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The lack of hemoglobin in the blood of a woman often goes unnoticed, without causing any symptoms. However, the consequences for the child of anemia during pregnancy 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 the transfer of 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 an important feature regarding the "nutrition" of the fetus in the mother's body. The blood of a pregnant woman and a baby in the uterus does not mix. The blood flow of the unborn child, although not directly related to the mother's blood flow, but 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 allegedly small decrease in blood hemoglobin levels. The level of hemoglobin in the body of a pregnant woman should not fall below 110 g / l, subject to other normal blood parameters.

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 the antenatal clinic.

Expectant mothers should understand that their body and fetus are a single whole in every sense. From the pathophysiology 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 how to plan a pregnancy and how to approach such an event examined and healthy. Unfortunately, most expectant mothers ignore such recommendations, considering themselves healthy, do not pay due attention to timely diagnosis, and often the observation of 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 the activation of chronic inflammation, as well as the formation of connective tissue. In turn, a decrease in functional activity against the background of an exacerbation of chronic pathology will lead to a very difficult course of pregnancy. Naturally, in addition to the health of the mother in such a situation, the growth and development of the fetus suffers sharply.
• 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 of all, 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 with 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, it is also primarily about the life and health of the mother, and not the fetus.

The following diseases are distinguished, accompanied by anemia, in which pregnancy is contraindicated at all 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 hemolysis of the blood.
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 first of all poses a threat to her life, which in any case, with inadequate treatment, is fatal for the fetus.

What are the consequences for the child?

For a future baby who is completely dependent on his mother while he is in her womb, anemia can provoke such unwanted obstetric pathologies:

• Syndrome of fetal growth retardation. It occurs due to insufficient function of the placenta, 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 termination of pregnancy at different gestational ages. If proper obstetric care is not provided, such a pregnancy may end in spontaneous abortion.
• premature birth. Although modern medicine is able to produce children born even at the earliest 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 the likelihood of developing cerebral palsy (infantile paralysis), various allergic reactions and reduced immunity, poor development and other disorders.
• The 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 way to placental insufficiency. It is she who 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 both external aggressive environmental factors and internal hidden pathological processes that were compensated until the moment of conception and did not manifest themselves in any way in a woman..

Therefore, the diagnosis of this condition is carried out regularly in the antenatal clinic during the observation period of pregnancy up to childbirth. Women are assigned a regular blood test, which allows you to establish an accurate diagnosis of anemia, which does not manifest itself clinically for a long time. Further, the doctor will be able to prescribe a wider range of examinations for the patient in order to establish the true cause of such a 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 the appointment of 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, the restoration of a normal level of hemoglobin in the blood, especially in severe anemia, is necessary in order to save the life and health of the mother. That's why treatment of such a condition and correction of red blood indicators is carried out depending on the cause in the following ways:

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

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

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

But during pregnancy, due to the fact that weight is added and the volume of blood circulating through the vessels increases, there are specific changes in the blood even in a normal state, without anemia. Therefore, it is important to take them into account in order to determine the boundaries of the norm and pathology, when it is necessary to replenish iron stores through food and vitamin-mineral complexes, and when - already therapeutic doses of iron in tablets.

Blood changes during pregnancy

During pregnancy, due to the active consumption of iron for the needs of the fetus, the hemoglobin level allows changes, which will negatively affect metabolic processes, as well as the growth and development of the fetus, if the iron level drops below normal values. There are two fundamental concepts during pregnancy:

• Physiological anemia of pregnant women , arising from the dilution of blood and an increase in the volume of the blood that circulates through the vessels,
• Pathological anemia that occurs with iron deficiency, and, accordingly, reduced hemoglobin synthesis.

Let's talk about how the amount of hemoglobin and blood properties change during pregnancy. So, as the duration of pregnancy increases, the amount of hemoglobin changes, with a tendency to decrease (even in a healthy woman) against the background of growth and full development of the hearth. This is due to the influence of several factors at once:

• Formation of the third circle of blood circulation - fetal-placental, where additional blood volume is required.
• The storage of iron by the fetus for its subsequent needs for hematopoiesis in the first six months of life (this is the last trimester of pregnancy).
• Dilution of blood with plasma by increasing the total volume of circulating blood.
• Increased iron consumption to meet all the needs of the mother's body - renewal of muscles and their tone, synthesis of enzymes containing iron to participate in metabolic processes.

In order for the volume of blood to be enough for all the needs of the female body, taking into account the increasing needs of the fetus and the placenta with the uterus, it is important to increase the volume of blood in the body. This is done by diluting it with plasma and enhancing the synthesis of red blood cells, which eventually forms a slightly more liquid blood, but in a larger volume (the total volume in the vessels is increased by about 1000 ml). Due to the dilution of blood with plasma, a relative decrease in hemoglobin in the blood occurs, which is referred to as physiological anemia in pregnant women. That is, the number of cells remains the same, while the plasma becomes larger, which is why there will be a relative decrease in red blood cells and hemoglobin. With it, there is no pronounced decrease in performance, tissue hypoxia does not occur and metabolism does not suffer.

Norms and pathologies: gestational anemia

According to doctors, normal hemoglobin levels during pregnancy include values ​​of 110-130 g / l, but its decrease to 105-110 g / l is conditionally acceptable against the background of normal health and the absence of signs of tissue hypoxia.

With such a borderline level of hemoglobin, there are no ailments, the fetus develops normally, there is no delay in its development, and the mother at the same time fully eats, takes nutritional supplements with vitamins and minerals.

The level of hemoglobin begins to decrease as the tummy grows, this is after 16-18 weeks, which is associated with the growing needs of the baby for iron to form muscles and tissues, ensure hematopoiesis and deliver oxygen to the tissues. If a woman did not have anemia before pregnancy and in the first trimester, such dynamics of a decrease in hemoglobin should not be a concern. If initially there was a latent iron deficiency and borderline hemoglobin values, or anemia was before pregnancy, with the onset of active growth of the abdomen, it will become more pronounced and will require immediate initiation of therapy.

It is important not only the very presence of reduced hemoglobin, but also the rate of its decline, estimated in dynamics according to blood tests. It is important to understand that hypoxia caused by anemia in the early stages of pregnancy is the most dangerous, when the rudiments of tissues or organs are laid, and the fetus grows and differentiates. If, according to the doctor, hemoglobin is low, he will prescribe iron supplements, and the expectant mother should not refuse them in favor of food. Due to the drugs, iron reserves will be quickly and actively replenished, which are actively spent on the needs of the fetus and mother, only nutrition cannot achieve such an effect. And also the doctor can apply the intake of iron preparations for the purpose of prevention.

A decrease in hemoglobin in the first trimester is not physiological anemia, it is a pathology that leads to high risks of abortion, fetal growth retardation, and maternal health complications.

Reasons for a decrease in pregnancy rates

A gradual decrease in the level of hemoglobin in the blood of a pregnant woman can be caused due to various influences, and above all, due to changes in the physiological plan. In this case, the number of red blood cells remains the same, but the plasma becomes larger, the blood is diluted, and against this background, there is relatively less hemoglobin and cells per unit of blood (in a liter or milliliter). This is not attributed to pathology, but only to typical changes during pregnancy. It is possible to diagnose such a condition if the hemoglobin level does not drop below 110-105 g / l by the middle and end of pregnancy, and if hemoglobin drops by more than 5 g / l from this value, one should already think about pathological anemia.

The reasons for its formation can be various problems and pathologies during pregnancy:

• Active consumption of mineral reserves, even if a quite normal amount of it is supplied. This is especially true for pregnancy, when a large baby develops or a mother carries a multiple pregnancy if less than 3-4 years have passed between the births of the previous child.
• The problem with the intake of iron due to its deficiency in nutrition. Often this occurs in those women who often lose weight, go on diets or eat vegetarian food even before the onset of pregnancy. Deficiency in the diet of animal products and high-grade food proteins threatens with anemia. The same can occur in diseases that require a restrictive diet and in violation of the absorption of minerals in the intestine.
• Blood loss due to various pathologies of pregnancy - constant micro-bleeding from the gums, digestive tract, hemorrhoids, bleeding with placental abruption, presentation, etc.

Iron deficiency anemia is, in fact, a pathology associated with a discrepancy between iron intake and its costs during pregnancy, the predominance of costs over income.

Iron is spent both on the increased mother's needs and on the baby, and if its reserve (depot of iron in the body) was not created in advance, during pregnancy, the predominance of consumption with the same intake of it with food leads to a gradual depletion of resources and anemia.

Clinical manifestations of anemia and sideropenia

In a state of latent iron deficiency, when it is no longer enough, but the shortage is not yet critical, a latent iron deficiency occurs, referred to by physicians as sideropenia . With her, apart from a low level of hemoglobin and mild symptoms of weakness, there are no manifestations. Usually, in this condition, a hemoglobin level of 105-95 g / l can be recorded., certain metabolic changes already exist, but many, with a similar level of hemoglobin, bear completely healthy children and, without feeling health problems, often neglect the doctor's advice on taking iron supplements.

Although you may feel relatively normal, it is important to follow your doctor's advice and take all of your medications as directed to increase your hemoglobin levels and your body's iron stores. This is necessary so that anemia does not increase in severity, and this does not affect the development of the fetus. He needs to accumulate iron for his needs after birth, as well as constantly receive oxygen in the required amount at the expense of his mother's hemoglobin. If hemoglobin is reduced and the condition progresses, sooner or later children suffer from chronic hypoxia, especially later in childbirth.

Clinically exposed anemia usually has trophic disorders (malnutrition of tissues with oxygen), and they are more pronounced, the more hemoglobin is reduced. The first manifestations in pregnant women will be a feeling of lethargy with weakness, a constant feeling of fatigue right in the morning, especially against the background of even minor loads. Many associate this with the pregnancy itself. Pallor of the skin and lips, mucous membranes of the mouth is also typical, and may also occur- they are usually not strong, dull in nature, but occur almost constantly or often. The appearance of this symptom is associated with hypoxia of the brain tissue due to a lack of oxygen supply to it. It can also form, a feeling of darkening in the eyes during physical exertion, palpitations when changing body position, bouts of lightheadedness.

A feeling of constant freezing and chilliness is also typical, due to the fact that due to the slowdown in metabolic processes, the body temperature drops. Against the background of walking or active physical movements, there may be chest pain with a feeling of lack of air, especially if it is brisk walking or climbing stairs. In addition, due to all these sensations, women become irritable and in a constantly bad mood.

For anemia, with a fairly pronounced decrease in hemoglobin, a typical feeling of creeping goosebumps in the area of ​​\u200b\u200bthe fingers and toes, and one of the specific complaints of future mothers in the presence of anemia becomes perversion of taste . This is an irresistible need to eat inedible substances - earth or chalk, clay, ice or whitewash.. There may be a desire to eat raw vegetables - potatoes or beets, or sniff caustic liquids (gasoline, acetone, car exhaust). Against the background of anemia, toxicosis is usually more pronounced, pressure can change dramatically, it usually decreases, and the general state of health is poor. The stronger the hemoglobin deficiency is, the worse the expectant mother feels.

The severity of iron deficiency anemia in pregnant women

If we talk about the severity of the manifestation and the level of hemoglobin in them, anemia during pregnancy is usually divided into three categories. This is necessary in order to know the possible clinical picture of the pathology, and to properly provide assistance and carry out further prevention of anemia.

The main guideline for dividing into degrees is the level of hemoglobin in capillary blood (from a finger). Can be distinguished:

• Light degree - with it, hemoglobin can decrease to 90 g / l, and it is possible to use iron supplements in combination with changes in nutrition and the use of more iron-containing foods. Treatment is usually carried out on an outpatient basis, regularly monitored by a gynecologist and blood tests.
• Average degree , with her hemoglobin fluctuates from 89 to 60 g / l, with vile figures there is already a pronounced suffering of general well-being, there are problems in the development of the child, he suffers from hypoxia. It is important for such a level of hemoglobin to be constantly monitored and required to take iron supplements, as well as changes in diet that improve the absorption and absorption of iron from drugs. You can be treated on an outpatient or inpatient basis (depending on concomitant obstetric pathologies).
• severe anemia I with hemoglobin below 60 g / l leads to the need for an urgent placement of a woman in a hospital, and her treatment with iron supplements, and if hemoglobin is low, even a blood transfusion will be indicated. This is necessary because at a similar level of hemoglobin, both the mother herself and the fetus suffer greatly, it is severely lacking in oxygen, which is brought with the blood stream is extremely small. Therefore, against the background of the treatment of anemia, a correction is carried out.

Dynamics of changes in indicators in the analyzes of pregnant women

Iron deficiency usually forms from the second half of pregnancy, starting from the time of active growth of the abdomen, after 20 weeks. This is due to the fact that against the background of the active growth of the child, uterus and placenta, the volume of blood increases, which actively circulates through the vessels, due to which it is diluted with plasma. In addition, the fetal iron requirements also gradually increase due to the building of muscle mass. The decrease in hemoglobin reaches its maximum by the period of the third trimester, namely the 32-35th week of pregnancy. A decrease in hemoglobin levels by the end of pregnancy is considered normal if it does not fall below 105 g / l, and in such a situation only prophylactic iron intake in the form of food supplements and vitamin-mineral complexes will be required. But by the time of childbirth, the amount of hemoglobin should increase so as not to form complications during childbirth, including due to blood loss.

Consequences of iron deficiency anemia during pregnancy for the child and mother

When hemoglobin drops very quickly or slowly, but significantly, it is important to take the necessary therapeutic actions. If hemoglobin is critically reduced, the fetus suffers, first of all, less nutrients are delivered to the placenta and umbilical cord, and especially oxygen, which is necessary for the processes of oxidation and energy production to build body tissues. Accordingly, against the background, all metabolic processes slow down, metabolism suffers and it develops worse, both in terms of growth and weight, and the maturation of organs, tissues and the nervous system.

The presence of anemia during pregnancy can become one of the provocateurs of interruption, threat, or one of the factors for triggering premature birth at a later date. Also, against the background of anemia, early toxicosis and in the second half occur more often and more severely. Complications in childbirth are also more likely, even if they were urgent - this is a late outflow of amniotic fluid, discoordination of the birth act, protracted labor, or, conversely, rapid, with tissue ruptures, and bleeding, problems with the placenta and uterine contractility. Against the background of such problems in childbirth, children are born in a state of pathological birth stress, and may be more susceptible to infections, respiratory disorders and death.

Babies from mothers with pregnancy anemia are often or immature, they often get sick for a long time, have early neonatal anemia, bone marrow suppression, problems with the immune system, digestion and liver function, muscle hypotension and problems with the nervous system.

Treatment of anemia during pregnancy

If preventive measures to prevent anemia did not help or they simply were not carried out by the pregnant woman, it is important, together with the doctor, to carry out a complete correction of the hemoglobin level. It is important at the planning stage and at the beginning of pregnancy to use multivitamin complexes with mineral supplements, including iron. It is also important to eat right so that the iron intake is sufficient, and it is fully absorbed from food without passing through the intestines in transit. But it is not always possible to provide a complete, iron-rich diet and preliminary replenishment of iron reserves in the body by taking dietary supplements.

If there is a decrease in hemoglobin from the very beginning of pregnancy, from the first trimester, the doctor applies preventive courses, or their therapeutic doses for at least 6-8 weeks. It is important to understand that the rate of increase in hemoglobin is 1-2 g / l per week, and therefore long-term use of these drugs is necessary. It is necessary to supplement the medication with a special diet.

Diet changes during pregnancy and anemia

As such, there is no special strict and restrictive diet for lowering hemoglobin, and this diet can be called relatively conditionally. In fact, nutrition for anemia is a balanced, complete diet, enriched with proteins and mineral and vitamin components, as well as a sufficient amount of all the necessary nutrients, including fats and carbohydrates.

It is important that during pregnancy, the amount of food consumed is such that it covers all the necessary energy and nutrient needs, while being fresh, of high quality and varied. In addition, the diet should always include those foods that contain a lot of iron in an easy-to-digest form - these are red meat, white meat and fish and eggs.

From red meats, up to 22-23% is absorbed, from other animal dishes - up to 10-15%, while plant foods give no more than 2-7% of iron absorption. But even from animal products, iron may not always be actively absorbed, you need to combine their intake with vitamin C and food folates, which are abundant in plant foods. Therefore, a reasonable combination of meat food and fresh vegetables and fruits is important. For pregnant women, boiled beef, lean pork, poultry and fish, supplemented with fresh vegetable salad, should become regular meals in the diet.

Various meat products (animal and poultry liver, kidneys, chicken ventricles, hearts or lungs) will be useful as suppliers of iron.

note

There is a common misconception about the benefits of taking apples and pomegranates, although they contain iron, they do not lead to the replenishment of its reserves in significant quantities, and with a large amount of them in the diet, they can threaten bloating and constipation.

It will be useful to take meat with pomegranate juice or eat it with apples, due to flats and ascorbic acid, they will help the meat gland to digest, and by themselves as a separate product - they are practically useless in the treatment of anemia.

Sausages, sausages or other supposedly meat products are useless from the point of view of treating anemia, they really have so little meat that there is almost no iron in them. Therefore, it is normal lean meat that is important, and not even semi-finished products in the form of cutlets or chops from the store.

Worth knowing!During heat treatment, iron is not lost, so the myth that you need half-cooked and raw meat and liver will be completely groundless. Consumption of such products by pregnant women is dangerous by infection with dangerous infections and helminths, and there will no longer be any benefit for the treatment of anemia.

Drug treatment of anemia during pregnancy

It is worth mentioning that during pregnancy, anemia is not cured only due to food, because food can cover at best 10-20% of absorption, and iron is absorbed from drugs by 40-60%, which helps much better in treatment, in mind high concentrations of iron in drugs. Drugs are prescribed even with a mild decrease in the level of hemoglobin, and sometimes even with its borderline value. In the presence of severe anemia, drugs are prescribed and used throughout the entire period of gestation, from the moment the diagnosis is made.

Neither hematogen, nor multivitamins, and even more food, especially plant foods, can not help in the treatment of anemia. Only tablets containing iron are capable of increasing its plasma levels and restoring hemoglobin levels.

Selection of drugs for the treatment of anemia during pregnancy

Unlike the last century, today there are many iron preparations that are safe during pregnancy and do not harm the fetus, while effectively increasing the level of hemoglobin in the mother. Each of the products has its own specific level of iron, often with a whole range of additional compounds that improve the absorption of the mineral, while reducing the number of side effects from taking it.

Iron preparations are not equally well tolerated by women, especially during pregnancy, unpleasant side effects may occur that may require the replacement of the medication with another one. In addition, the form of the drug is also selected - these are capsules, solutions, coated tablets that do not harm the teeth. The dosage is selected individually, starting with small doses, gradually increasing it under the control of tolerance, so that there is an effect on hemoglobin, but at the same time no negative effects of the intake are formed.

Depending on the form and assimilation, iron-containing agents are used from a single to three or four single doses per day, and it is important to remember the conditions for taking them. They are not washed down and not used in conjunction with dairy dishes and drinks, due to the fact that calcium inhibits the absorption of iron. It is useful to take the tablets with water or juices (both from fruits and vegetables) containing vitamin C, which will help in the absorption of iron. It is recommended not to use drugs on an empty stomach, they can lead to constipation or form diarrhea, depending on the reaction of the intestines to them.

note

The stool against the background of treatment will be black, do not be afraid of this.

The drugs must be used for several months in a row at a therapeutic dosage, and a very good rate of increase in hemoglobin during therapy will be an increase in hemoglobin levels by 1-2 units per week. That's why it is important to use drugs for a long time, without taking breaks, and then, upon reaching a normal level of hemoglobin, the dose is halved from the therapeutic dose in order to saturate all the body's depots with iron so that anemia does not progressively develop again when the drug is discontinued.

Complexities and nuances of treatment

In addition to changing the color of the stool, which can sometimes frighten a pregnant woman, constipation is typical for taking iron supplements as one of the side effects of therapy. During pregnancy, this is extremely unpleasant, given that even without treatment it is not uncommon. In this regard, against the background of therapy, it is necessary to use foods and dishes rich in coarse fiber - these are salads, vinaigrettes, oil dressings for them and whole grain cereals. It is also necessary to consume enough liquid.

Injectable iron preparations are rarely used today and only in severe cases, they can lead to complications and side effects during therapy, and they are used for intolerance to oral forms of drugs, the presence of peptic ulcer, and a strong decrease in hemoglobin.

Despite the fact that hemoglobin rises for a long time and slowly, as the drug is treated in pregnant women, the condition quickly improves, unpleasant symptoms disappear relatively soon, and when the baby is examined according to ultrasound, a positive trend in physical development is revealed, signs of hypoxic changes are eliminated. You can not stop taking pills or capsules as it gets better, iron losses are pronounced and it is necessary to fully restore them and normalize the level of hemoglobin. With the abolition of drugs, all symptoms of anemia return extremely quickly.

With the formation of anemia at the beginning of pregnancy, the situation is the most serious and the prognosis is the most serious, iron supplements may be needed throughout the gestation of the fetus. But the third trimester for anemia is the most favorable time in terms of prognosis, it is treated more actively and faster. Women are treated on an outpatient basis, regularly conducting blood tests for control, and selecting dosages, taking into account tolerability and the development of side effects from therapy.

Anemia during pregnancy is a serious diagnosis, it cannot be treated as a non-serious violation, it threatens with serious complications.

Alena Paretskaya, pediatrician, medical commentator

Content

Anemia has the ICD code D50. The disease is characterized by insufficient concentration of iron in the body. Under such conditions, there is a violation of the synthesis of red blood cells in the blood. Anemia and pregnancy are incompatible concepts, since the disease can harm the fetus and mother.

What is anemia during pregnancy

Anemia during gestation is an iron deficiency during pregnancy. The disease begins to manifest itself by the second trimester, reaching the peak of its development by 29-36 weeks. The mechanism of the formation of the disease is based on the increasing need of the mother's body for iron, since thanks to it, blood hemoglobin is produced. If the element is supplied in insufficient volume, then there is an imbalance between its consumption and expenditure. Anemia must be treated to avoid negative consequences for the mother and child.

Causes of anemia can be:

• chronic inflammatory diseases of the genital organs;
• hereditary predisposition (with a genetic disease);
• insufficiently balanced menu;
• alcohol, smoking;
• changes in liver diseases;
• neoplasms;
• early re-pregnancy (hypochromia develops);
• violation of the functioning of enzymes;
• hormonal disruptions.

Iron deficiency anemia in pregnant women

The element iron plays an important role in the formation of hemoglobin. If there is a shortage, the transfer of oxygen from the lungs to the tissues of the organs is disrupted. Iron deficiency anemia during pregnancy (should be distinguished from thalassemia) can be caused by a failure in the absorption of an important substance or a decrease in its intake. The expectant mother can get iron only with food, since the element is not synthesized by the body. In order for proper absorption to occur, there must be no malfunction of the liver and small intestine, since the molecules move due to the proteins of these organs.

Gestational anemia during pregnancy

The definition of "gestation" is translated from Latin as "pregnancy". The disease affects up to half of expectant mothers. The period from the process of the introduction of a fertilized egg into the uterine wall is calculated, which is less than the period set by obstetricians. Gestational anemia during pregnancy refers only to this period, if the disease occurred before or after, then it is diagnosed differently.

The disease provokes failures in the process of strengthening the child in the uterine cavity, hypoxia of placental tissues, and the development of defective cells of the inner layer of the uterus. In the second trimester, the oxygen starvation of the fetus in the womb can increase due to thrombosis of small capillaries that connect the mother's circulatory system with the placenta.

What is dangerous anemia during pregnancy

The disease is an iron deficiency in the body of the expectant mother. Anemia can lead to serious consequences for both the woman herself and the fetus. The disease can cause toxicosis in the second half of the childbearing period. Iron deficiency during pregnancy is also dangerous because it can create conditions for premature birth. This scenario of events is often provoked by severe bleeding during the birth of the fetus (posthemorrhagic anemia). This is explained by the fact that the disease reduces the ability of blood to coagulate.

If left untreated, anemia can lead to loss of milk supply after childbirth. A child whose mother during the period of gestation had a low iron content in the body receives few resources for proper development. Such disorders are caused by a lack of oxygen and nutrients. Significantly increases the risk of hypoxia and fetal hypotrophy. As a result, the baby may be born with an underweight, not formed immune system.

Anemia 1 degree during pregnancy

The mild stage of this disease is diagnosed in almost all pregnant women. The internal organs can only assimilate their iron norm, although much more is required. Anemia during pregnancy of the 1st degree can occur with virtually no symptoms, it is detected when taking a blood test, a test for the level of serum iron. However, diagnosis and timely treatment is necessary to prevent complications and consequences for mother and baby. The fetus, even in the absence of manifestations of the disease in a woman, experiences slight hypoxia.

Anemia 2 degrees during pregnancy

At this stage, the lack of iron content becomes more pronounced. Moderate anemia during pregnancy gives a woman some discomfort that can affect the health of the fetus. There are external signs, having discovered which, you need to consult a doctor:

• the appearance of cracks in the corners of the mouth;
• hair becomes dry, brittle, falls out strongly;
• the nail plate is deformed, loses its hardness and elasticity.

Anemia 3 degrees during pregnancy

The last stage of the disease requires immediate medical attention and inpatient treatment. Anemia of the 3rd degree during pregnancy can cause irreparable harm to the development of the fetus. Under such circumstances, premature birth, miscarriage or stillbirth are possible. If an ailment at this stage is detected when planning children, then doctors regard it as a clinical indication for treatment.

Signs of anemia during pregnancy

Symptoms of anemia in pregnant women occur during the transition of the disease to the second stage, they are expressed by the following manifestations:

• an increase in the frequency of heart beats;
• increased fatigue, drowsiness and general weakness in the body;
• the appearance of irritability and nervousness;
• pain in the region of the heart;
• loss of appetite;
• dizziness, nausea, vomiting;
• metabolic disorders, malfunctions of the digestive system;
• a drop in concentration;
• fainting;
• numbness of the limbs;
• dryness and blanching of the skin;
• fragility of nails and hair;
• peeling of the skin in the area of ​​​​the palms and feet;
• the appearance of cracks in the corners of the lips.

Treatment of anemia during pregnancy

Depending on the stage of development, symptoms and type of disease, specialists establish the treatment of anemia in pregnant women. The set of activities includes:

• food according to a special diet;
• taking iron tablets;
• the use of injections (for stomach ulcers, heartburn);
• the use of folk remedies.

Drugs for anemia in pregnant women

Drug treatment of the disease is selected individually for each woman, based on the etiology and stage of the disease. Drugs for anemia in pregnant women can be useful for the fetus, but have a harmful effect on the mother's body. Popular medicines are:

• Ferroceron;
• Ferroplex;
• Ferrocal;
• Conferon;
• Tardiferon.

What to eat with anemia during pregnancy

An anemia diet is aimed at compensating for iron deficiency. Eating with anemia during pregnancy should be certain foods. The following describes what is best to consume with an ailment, what are the features:

• The element is best absorbed from meat (pork liver, heart, turkey, beef).
• Seafood (fish, mussels, shrimp).
• Vegetables and fruits (spinach, apricots, tomatoes, cauliflower, bell peppers, strawberries, kiwi, apple).
• Cereals (for example, buckwheat).
• Folic acid will help in the prevention of anemia (turnips, cabbage, lentils, citrus fruits, lettuce, broccoli, dried apricots, raspberries, nuts).
• Vitamin B12 is found in eggs, legumes, and meat.

Contraindications for anemia

In some cases, contraindications for anemia consist in the recommendation of doctors to terminate the pregnancy. The decision is made at the council, may take effect up to 12 weeks. However, the final choice belongs to the woman. The following types of anemia can become a contraindication to pregnancy:

• severe degree of chronic iron deficiency;
• hemolytic (in which red blood cells break down);
• aplastic;
• sickle cell;
• an ailment that occurs against the background of leukemia;
• if the disease accompanies Werlhof's disease.

Prevention of anemia in pregnant women

Before getting pregnant, a woman must carefully prepare. You need to pay attention to the level of hemoglobin in the blood. If anemia is found, then it is necessary to find out its cause. Prevention of anemia in pregnant women is to take multivitamin preparations. Suitable complexes should contain iron and folic acid. These medicines should only be taken as a preventive measure, as they contain too little of a substance to treat.

The use of a complex of vitamins should be started 3 months before the intended conception. During pregnancy, the intake of nutrients should occur up to 12 weeks. However, each woman needs her own time, so it is important to get expert advice. In no case do not neglect the advice of a doctor and constantly visit a antenatal clinic so that the disease can be detected in time.

Video: anemia during pregnancy

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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Anemia during pregnancy - degrees and risks to the fetus. Symptoms and treatment of iron deficiency anemia in pregnant women

Anemia is characterized by a decrease in the level of hemoglobin in the blood, a decrease in the number of erythrocytes (red blood cells), the appearance of their pathological forms, as well as a change in the vitamin balance, a decrease in the number of trace elements and enzymes in the body. Anemia is one of the most common complications of pregnancy. The leading sign of anemia in pregnant women is a decrease in hemoglobin levels below 110 g/l. Anemia in pregnant women in 90% of cases is iron deficiency. Such anemia is characterized by impaired hemoglobin synthesis due to iron deficiency developing due to various physiological and pathological processes. According to WHO, the frequency of iron deficiency anemia in pregnant women ranges from 21 to 80%. The presence of iron deficiency anemia leads to a violation of the quality of life of patients, reduces their performance, causes functional disorders in many organs and systems. With iron deficiency in pregnant women, the risk of complications in childbirth increases, and in the absence of timely and adequate therapy, iron deficiency may also occur in the fetus.

The human body contains about 4 g of iron, which is one of the vital elements for the body. It is part of hemoglobin and a number of other vital substances that affect the function of various organs and systems in the human body. 75% of the iron in the human body is in hemoglobin. Iron is most fully absorbed from animal products (meat), much worse from plant foods. The release of iron from products is reduced during their heat treatment, freezing and long-term storage.

Iron is excreted from the body of a woman in the amount of 2-3 mg per day through the intestines, bile, urine, through the exfoliating epithelium of the skin, during lactation and menstruation.

In non-pregnant women, the iron requirement is 1.5 mg per day. During pregnancy, the need for iron steadily increases in the first trimester by 1 mg per day, in the second trimester - by 2 mg per day, in the third trimester - by 3-5 mg per day. To produce additional iron, 300-540 mg of this element is used. Of these, 250-300 mg of iron is spent on the needs of the fetus, 50-100 mg - on the construction of the placenta, 50 mg of iron is deposited in the myometrium. Iron loss is most pronounced at 16-20 weeks of gestation, which coincides with the period of the onset of hematopoiesis in the fetus and an increase in blood mass in the pregnant woman. In the third stage of labor (with physiological blood loss), from 200 to 700 mg of iron is lost. Later, during lactation, about 200 mg more. Thus, about 800-950 mg of iron is consumed from the maternal depot during pregnancy and in the postpartum period. The body is able to restore iron stores within 4-5 years. If a woman plans a pregnancy before this time, she will inevitably develop anemia. Iron deficiency cannot but occur in multiparous women.

Of interest are some indicators (presented in the table) of peripheral blood, depending on the timing of pregnancy.

Factors contributing to the development of iron deficiency anemia

• Reduced intake of iron in the body with food (vegetarian diet, anorexia).
• Chronic diseases of internal organs (rheumatism, heart defects, pyelonephritis, hepatitis). In diseases of the liver, there is a violation of the processes of accumulation of iron in the body and its transportation. Particular attention should be paid to diseases of the gastrointestinal tract. Gastrointestinal bleeding in gastric and duodenal ulcers, hemorrhoids, as well as intestinal diverticulosis, ulcerative colitis, and helminthic invasion lead to anemia in patients.
• The presence of diseases manifested by chronic nosebleeds (thrombocytopathy, thrombocytopenic purpura).
• Gynecological diseases, accompanied by heavy menstruation or uterine bleeding, endometriosis, uterine fibroids.
• Burdened obstetric history: multiparous women; spontaneous miscarriages in history; bleeding in previous births, contribute to the depletion of the iron depot in the body.
• Complicated current pregnancy: multiple pregnancy; early toxicosis; young age of the pregnant woman (under 17 years old); nulliparous older than 30 years; arterial hypotension; exacerbation of chronic infectious diseases during pregnancy; preeclampsia; placenta previa; premature detachment of the placenta.

Pregnancy is contraindicated in the following forms of diseases of the blood and hematopoietic system: chronic iron deficiency anemia III-IY degree; hemolytic anemia; hypo- and aplasia of the bone marrow; leukemia; Werlhof's disease with frequent exacerbations. In the event of pregnancy with these diseases, it is advisable to terminate the pregnancy up to 12 weeks.

The development of anemia during pregnancy is facilitated by: metabolic changes that occur in the body of the patient during pregnancy; decrease in the concentration of a number of vitamins and microelements - cobalt, manganese, zinc, nickel; changes in hormonal balance during pregnancy, in particular, an increase in the amount of estradiol, which causes inhibition of erythropoiesis; deficiency in the body of a pregnant woman of vitamin B12, folic acid and protein; lack of oxygen, in which there is a violation of redox processes in the body of a woman; immunological changes in the body of a pregnant woman, occurring due to constant antigenic stimulation of the maternal organism from the tissues of the developing fetus; the consumption of iron from the depot of the mother's body, necessary for the proper development of the fetus.

During pregnancy, so-called physiological or “false” anemia can also occur. The emergence of this form is due to an uneven increase in the individual components of the blood. The fact is that during pregnancy, as a compensatory reaction, there is an increase of 30-50% of the mother's blood volume, but mainly due to plasma (the liquid part of the blood). Accordingly, the ratio of the volume of blood cells (including erythrocytes containing hemoglobin) and the liquid part of the blood ( plasma) shifts towards the latter. This form of anemia does not require treatment.

Anemic syndrome is manifested by a complex of nonspecific symptoms and is caused by insufficient oxygen supply to tissues. The main clinical manifestations of this pathology are general weakness, fatigue, dizziness, tinnitus, flies before the eyes, tachycardia, shortness of breath during exercise, fainting, insomnia, headache and decreased performance.

The consequence of iron deficiency are: dry skin, the formation of cracks on it; violation of the integrity of the epidermis; the appearance of ulcers and cracks in the corners of the mouth with inflammation of the surrounding tissues; changes on the part of the nails (brittleness, layering, transverse striation, the nails become flat, take a concave spoon-shaped shape); damage to the hair (the hair splits, their ends exfoliate). In patients due to iron deficiency, there is a burning sensation of the tongue; perversion of taste (desire to eat chalk, toothpaste, ashes, clay, sand, raw cereals); unhealthy addiction to certain smells (acetone, gasoline, kerosene, naphthalene); difficulty swallowing dry and hard food; the appearance of a feeling of heaviness and pain in the abdomen, as with gastritis; urinary incontinence when coughing and laughing, nocturnal enuresis; muscle weakness; pale skin; arterial hypotension; subfebrile temperature. In a severe form of iron deficiency anemia, anemic myocardial dystrophy develops.

Complications of pregnancy in iron deficiency anemia

Due to the fact that during pregnancy oxygen consumption increases by 15-33%, pregnant women with iron deficiency anemia are characterized by severe tissue hypoxia with the subsequent development of secondary metabolic disorders, which may be accompanied by the development of dystrophic changes in the myocardium and a violation of its contractility. Iron deficiency anemia is characterized by protein metabolism disorders with protein deficiency in the body, which leads to the development of edema in a pregnant woman. With iron deficiency anemia, dystrophic processes develop in the uterus and in the placenta, which lead to a violation of its function and the formation of placental insufficiency. At the same time, the developing fetus does not receive enough nutrients and oxygen due to it, as a result of which there is a delay in the development of the fetus.

The main complications of pregnancy with iron deficiency anemia are: threat of abortion (20-42%); preeclampsia (40%); arterial hypotension (40%); premature detachment of the placenta (25-35%); fetal growth retardation (25%); preterm birth (11-42%). Childbirth is often complicated by bleeding. In the postpartum period, various inflammatory complications may occur (12%).

In addition to assessing standard indicators for a clinical blood test (hemoglobin, erythrocytes, hematocrit, ESR), the diagnosis of iron deficiency anemia is based on the assessment of a number of other indicators, such as: color index, average hemoglobin content in an erythrocyte, morphological picture of erythrocytes, iron level in blood serum, total iron-binding capacity of blood serum, and some others.

Diet for pregnant women with iron deficiency anemia

Pregnant women with iron deficiency anemia, in addition to drug treatment, are also prescribed a special diet. From food, 2.5 mg of iron is absorbed per day, while from drugs - 15-20 times more. The largest amount of iron is found in meat products. The iron contained in them is absorbed in the human body by 25-30%. The absorption of iron from other products of animal origin (eggs, fish) is 10-15%, from plant products - only 3-5%.

The largest amount of iron (in mg per 100 g of product) is found in pork liver (19.0 mg), cocoa (12.5 mg), egg yolk (7.2 mg), heart (6.2 mg), calf liver ( 5.4 mg), stale bread (4.7 mg), apricots (4.9 mg), almonds (4.4 mg), turkey meat (3.8 mg), spinach (3.1 mg), and veal ( 2.9 mg). A pregnant woman with iron deficiency anemia should adhere to a rational diet. From protein products are recommended: beef, bovine liver, tongue, liver and heart, poultry, eggs and cow's milk. Fats are found in: cheese, cottage cheese, sour cream, cream. Carbohydrates should be replenished by: wholemeal rye bread, vegetables (tomatoes, carrots, radishes, beets, pumpkins and cabbages), fruits (apricots, pomegranates, lemons, cherries), dried fruits (dried apricots, raisins, prunes), nuts, berries ( currants, rose hips, raspberries, strawberries, gooseberries), cereals (oatmeal, buckwheat, rice) and legumes (beans, peas, corn). Be sure to include fresh herbs and honey in the diet.

Prevention and treatment of iron deficiency anemia, use of iron preparations A necessary condition for the treatment of iron deficiency anemia is the use of iron preparations, which are prescribed only by the attending physician. To prevent the development of iron deficiency anemia during pregnancy, the same drugs are used as for the treatment of this complication. Prevention of the development of iron deficiency anemia in pregnant women at risk for the occurrence of this pathology consists in prescribing small doses of iron preparations (1-2 tablets per day) for 4-6 months, starting from 14-16 weeks of pregnancy, in courses of 2-3 weeks, with breaks for 14-21 days, only 3-5 courses per pregnancy. At the same time, it is necessary to change the diet in favor of increasing the consumption of foods containing a large amount of easily digestible iron. According to WHO recommendations, all women during the II and III trimesters of pregnancy and in the first 6 months of lactation should take iron supplements. Treatment with iron preparations should be long-term. The content of hemoglobin increases only by the end of the third week of therapy for iron deficiency anemia. Normalization of red blood counts takes place after 5-8 weeks of treatment.

The most preferable is the intake of iron preparations inside, and not in the form of injections, since in the latter case various side effects may occur more often. In addition to iron, medicines for the treatment of iron deficiency anemia contain various components that enhance the absorption of iron (cysteine, ascorbic acid, succinic acid, folic acid, fructose). For better tolerability, iron supplements should be taken with food. It should be borne in mind that under the influence of certain substances contained in food (phosphoric acid, phytin, tannin, calcium salts), as well as with the simultaneous use of a number of medications (tetracycline antibiotics, almagel), iron absorption in the body decreases.

It is preferable for pregnant women to prescribe iron preparations in combination with ascorbic acid, which is actively involved in the processes of iron metabolism in the body. The content of ascorbic acid should exceed 2-5 times the amount of iron in the preparation. Currently, a number of effective drugs are used to treat anemia in pregnant women. The issue of prescribing a particular drug, as well as its single dose, the frequency of use and the duration of the course of treatment, is decided only by the attending physician on an individual basis. The physician must also monitor the effectiveness of the treatment, which is best assessed by the level of transferrin and ferritin in the blood serum, and not by the level of hemoglobin and erythrocytes.

You should not stop treatment with iron preparations after the normalization of hemoglobin levels and the content of red blood cells in the body. Normalization of hemoglobin levels in the body does not mean the restoration of iron stores in it. For this purpose, WHO experts recommend that after 2-3 months of treatment and the elimination of the hematological picture of anemia, do not stop therapy, but only halve the dose of the drug that was used to treat iron deficiency anemia. This course of treatment continues for 3 months. Even having fully restored iron stores in the body, it is advisable to take small doses of iron-containing preparations for six months.