists who observe the patient. The task of blood in the body of any person is to transport important nutrients, as well as bound oxygen, which supply cells with energy and “building” material (protein, fats and other components). A decrease in the concentration of oxygen in the blood, which is closely related to hemoglobin, reduces the rate of metabolic reactions in all tissues without exception.

It is worth noting important feature regarding the “nutrition” of the fetus in the mother’s body. The blood of a pregnant woman and baby does not mix in the uterus. The blood flow of the unborn child, although not directly related to the blood flow of the mother, is due to a special organ - the placenta - the fetus can receive oxygen only from the mother’s blood. This fact is often unknown to patients who deliberately ignore the supposedly slight decrease in blood hemoglobin levels. The hemoglobin level in a pregnant woman’s body should not fall below 110 g/l, provided other normal blood parameters are present.

Quite often, anemia in a pregnant woman can be detected only by chance, by conducting a general blood test for preventive purposes during the observation period in antenatal clinic.

Expectant mothers should understand that their body and fetus are a single whole in every sense. From the pathophysiological point of view, everything that is bad for the health of the mother is likely to lead to even worse disorders on the part of the fetus.

Therefore, the task of doctors all over the world is to teach women to plan pregnancy and approach such an event examined and healthy. Unfortunately, most expectant mothers ignore such recommendations, considering themselves healthy, and do not pay due attention to timely diagnosis, and often to monitoring pregnancy by a gynecologist. This leads to the following dangers for a pregnant woman when she develops moderate or severe anemia:

• Oxygen deficiency in tissues and cells leads to activation of chronic inflammation, as well as the formation of connective tissue. In turn, a decrease in functional activity against the background of exacerbation of chronic pathology will lead to a very difficult pregnancy. Naturally, in addition to the health of the mother in such a situation, the growth and development of the fetus is sharply affected.
• Anemia becomes a symptom of damage to the kidneys, liver, bone marrow, a consequence of severe toxicosis during pregnancy. In this case, the woman’s life is considered first, measures are taken to preserve her health, and the child’s condition does not play any role until the mother’s condition is completely stabilized.
• Prolonged chronic bleeding from ulcers in the gastrointestinal tract, lungs due to hemoptysis due to infections or as a result of the threat of miscarriage, as well as premature placental abruption(bloody and spotting vaginal discharge is often mistaken for menstruation by women in early gestation) will lead to anemia. But in such situations, we are also primarily talking about the life and health of the mother, and not the fetus.

The following diseases are accompanied by anemia, in which pregnancy is completely contraindicated and must be terminated in the first trimester for medical reasons if the problem cannot be successfully solved:

1. Chronic severe iron deficiency anemia.
2. Any form of blood hemolysis.
3. Pathology of the bone marrow, leading to the aplastic form of the disease, as well as oncological processes in it.
4. Any form of anemia with concomitant thrombocytopenia.

Thus, severe anemia in a pregnant patient primarily poses a threat to her life, which in any case, with inadequate treatment, is fatal for the fetus.

What consequences can there be for the child?

For the unborn baby, who is entirely dependent on his mother while he is in her womb, anemia can provoke the following unwanted obstetric pathologies:

• Fetal growth retardation syndrome. It occurs due to insufficient placental function, which is aggravated by a lack of hemoglobin in the blood. The outcome of such a pathology during pregnancy can be various disorders of the mental and nervous development of the child, his mental retardation in the future, etc.
• The emergence of a threat of miscarriage at different stages of gestation. If proper obstetric care is not provided, such a pregnancy may end in spontaneous abortion.
• Premature birth. Although modern medicine is capable of delivering children born even in the most early dates and weighing about 1000 grams, health problems in such children often accompany them for the rest of their lives. This is an increase in probability development of cerebral palsy(infantile paralysis), various allergic reactions and reduced immunity, poor development and other disorders.
• Phenomena of toxicosis during pregnancy, which leads to a deficiency of nutrients passing through the placenta to the fetus.

Thus, anemia in a pregnant woman is a sure path to placental insufficiency. It is this that becomes the pathogenetic factor causing the development of all of the above complications.

In general, anemia during pregnancy leads to a decrease in the body's resistance to external aggressive factors. environment, and internal hidden pathological processes that were compensated before the moment of conception and did not manifest themselves in any way in the woman.

Therefore, diagnosis of this condition is carried out regularly in the antenatal clinic during the period of observation of pregnancy until childbirth. Women are prescribed regular blood tests, which makes it possible to establish an accurate diagnosis of anemia, which does not manifest itself clinically for a long time. Next, the doctor will be able to prescribe a wider range of examinations for the patient in order to establish the true cause of this pathological condition and give recommendations on how to overcome it.

How to eliminate anemia during pregnancy?

Treatment of any form of anemia in a pregnant woman has its own characteristics. The fact is that prescribing a number of drugs during the period when a woman is carrying a child is impossible and contraindicated due to the negative impact on the growth and formation of the fetus. On the other hand, restoring the normal level of hemoglobin in the blood, especially with severe anemia, is necessary in order to preserve the life and health of the mother. That's why Treatment of this condition and correction of red blood counts is carried out depending on the cause in the following ways:

1. Optimizing the nutrition of the expectant mother. Quite often, anemia during pregnancy is a condition caused by malnutrition and poor nutrition against the background of toxicosis or changes in eating habits. A proper diet, rich in iron, protein and other important nutrients, allows you to stop anemia within a few weeks, without even resorting to drug therapy. But we are talking only about conditions borderline with the norm, and not about severe cases.
2. Iron supplements. They are a classic treatment for iron deficiency conditions that develop against the background of both a long-term improper diet and an increased need for such a substance by the human body. Naturally, pregnancy worsens the course of this condition and requires special replacement therapy. However, unlike the standard procedure for treating such drugs during pregnancy, special care is required in calculating the dosage and frequency of taking medications containing iron. Diet and properly prescribed doses of iron-containing drugs can relieve mild to moderate anemia within 1-2 months in expectant mothers.
3. Replacement blood transfusion. It is advisable to carry out for women with chronic blood loss, which is complicated by severe anemia or hemorrhagic shock of the 2-3rd degree. Naturally, such a radical measure to replenish the volume of hemoglobin and red blood cells is fraught with a number of complications in pregnant women, but, unfortunately, there are no alternatives.

Every woman should understand that during pregnancy and planning it, it is much easier to avoid and cure anemia than to deal with its consequences and severe forms.

What consequences can anemia during pregnancy have for the child? updated: March 22, 2017 by: admin

This is a decrease in hemoglobin levels that occurs during gestation and is pathogenetically associated with it. It manifests itself as weakness, fatigue, dizziness, perversion of taste and olfactory preferences, cardiac pain, muscle weakness, paresthesia, damage to the mucous membranes, changes in the skin, nails, and hair. Diagnosed using a general clinical blood test and laboratory testing of iron metabolism. For treatment, iron-containing drugs, folic acid, cyanocobalamin are used, and complex antihypoxic therapy is carried out according to indications.

ICD-10

O99.0 Anemia complicating pregnancy, childbirth and the postpartum period

General information

The existence of physiological prerequisites for the occurrence of gestational anemia (hydremia) makes this disease one of the most common types of pathology during pregnancy. Manifest forms of the disease with clinically pronounced symptoms in economically developed countries occur in 16-21% of patients; in developing countries their prevalence reaches 80%. At the same time, hidden (latent) iron deficiency, taking into account the completeness of the diet, by the end of pregnancy is observed in 50-100% of women. The predominant form of anemia of the gestational period is iron deficiency, diagnosed in 75-95% of cases. The relevance of timely detection of pathology is associated with a high probability of complicated pregnancy and the occurrence of hypoxic conditions against the background of a physiological increase in oxygen demand by 15-33%.

Causes of anemia during pregnancy

The insufficient content of hemoglobin and red blood cells in the blood of a pregnant woman is due to both factors directly related to gestation and previous diseases. According to the observations of specialists in the field of obstetrics, in most patients, gestational hydremia has easily explainable physiological causes such as:

• Increased need for iron. Starting from the second trimester of pregnancy, more iron is required to adequately maintain the fetoplacental complex. This microelement is rapidly consumed by the growing fetus, enters the placenta, and is used to increase total number red blood cells circulating in a woman's blood. By the beginning of the third trimester, a pregnant woman’s daily need for iron is at least 4-6 mg, and at 32-34 weeks it requires at least 10 mg/day.
• Physiological hemodilution. During pregnancy, the volume of circulating plasma increases by 40-50%, and the volume of erythrocyte mass by only 20-35%. This is due to the body’s increased need for iron and plastic substances, with insufficient supply of which the rate of erythropoiesis does not correspond to the rate of increase in BCC. According to WHO recommendations, the permissible hemoglobin level in pregnant women is reduced to 110.0 g/l, and hematocrit - to 33%.

A factor that aggravates anemia in the postpartum period is the physiological loss of up to 150 ml of blood during childbirth, each 2.0-2.5 ml of which contains up to 1 mg of iron. Experts also highlight a number pathological reasons, causing the disease. A decrease in the volume of red blood cells (microcytic variant of anemia) with a corresponding drop in hemoglobin levels is observed in case of poisoning with industrial poisons (for example, lead), many chronic diseases (rheumatism, diabetes mellitus, peptic ulcer, gastritis, chronic infectious processes), sideroblastic anemia, thalassemia. This condition also occurs with iron deficiency, caused by insufficient meat in the diet and consumption of foods containing non-heme forms of the microelement (plant foods, milk and dairy products).

Normocytic anemia with a reduced content of normal red blood cells is more often observed with blood loss due to pathology of the placenta, chronic renal failure, hypothyroidism, hypopituitarism, autoimmune hemolytic form of the disease, inhibition of erythropoiesis in the bone marrow. The macrocytic type of anemia with an increase in the volume of red blood cells is characteristic of a deficiency of folic acid and vitamin B12, acute myelodysplastic syndrome, liver pathology (hepatitis, cirrhosis), alcohol dependence, and reticulocytosis. Additional risk factors are the low material standard of living of the pregnant woman, frequent childbirth, multiple pregnancies, long breastfeeding with a short interbirth interval, complicated course of this pregnancy (severe early toxicosis with repeated vomiting, gestosis).

Pathogenesis

The mechanism for the formation of anemia during pregnancy is usually associated with an imbalance between the intake of iron into the body, especially in combination with a deficiency of protein, folic acid, vitamin B12, and their high consumption for plastic purposes. An additional link in the pathogenesis is the inhibition of erythropoiesis due to an increase in the concentration of estradiol and the accumulation of metabolites that have a toxic effect on the bone marrow. The situation is aggravated by immunological changes associated with the constant stimulation of the mother's body by fetal antigens, which increases anti-tissue sensitization. The results of pathophysiological processes are tissue, hemic and circulatory hypoxia with metabolic disorders and further accumulation harmful products exchange.

Classification

The optimal criteria for systematizing the forms of anemia in pregnant women are the concentration of hemoglobin in the blood and the element or substance whose deficiency led to the onset of the disease. This approach to classification makes it possible to more accurately predict possible complications and select a pregnancy management regimen. Modern obstetricians-gynecologists distinguish the following forms of gestational anemia:

• By severity: according to the WHO classification, taking into account the level of hemoglobin, the disease can be mild (90-109 g/l), moderate (70-89 g/l), severe (less than 70 g/l).
• By type of deficiency: the most common is iron deficiency anemia (it accounts for about 95% of the incidence rate); folate deficiency and B12 deficiency forms of the disease are less common.

Symptoms of anemia during pregnancy

Mild degrees usually occur latently. When the iron concentration decreases to less than 90 g/l, signs of hemic hypoxia (anemic syndrome proper) and iron deficiency in tissues (sideropenic syndrome) become noticeable. The possible development of oxygen starvation is indicated by general weakness, dizziness, tinnitus, discomfort and pain in the precordial area, complaints of increased heart rate, shortness of breath during physical activity. The mucous membranes and skin look pale. The woman becomes irritable, nervous, inattentive, her memory decreases, and her appetite worsens.

Tissue iron deficiency is manifested by rapid fatigue, perverted taste (desire to eat plaster, chalk, clay, sand, minced meat, raw meat), thickening and brittleness of the nail plates, dryness and hair loss, muscle weakness, urinary incontinence due to weakening of the sphincter apparatus. In some patients, the epithelial membranes are affected: cracks (“jams”) appear in the corners of the mouth, the oral mucosa becomes inflamed, and complaints of itching and burning appear in the vulva area. With moderate and severe anemia, a slight yellowness of the palms and nasolabial triangle is often observed, associated with impaired carotene metabolism due to iron deficiency, and a “blue” discoloration of the sclera caused by degenerative processes.

Complications

Anemia in a pregnant woman poses a direct threat to the baby. Perinatal morbidity with this pathology can increase up to 100%, and mortality - up to 14-15%. Due to fetoplacental insufficiency, fetal hypoxia is observed in 63% of cases, hypoxic brain injury is observed in 40%, and developmental delay is observed in 32% of cases. Almost a third of newborns are born with asphyxia. Deficiency of vitamin B12 and folic acid causes abnormalities in the development of the spine and nervous system (spina bifida, etc.). Children whose mothers suffered from severe or severe anemia during pregnancy have worse established respiratory function. In the postnatal period, they are more likely to lag behind in height and body weight, and are more prone to developing infectious diseases.

Diagnostics

The key tasks of the diagnostic search for suspected anemia during pregnancy are to assess the severity of the disorder and timely identification of complications. Since in most cases anemia is iron deficiency, laboratory methods for determining iron and hemoglobin levels are the most informative for making a diagnosis:

• General blood analysis. The hemoglobin content is less than 110 g/l. The color index is reduced to 0.85. The red blood cell count is below 3.5 x 10 12 cells/l. There are signs of microcytosis (a decrease in the diameter of red blood cells to less than 6.5 microns). In the morphological picture of erythrocytes, poikilocytosis and anisocytosis are possible.
• Iron metabolism study. Serum iron level is less than 12 µmol/L. The total iron binding capacity of serum (TIBC) is increased to 85 µmol/l or more. The concentration of ferritin (less than 15 μg/l) and iron saturation of transferrin (less than 16%) are reduced. The latent iron-binding capacity of the blood (IBC) is increased.

To exclude B12-deficiency and folate-deficiency variants of anemia that occurs during pregnancy, serum levels of cyanocobalamin and folic acid are determined. Taking into account possible complications from the fetus, it is recommended to assess its condition over time using fetometry, cardiotocography, and phonocardiography. Differential diagnosis is carried out between different forms of the disease, hemoglobinopathies, anemia syndrome caused by complications of pregnancy, and extragenital pathology.

Treatment of anemia during pregnancy

The main goals of therapy in pregnant women with reduced hemoglobin are correction of iron deficiency, elimination of manifestations of hypoxia, stabilization of hemodynamics and metabolism. In case of moderate and severe anemia, special attention is paid to supporting the adequate functioning of the fetoplacental complex. The treatment regimen includes medicines allowing:

• Restore hemoglobin content. For iron deficiency anemia, oral administration of optimally high doses of iron in an easily absorbed divalent form is recommended. It is preferable to use depot preparations with a slow release of the element. Parenteral correction of anemia is carried out in case of intolerance to ferrous iron taken orally, impaired absorption of it by the gastrointestinal mucosa, aggravated peptic ulcer of the stomach or duodenum. For more efficient absorption of the microelement, ascorbic acid is prescribed. WHO experts recommend supplementing iron supplementation with folic acid, which prevents the development of folate deficiency anemia. Cyanocobalamin deficiency is the basis for parenteral administration of vitamin B12.
• Eliminate the consequences of hypoxia. To ensure adequate oxygen supply to the fetus and nutrients, have a complex effect on different elements of the uteroplacental blood flow system. To increase blood flow to the placenta, tocolytics are used to relax the uterine wall. Microcirculation can be improved with the help of angioprotectors and drugs that affect blood rheology. The administration of membrane stabilizers, anticosidants, and actovegin can increase the fetus's resistance to hypoxia. Antihypoxic therapy is usually used for II-III degrees of anemia complicated by fetoplacental insufficiency. If necessary, drugs are used to correct metabolic acidosis and improve the cardiac activity of a pregnant woman.

Antianemic therapy is usually long-term and allows red blood counts to completely normalize only after 5-8 weeks of treatment. To increase the effectiveness of medications, diet correction is required. It is recommended to supplement the diet with foods rich in iron: beef, veal, lean ham, pork, beef, chicken liver, fish. It is necessary to reduce the amount of food that impairs the absorption of iron: cereals, bran, soybeans, corn, tea, coffee, milk, carbonate, bicarbonate, phosphate mineral water. Almagel, tetracyclines, magnesium and calcium salts, which can aggravate anemia, are prescribed with caution.

Prognosis and prevention

Mild anemia, diagnosed in most pregnant women with reduced hemoglobin levels, does not pose a threat to the life of the mother and fetus. Timely correction of moderate and severe forms of the disease can significantly improve blood counts and prevent the development of complications. To prevent perinatal and maternal complications, a balanced diet and early administration of iron supplements are recommended for patients with a history of menorrhagia, a short interval between births, long-term lactation after a previous birth, and multiple pregnancies. Women with anemia should pay increased attention during childbirth to quickly identify and correct possible labor disturbances,

Anemia today is one of the most common conditions associated with pregnancy. And, as a rule, while carrying a baby, a woman is faced with iron deficiency anemia - a disease that is characterized by a disease responsible for the transport of oxygen to organs and tissues, and, accordingly, a decrease in the number of red blood cells - erythrocytes. Anemia has three forms of complexity - mild, moderate and severe. And its insidiousness lies in the fact that the mild form practically does not manifest itself at all: there are practically no symptoms signaling any changes in the body. Anemia can be suspected if a pregnant woman's skin is pale. Because great importance purchase regular blood tests: they will help specialists timely determine the presence or absence, as well as prevent the development of anemia in a pregnant woman. Since anemia can have very serious consequences for the development of the fetus, the condition of the mother, and also affect the course of the birth process, it is necessary to take preventive measures from the first weeks of pregnancy to avoid the development of the disease.

Why is anemia dangerous during pregnancy?

Anemia often appears in the second half of pregnancy, reaching its peak between 29 and 36 weeks. This is explained by the fact that during pregnancy the need for iron increases unusually, because this element is necessary for the production of hemoglobin, which is needed by both the expectant mother and the fetus. If iron is consumed at a faster rate than a pregnant woman enters the body, anemia occurs, which necessarily requires treatment. The fact is that if anemia is not “eliminated”, very unfavorable consequences are possible. Among them is the development of the second half of pregnancy, an increased risk. In this case, the birth process may be accompanied by heavy bleeding, because anemia impairs the function of blood clotting. After childbirth, “untreated” anemia can make itself known by a decrease in milk production. For a baby, iron deficiency in the mother's body is dangerous due to intrauterine growth retardation due to insufficient supply of oxygen and nutrients. In addition, the risk of development and malnutrition increases significantly. The baby may be born weak, underweight, with a weak immune system, and therefore more susceptible to infectious diseases.

Signs of anemia during pregnancy

So, it is a fact that anemia requires mandatory treatment. In addition to the fact that this disease is fraught with consequences, it also greatly affects general state pregnant woman.

Thus, weakness, fatigue, dry skin, and; in more severe forms - hair loss, rapid heartbeat and frequent fainting. These are the so-called anemic symptoms associated with a reduced amount of hemoglobin in the blood and caused by oxygen starvation, as well as a decrease in the amount of energy generated.

Another conditional group of anemia symptoms is called sideropenic. They can manifest themselves against the background of dysfunction of enzymes, a component of which is iron. Sideropenic signs of anemia during pregnancy are manifested by the following conditions: dryness and increased flaking of the skin, its pallor, the appearance of cracks and “stuck” in the corners of the lips, dry and brittle hair. In addition, a sign of anemia may be some “deviation-perversion” of a woman’s tastes: when, for no apparent reason, the expectant mother suddenly wants to eat chalk or earth, raw fruits (for example, potatoes), which was not observed before pregnancy.

Treatment of anemia during pregnancy

To prevent and treat anemia, a pregnant woman’s diet must contain foods that include iron and animal proteins. First of all, these are meat, liver and fish, dairy and dairy products, a large number of vegetables and fruits, some of which must be eaten raw (carrots, apples, cabbage), buckwheat. But, since diet alone cannot eliminate anemia, in addition to good nutrition, to treat the disease they also resort to iron-containing drugs, which are absolutely safe for the fetus. The fact is that the lack of iron cannot be compensated solely by food: if only a little more than 6% of iron is absorbed from food, then medications ensure that about 30-40% of this element enters the body.

Treatment with certain drugs is prescribed on an individual basis; as a rule, the doctor gives preference to tablets or pills, which must be taken orally. The duration of treatment is several months, although the increase in hemoglobin content begins approximately from 2-3 weeks. Despite the fact that the hemoglobin level is gradually stabilizing, this in no way means that the iron reserves in the body have already been replenished. Therefore, it is under no circumstances recommended to interrupt treatment at the first favorable changes. After 2-3 months, the doctor simply reduces the dose of the drug taken by half - thus, the prevention of anemia and its consequences for the pregnant woman and baby continues.

Especially for- Tatyana Argamakova

Anemia in pregnant women is a pathological condition that occurs due to a drop in hemoglobin levels. As a result, the number of red blood cells, the creation of which requires iron, decreases. This is not an independent disease, so initially it is necessary to identify the cause of the development of this symptom and, after eliminating the source of the problem, begin to increase the concentration of red blood cells.

Widespread among pregnant women, which is associated with the body’s increased need for vitamins and minerals. According to WHO, the percentage of expectant mothers suffering from iron deficiency ranges between 20 and 80%.

Several classifications of anemia have been compiled, based on pathogenetic, etiological and hematological indicators. About 80% of such conditions during gestation are caused by a deficiency of iron ions, as a result of which the required number of hemoglobin molecules that make up red blood cells is not created. This leads to a disruption in the transport exchange of oxygen between the blood and the lungs.

The following classification of degrees of iron deficiency anemia in pregnant women has been developed:

1. Mild severity - hemoglobin level 90-110 g/l.
2. Moderate severity - Hb concentration from 70 to 89 g/l.
3. Severe anemia - hemoglobin content does not exceed 70 g/l.

Detection of anemia in pregnant women of any degree requires immediate treatment, as it can cause uterine bleeding and other complications.

Treatment

Treatment of anemia during pregnancy – Long procces. The primary increase in the number of reticulocytes occurs 9-12 days after starting to take medications in the correct dosage. However, an increase in iron levels does not mean that therapy can be stopped. A persistent increase in hemoglobin is recorded only 6-8 weeks after starting to take the drugs. This is why the consumption of the medicine continues for several months.

In addition to iron compounds, pregnant women with low hemoglobin levels are prescribed B vitamins, including cyanocobalamin. A hematologist treats anemia in pregnant women, so it is he who prescribes a therapeutic dose, which depends on the individual characteristics of the body and the degree of deficiency of the substance in the blood.

Nutrition for anemia

During the treatment of anemia in pregnant women, in addition to prescribing medications, the diet is adjusted, due to which the supply of iron ions from food increases. There are certain patterns of food consumption during anemia.

Only 2.5 mg of iron is actively absorbed from food into the body of the expectant mother, and medications enrich the pregnant woman 15-20 times more. Therefore, trying to get rid of iron deficiency anemia only by changing your diet is ineffective.

The maximum amount of the substance was found in meat and its derivatives, a third of which is absorbed into the bloodstream. The absorption of ions from other products of animal origin is 10-15%, and from plant products - only about 3%.

Scroll healthy products foods containing iron (mg per 100 g):

• pork liver – 19.0;
• cocoa – 12.5;
• yolk chicken egg – 7,2;
• heart – 6.2;
• beef liver – 5.4;
• rye bread – 4.7;
• apricots – 4.9;
• almonds – 4.4;
• turkey meat – 3.8;
• spinach – 3.1.

Throughout the gestation period, a woman should be attentive to her diet and maintain a balance of macro- and micronutrients. In the first trimester, the daily calorie intake for the expectant mother should be 2500-2700 kcal, while the body should receive 80 g of fat, 80 g of protein and 320 g of carbohydrates. In the second half of gestation, the consumption of nutrients increases to 120 grams of protein and 400 grams of carbohydrates, while the calorie content is 2600-3000 kcal, depending on the woman’s activity level.

The main sources of protein are dairy products, meat, legumes and nuts. A pregnant woman can get the necessary fats by eating sea fish, sour cream and cottage cheese. Whole grains, cereals, fruits and vegetables will enrich the body with complex carbohydrates.

Iron supplements for pregnant women

Complete treatment of anemia during pregnancy without the use of medicines impossible, because iron coming from food is not able to compensate for the deficiency of the substance and regulate such an indicator as the level of hemoglobin in the blood.

Effective medications used to eliminate anemia:

1. Ferrous salts. A prominent representative of this group is Actiferrin. Available in the form of tablets, solution and capsules. Its analogues are Totema (solution in ampoules of 10 ml), Hemofer (liquid of 10 or 30 ml in dark glass vials).
2. Iron salt (2) and ascorbic acid. Hemohelper - produced in the form of tablets, as well as bars for children with various flavors. Analogues – Ferroplex.
3. Protein ferric succinylate. Ferlatum solution, packaged in glass ampoules.
4. Ferrum (3) hydroxide. Chewable tablets Maltofer, Ferrum Lek, presented in liquid form of the medicine.

It has been scientifically proven that the intake of a substance through venous vessels has a wider list of adverse reactions than the use of tablets or syrups:

• allergic manifestations of varying severity, up to anaphylactic shock;
• disseminated intravascular coagulation syndrome;
• indigestion;
• formation of hematomas and infiltrates at the injection site.

Prevention

According to the prescriptions of the World Health Organization, all pregnant women in the second half of pregnancy and during lactation are prescribed iron supplements in order to maintain the level of the substance in the blood and prevent anemia.

To prevent anemia in pregnant women, doctors recommend the same medications as for treating the disease. The main preventive measures for women susceptible to anemia in the second half of gestation consist of prescribing iron supplements in a small dosage of 1-2 tablets for six months, starting from 12-14 weeks of gestation. The course lasts 14-21 days, after which a break is taken for the same period. Then the medication is resumed. During the entire pregnancy, up to five such courses are carried out.

In addition to drug prevention of anemia, diet correction is carried out in favor of increasing meat and dairy products, vegetables and fruits.

Anemia during pregnancy is a common ailment that is highly treatable if the problem is detected early. During gestation female body spends reserve forces on creating a new life, which is why its own reserves of vitamins, minerals and other substances necessary for normal functioning are depleted. Preventive intake of iron-containing medications and sufficient ion intake of this element food will be saved expectant mother from an unpleasant illness.