Anemia in Pregnancy😊

Anemia in Pregnancy

• M/c indirect cause of maternal mortality in India.

• Causes :
• Physiological Anemia
• Hb cut off is raised for defining anemia in pregnancy.
• M/c cause of anemia in pregnancy.
• Normocytic normochromal anemia.
• Hb : Never falls below 11 g/dL.
• Pathological Anemia
• M/c cause : Iron Deficiency Anemia (IDA).
• Microcytic hypochromic anemia.
• Hb : <11 g/dL.

• WHO Classification : 7 - 10 - 11
• Mild : 10-10.9 g/dL.
• Moderate : 7-9.9 g/dL.
• Severe : <7 g/dL.

• Best Screening test for anemia in Pregnancy
• S. ferritin > MCHC

Iron requirements

• Total iron requirement during pregnancy - 1000 mg
• Fetus and placenta -300 mg
• Rest for mother

• Fe - trimester wise
• 1st : 1-2 mg/day
• 2nd: 4-6 mg/day
• 3rd: 6-8 mg/day
• 2nd half of pregnancy : 6-8 mg/day

• Note :
• ICMR Very severe anemia : Hb <4 g/dL.
• Thalassemia : Rx with iron is C/I.
• Nestroft test.
• IDA : Rx with iron supplementation.

ANEMIA MUKT BHARAT PROGRAM

• 6 x 6 x 6 Initiatives

Interventions :

1. IFA pill : Weekly

2. Deworming : Albendazole for hookworm infection
• 200 mg (1/2 tab) for 1-2 yrs
• 400 mg (1 tab) for >2 yrs
• Biannually (Twice a year) :
• (National deworming days)
• 10th February &
• 10th August
• Not against ascariasis

3. Delayed cord clamping : Prevention of neonatal anemia

4. Digital hemoglobinometer.

5. Mandatory iron & folic acid fortified foods

6. Non-nutritional causes of anemia

• Pregnant woman IFA
• From 4th month of pregnancy till 6 months post-delivery

Mnemonic

• Pink → Primary kids (5–9 yrs)

• Blue → Boys & girls (Adolescents)

• Red → Reproductive (Pregnant + Lactating)

Supplementation in Pregnancy

• Deworming: Once in second trimester.

IFA Pill

• Red color pill.

• Fe : 60 mg + Folic acid : 500 mcg (To prevent megaloblastic anemia).

• Dose to
• Prevent anemia : 1 tablet/day 
• Rx anemia : 2 tablets/day.

• Recommended after 12 weeks

• 1 tablet/day for at least 180 days in pregnancy

MANAGEMENT

Parenteral iron :

• C/I : 1st trimester.

• Rate of Hb ↑ :  0.7 g/dL/week after 3rd week.

Dose : Ganzoni formula.

• 2.4 x Pre-pregnancy weight x Hb deficit (target Hb - Patients Hb) + 500 mg

• Mnemonic Iron man te set Gansoni

• Note:
• Target Hb can be 11 or 14
• If target = 11
• Need maintenance till 180 days after delivery
• Oral Iron is given
• If target is 14
• Do not need maintenance

• Minimum time gap b/w oral & parenteral iron : 
• 3 weeks (Oral iron tablets C/I with parenteral therapy).

Oral iron therapy :

• Rate of Hb↑ : Same as parenteral

• For loading as well as maintenance therapy
• If target Hb = 11 g/dL

• Maintenance dose : 
• 1 pill/day continued throughout pregnancy up to 180 days after delivery.

Treatment Algorithm :

Blood transfusion at any GA if

• Hb <5g%

• Signs of heart failure

1st trimester

• No parenteral iron therapy
1. 2 IFA tab per day OR
• 60 mg elemental Fe + 0.5 mg FA
2. Blood transfusion if
1. Unstable vitals.
2. Signs of heart failure
3. Thalassemia.
4. Hb <5 g/dL at any gestational age.

2nd and 3rd trimester

Special Considerations

• Thalassemia & Sickle Cell Disease: 
• Folic acid only

• Calcium Recommendation (Pregnant & Non-Pregnant Females): 
• 1000 mg