gynecology and obstetrics
Anemia in Pregnancy
Iron Deficiency Anemia in Pregnancy
About 95% of anemia cases during pregnancy are Iron Deficiency Anemia . The cause is usually Inadequate dietary intake (especially in adolescent girls) A previous pregnancy The normal recurrent loss of iron in menstrual blood (which approximates the amount normally ingested each month and thus prevents iron stores from building up) before the woman became pregnant Measurement of serum iron, ferritin, and transferrin Typically, Hct is≤30%, and MCV is<79 fL. Decreased serum iron and ferritin and increased serum transferrin levels confirm the diagnosis of iron deficiency anemia. Usually ferrous sulfate 325 mg orally once a day One 325-mg ferrous sulfate tablet taken midmorning is usually effective. Higher or more frequent doses increase GI adverse effects, especially constipation, and one dose blocks absorption of the next dose, thereby reducing percentage intake. About 20% of pregnant women do not absorb enough supplemental oral iron; a few of them require parenteral therapy. The iron deficit may be calculated, and the iron can often be replaced over one or two infusions. Hct or Hb is measured weekly to determine response. If iron supplements are ineffective, concomitant folate deficiency should be suspected. Neonates of mothers with iron deficiency anemia usually have a normal Hct but decreased total iron stores and a need for early dietary iron supplements. Although the practice is controversial, iron supplements (usually ferrous sulfate 325 mg orally once a day) are usually given routinely to pregnant women to prevent depletion of body iron stores and prevent the anemia that may result from abnormal bleeding or a subsequent pregnancy. 