Introduction:
The health of both the mother and the baby can be significantly affected if iron deficiency anemia goes undiagnosed and untreated. Chronic iron deficiency can also impact a mother's general well-being during pregnancy. Due to this adverse impact on maternal-fetal outcomes, prompt recognition and initiation of treatment of this clinical condition are essential. The global prevalence of iron deficiency anemia in pregnancy is approximately 41 %. The physiological iron requirement in pregnant women corresponds to 1000 to 1200 mg for women with an average weight of 55 kg.
What Is Iron Deficiency Anemia?
Anemia is a condition of lower hemoglobin levels in the blood below the normal range. Hemoglobin is a type of protein present in the red blood cells that carry oxygen. Iron is an essential component of hemoglobin structure. Hence, a deficiency of iron in the body can cause anemia. Iron deficiency anemia is the prevailing type, responsible for 75 to 95 % of anemia cases during pregnancy.
What Are the Outcomes of Iron Deficiency Anemia During Pregnancy?
Depending on the severity of the condition, iron deficiency anemia during pregnancy may give rise to the following symptoms:
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Fatigue and decreased working capacity.
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Pallor.
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Breathlessness.
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Palpitations.
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Headaches.
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Dizziness.
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Irritability.
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Vertigo.
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Leg cramps.
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Cold intolerance.
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Irritability.
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Poor concentration.
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Hair loss.
In addition, pregnant women with iron deficiency anemia have an increased risk of having complications such as higher susceptibility to infections, eclampsia, cardiovascular insufficiency, premature birth, low birth weight, intrauterine growth restriction, and low neonatal iron status.
Higher risk of hemorrhagic shock or requirement of peripartum blood transfusion if heavy blood loss has occurred during delivery. In addition, the risk of maternal mortality is directly associated with the severity of iron deficiency anemia.
Why Is the Need for Iron Increase During Pregnancy?
Iron needs to increase exponentially in the course of pregnancy due to the following three main reasons;
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To meet the increasing demands of the fetoplacental unit to nourish the developing baby.
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During pregnancy, particularly after the first trimester, the mother's heart exerts additional effort to accommodate the expansion of maternal red blood cell mass, as the blood volume in her body increases by approximately 30 to 50 %.
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To compensate for iron loss at delivery.
What Are the Tips for Preventing Iron Deficiency Anemia During Pregnancy?
A pregnant woman requires about two to 2.8 mg of iron daily. But the pregnant woman will need to intake much more to obtain this daily need of iron which is 20 to 48 mg of dietary iron. Even though many foods contain iron, it is hard to absorb it, thus making it difficult for the body to get enough to meet its needs during pregnancy. There are mainly two ways to prevent iron deficiency anemia as follows;
Dietary Sources:
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Consuming foods fortified with iron, such as cereal flour (wheat or maize), salt, beverage, sugar, noodles, rice, milk, and fish sauce, can boost the pregnant woman's iron stores as dietary supplements, improving hemoglobin levels.
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Including more iron-rich food in the diet. This includes consuming dark green leafy vegetables such as spinach, lentils, tofu, baked potatoes, cashews, poultry, pork, beans, peas, lean beef, oysters, chicken, turkey, dried fruit, and red meat.
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Taking a vitamin C supplement and eating foods comprising vitamin C, such as citrus fruits, kiwi, melon, leafy green vegetables, strawberries, bell peppers, and tomatoes, may aid in iron absorption.
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It is also important to remember that plant-based sources of iron are less readily absorbed than meat-based sources. Thus, when eating iron-rich plant-based food, it is advisable to eat foods containing vitamin C with the same meal to help absorb iron.
Medications:
The high physiological need for iron in pregnancy is very difficult to meet with most diets, especially vegetarians and vegans may need additional iron-fortified food and iron supplementation to overcome the possible shortages of iron through dietary intake. Moreover, young and teenage mothers are prone to develop iron deficiency during pregnancy as they have a higher nutritional requirement because of their growth spurts and pregnancy. The doctor will advise, in most cases, to take an iron supplement from the second trimester as the stoppage of menstruation stops the physiological iron loss from the woman's body, which can meet the requirement for iron during the first trimester. But from the second trimester, the blood volume and nutritional demands for the baby also increase. Hence doctor will prescribe iron supplements according to the need of each pregnant woman.
There are different forms of prophylactic treatment of iron deficiency anemia in pregnancy. Iron supplements are available to intake by mouth and the parenteral route, also as intramuscular and intravenous injections. Moreover, it can also be administered as a blood transfusion and recombinant erythropoietin. However, the first line of therapy in the prophylactic management of iron deficiency anemia for almost all pregnant women is an oral iron replacement due to its effectiveness, safety, and low cost.
However, the pregnant woman seeking iron supplements should always first consult with a doctor for a prescription of adequate doses of iron medications. She should not take it from an over-the-counter medical store as taking the iron supplement in excess can cause adverse effects on the gastrointestinal system, including constipation, nausea, diarrhea, and vomiting. The frequency and severity of this distress are commonly observed in women taking high iron supplements on an empty stomach.
Conclusion:
Iron deficiency is the leading cause of iron deficiency anemia among pregnant women. Iron deficiency anemia is associated with higher risks of low birth weight, premature delivery of the baby, and maternal morbidity. The nutritional status is the primary factor in preventing iron deficiency anemia during pregnancy. Pregnant women should add an iron-rich healthy, varied diet to their routine, consume iron-fortified food, and take prophylactic doses of iron to prevent depletion of iron stores. The doctors recommend laboratory investigations from the first trimester to assess the iron level of the blood.
In most cases, oral iron supplements are the first line of treatment for mild anemia. However, there is an issue of poor compliance in the pregnant woman due to its numerous gastrointestinal adverse effects. Hence, other sources of iron supplementation are essential.
