Anemia is a pathological condition characterized by a decrease in the concentration of hemoglobin and, in the vast majority of cases, the number of red blood cells per unit volume of blood.
IDA during pregnancy is a condition caused by a decrease in the content of iron in the blood serum, bone marrow and depot due to an increase in the volume of circulating blood and the need for a trace element, a decrease in its deposition, and high growth rates of the fetal body. This is one of the most common complications during pregnancy, which adversely affects the course of the gestational process, childbirth, the condition of the fetus and newborn.
Epidemiology
According to WHO, the frequency of IDA in pregnant women in different countries ranges from 21 to 80% as measured by hemoglobin levels, and from 49 to 99% as measured by serum iron levels. In underdeveloped countries, the frequency of IDA in pregnant women reaches 80%. In countries with a high standard of living and a lower birth rate, IDA is diagnosed in 8-20% of pregnant women.
IN last years there is an increase in the frequency of IDA among pregnant women without a tendency to decrease. According to the Ministry of Health of the Russian Federation since 1999, IDA has been detected in more than 40% of pregnant women.
Classification
There are several classifications based on etiological, pathogenetic and hematological features.
In the absolute majority (up to 98-99%) of observations, anemia in pregnant women is a consequence of iron deficiency conditions.
There are the following stages of iron deficiency (ID):
Pre-latent iron deficiency, in which stocks in the depot are depleted, but its supply for hematopoiesis is not reduced;
- latent iron deficiency, characterized by complete depletion of iron stores in the depot, a decrease in the level of ferritin in the blood serum, an increase in the total iron-binding capacity of the serum and the level of transferrin.
WHO experts have adopted the following classification of anemia in pregnant women:
Mild anemia - Hb from 100 to 109 g/l;
- moderate anemia - Hb from 80 to 99 g/l;
- severe anemia - Hb less than 80 g/l.
In practice, the following classification of anemia according to severity is more often used:
Mild degree - Hb from 90 to 109 g/l;
- moderate degree - Hb from 70 to 89 g/l;
- severe degree - Hb less than 70g/l.
In addition, there are 2 groups of anemia: diagnosed during pregnancy and existing and its onset. Anemia most often occurs during pregnancy. Most women develop anemia by the 28th to 30th week of a physiologically proceeding pregnancy, associated with an uneven increase in the volume of circulating blood plasma and the volume of red blood cells. As a result, the hematocrit index decreases from 0.40 to 0.32, the number of erythrocytes decreases from 4.0 x 10 12 /l to 3.5 x 10 12 /l, the hemoglobin index decreases from 140 to 110 g / l from I to III trimester . Such changes in the picture of red blood, as a rule, do not affect the condition and well-being of the pregnant woman. True anemia of pregnant women is accompanied by a typical clinical picture and affects the course of pregnancy and childbirth. Compared with anemia that developed before pregnancy, anemia of pregnant women is more severe, since it is a complication similar to preeclampsia (hemogestosis, in the terminology of D.Ya. Dimitrov, 1980). With anemia in pregnant women, that is, anemia that began before pregnancy, the body has time to adapt.
Etiology
During pregnancy, iron consumption rises sharply to meet the needs of the fetus and placenta, blood loss during childbirth and lactation. The balance of iron during this period is on the verge of deficiency, and various factors that reduce the intake or increase the consumption of iron can lead to the development of iron deficiency anemia.
The leading causes of IDA in pregnant women include the following:
Pathogenesis
The development of IDA during pregnancy is a consequence of an imbalance between the increased consumption of iron and its intake into the body. The biological significance of iron is determined by its participation in tissue respiration. In this regard, iron deficiency anemia of pregnant women is characterized by tissue hypoxia and the pathology caused by it. With IDA, the iron content in the blood serum, bone marrow and depot decreases, which leads to impaired Hb synthesis. Hemoglobin provides binding, transport and transfer of oxygen. With iron deficiency in pregnant women, progressive hemic hypoxia occurs with the subsequent development of secondary metabolic disorders. Since oxygen consumption increases by 15-33% during pregnancy, this exacerbates the development of hypoxia. In pregnant women with a severe degree of iron deficiency anemia, not only tissue and hemic hypoxia develop, but also circulatory, due to the development of dystrophic changes in the myocardium, a violation of its contractility, and the development of a hypokinetic type of blood circulation.
Changes in IDA, leading to metabolic, volemic, hormonal, immunological disorders in pregnant women, contribute to the development of obstetric complications, the frequency of which is directly dependent on the severity of anemia.
Iron loss during each pregnancy, childbirth and during lactation is 700-900 mg (up to 1 g) of iron. The body is able to restore iron stores within 4-5 years. If a woman gives birth before this period, she inevitably develops anemia.
Clinical signs and symptoms
The clinical picture of iron deficiency states depends on the degree of iron deficiency, the rate of its development, and includes signs of anemia and tissue iron deficiency (sideropenia).
In mild cases of anemia, general symptoms may be absent, since compensatory mechanisms (increased erythropoiesis, activation of the functions of the cardiovascular and respiratory systems) provide the physiological need for oxygen in tissues.
Clinical symptoms usually appear with moderate anemia and increase with severe anemia. It is caused by incomplete oxygen supply of tissues and is manifested by the following complaints:
An objective examination of patients reveals:
All these signs of violation of the trophism of epithelial tissues are associated with tissue sideropenia and hypoxia.
With prolonged anemia, dysfunctions of various parenchymal organs are possible, developing as a result of dystrophic processes caused by chronic hypoxia. Changes in the function of various organs and systems in iron deficiency anemia are not so much a consequence of anemia, but of tissue iron deficiency. The proof of this is the discrepancy between the severity of the clinical manifestations of the disease and the degree of anemia and their appearance already in the stage of latent iron deficiency.
As the disease develops, the concentration of iron in the blood plasma decreases, the iron-binding ability increases, as a result, the percentage of transferrin saturation with iron decreases to 15% or less (normally 35-50%). The hematocrit is reduced to 0.3 or less.
Criteria for IDA in pregnant women:
1) The concentration of hemoglobin in the blood<110 г/л.
2) Color indicator< 0,85.
3) Micro- and anisocytosis.
4) The average diameter of erythrocytes is less than 6.5 decimal places.
5) Serum iron<12,6 мкмоль/л, ОЖСС >64.4 µmol/l, CST< 16%.
Currently, the most informative hematological parameter of IDA is considered to be the level of serum Ferritin (normally 32 - 35 μg / l), which serves as an indicator of iron deficiency in the body (with IDA - 12 μg / l or less). Serum ferritin is determined by radioimmunoassay. However, serum ferritin does not always reflect iron stores, as it also depends on the rate of release of ferritin from tissues and plasma.
The severity of the clinical course of anemia is usually determined by the level of hemoglobin in the peripheral blood.
Differential Diagnosis
To clarify the nature of anemia, it is necessary to study urine and blood, determine the ESR, the amount of bilirubin in the blood, the concentration of urobilinogen and bile pigments in the urine, serological studies to determine the content of anti-erythrocyte factors (antibodies), study the function of the liver, kidneys, gastrointestinal tract. Exclude the presence of specific infectious diseases, tumors of various localizations.
General principles of treatment
Pharmacotherapy
The appointment of iron preparations is the main component of IDA therapy, since it is impossible to stop iron deficiency only through good nutrition.
A variety of preparations are used orally, mainly ferrous ferrous iron (since only it is absorbed). The ferric oxide contained in some preparations in the digestive organs must turn into ferrous in order to be absorbed and, having been converted into ferric iron in the blood plasma, participate in the restoration of hemoglobin levels. Medicinal iron entering the body is deposited in the form of ferritin and hemosiderin, and only then is it mobilized for hemoglobin formation.
The daily dose for the prevention of anemia and the treatment of a mild form of the disease is 50-60 mg Fe 2+ , and for the treatment of severe anemia - 100-120 mg Fe 2+ . Daily iron supplementation is preferred over weekly iron supplementation. Ferrous sulfate inside 320 mg (corresponding to 100 mg Fe 2+) 2 r / day 1 hour before or 2 hours after meals.
It is advisable to prescribe iron preparations containing ascorbic acid. The content of ascorbic acid should exceed 2-5 times the amount of iron in the preparation. In addition, drugs may contain other components that enhance iron absorption: cysteine, succinic acid, etc.
In recent years, complex preparations have appeared that are intended for pregnant women, containing vitamins and microelements. They are successfully used for the treatment and prevention of IDA in pregnant and lactating mothers.
Iron preparations for parenteral administration should be used for special indications:
This is due to the fact that preparations for parenteral administration can cause allergic reactions up to anaphylactic shock due to a significant amount of rapidly ionized iron in the absence of the necessary transferrin content that can bind it.
For parenteral administration, ferric iron preparations are used. The course dose of an iron preparation for parenteral administration is calculated for a particular patient according to the formula: patient's body weight (kg) x hemoglobin concentration in the blood (g / 100 ml) x 2.5. Given the prooxidant and lysosomotropic effect of iron preparations, their parenteral administration should be combined with low molecular weight dextrans, which protect the cell and avoid macrophage overload with iron.
Iron (III) polyisomaltosate IM 100 mg/2 ml solution 1 r/day +
Low molecular weight dextrans IV 400.0 ml 1 r / week
To date, certain experience has been gained in the use of recombinant erythropoietin (REPO) preparations for the correction of anemic conditions in pregnant women, puerperas, and premature babies.
Epoetin alfa IV 30-100 IU/kg 3 p/week until optimal Hb concentration is reached
A prerequisite for the use of REPO is adequate saturation of the body with iron, as it is a limiting factor in effective erythropoiesis.
Prevention
Prevention of anemia is primarily required for pregnant women with a high risk of developing anemia. These include:
Prevention consists in prescribing a small dose of iron preparations (1-2 tablets per day) for 4-6 months, starting from 12-14 weeks of pregnancy. At the same time, it is recommended that patients increase the content of meat products in their daily diet.
Prevention of IDA in pregnant women promotes the creation of higher iron stores in newborns, preventing the development of iron deficiency and anemia in infants.
Evaluation of the effectiveness of treatment
The effect of treatment with iron preparations occurs gradually, and therefore therapy should be long-term. The rise of reticulocytes (reticulocyte crisis) is observed on the 8-12th day with adequate administration of iron preparations in a sufficient dose, the hemoglobin content - by the end of the 3rd week. Normalization of red blood counts occurs only after 5-8 weeks of treatment. However, the general condition of patients improves much earlier.
The effectiveness of treatment is best controlled by the level of transferrin and ferritin in the blood serum.
Complications and side effects of treatment
When using high doses of iron preparations, various dyspeptic disorders are likely to occur, to which pregnant women are already prone.
With intravenous administration of iron preparations, pronounced allergic reactions are possible, therefore, preparations should be administered only in stationary conditions.
Excessive administration of iron preparations can lead to hemosiderosis (kidney, liver, heart), especially when it is used parenterally. In case of iron overload, the complexing compound deferoxamine at a dose of up to 500 mg/day is used to remove it.
Mistakes and unreasonable appointments
Treatment should be with iron preparations. The appointment of vitamins B1, B2, B6, B12, folic acid, liver preparations or copper instead of iron is not justified. Combinations of iron preparations with vitamin B12 and folic acid, as well as iron preparations containing folic acid (fefol, irrovit, maltoferfol), are also not justified, since folic acid deficiency anemia in pregnant women is rare and has specific clinical and laboratory signs.
Forecast
Against the background of untreated true iron deficiency anemia in pregnant women, 40% of women develop OPG - gestosis. In the presence of severe disorders of erythropoiesis, the development of premature detachment of the placenta, bleeding during childbirth and the postpartum period is possible.
LITERATURE
1. Belokrinitskaya T.E., Kuznik B.I. New approaches to the treatment of anemia of the gestational period (exchange of opinions). // Russian Bulletin of Perinatology and Pediatrics 1993; 6:13-6
2. Burlev V.A., Konovodova E.N., Murashko L.E., Sopoeva Zh.A. 6, 30-34.
3. Vakhrameeva S.N., Denisova S.N., Khotimchenko S.A., Alekseeva I.A. Latent form of iron deficiency anemia in pregnant women and the health status of their children. //Ros. vestn. perinatol. and pediatrician. 1996; 41(3):26-30
4. Vorobyov P.A. Anemia syndrome in clinical practice. M. - 2001, p. 36-94
5. Dvoretsky L.I. iron deficiency anemia. Russian Medical Journal, 1997, 5 (19): 1234-42.
6. Idelson L.I. Hypochromic anemia.// M., Medicine, 1981, 190
7. Kazyukova T.V., Samsygina G.A., Kalashnikova G.V. et al. New possibilities of ferrotherapy for iron deficiency anemia // Clinical Pharmacology and Therapy 2000; 2:88-91.
8. Loseva M.I., Sazonova O.V., Zyubina L.Yu. and other methods of early detection and treatment of patients with iron deficiency. Ter. archive 1989;7:36-40
9. Beaufrere B., Bresson J.L., Briend A. et al. Iron and pregnancy. Arch. Pediatr. -1995-vol. 2-#1 -p. 1209-1218.
10. Conrad M.E. Iron Overloading Disorders and Iron Regulation. Seminars in Hematology. W.B. Saunders Company. 1998, v 35, n1, 1-4.
11. Cook J.D., Skikne B.S., Baynes R.D. Iron deficiency: the global perspective. // Adv. Exp. Med. Biol. -1994-vol. 356-p.219-228.
12. Frewin R, Henson A, Provan D. Iron deficiency anemia. BMJ 1997;314:360-3.
- Premature detachment of a normally located placenta (due to circulatory disorders in the "mother - placenta - fetus" system).
- Chronic placental insufficiency leading to fetal hypoxia and fetal developmental delay (supplying the baby with blood with insufficient oxygen saturation leads to constant oxygen starvation).
- Premature birth (due to chronic placental insufficiency and depletion of resources at a certain stage of gestation).
In the postpartum period, women with anemia have a higher incidence of hypotonic and atonic bleeding (which further aggravates the degree of anemia), purulent-septic complications and lactation disorders.
Effects of anemia on the fetus
Birth with low body weight, delayed physical development of the fetus.
Belated falling off of the umbilical cord, slow healing of the umbilical wound.
The development of anemia in a child in the neonatal period.
Delayed psychomotor development.
Reduced immunity, low resistance to infections.
Diagnostics:
- CBC (general blood test) is the first method for diagnosing an iron deficiency state. According to the result of the KLA, you can find out the level of hemoglobin, the number of erythrocytes (red blood cells), hematocrit, color index. Monitoring the state while taking iron supplements is also carried out according to the KLA.
UAC norms:
- hemoglobin 110 - 140 g/l
- hematocrit 36 - 42%
- erythrocytes 3.7 - 4.7*10 12/ml
- color index 0.8 - 1.0
In the KLA, a change in the size and shape of erythrocytes is also determined: small erythrocytes (microcytosis), deformation of erythrocytes (poikilocytosis), the presence of separate fragments of erythrocytes (schizocytosis).
- Total serum iron-binding capacity (TIBC). OZhSS in normal women has the following indicators: 38.0-64.0 microns / l. with anemia, this figure increases.
Blood iron. Normally, in women, blood iron is in the range of 12 - 25 µmol / l.
- Transferrin saturation with iron. Transferrin is a protein that transports iron to organs and tissues. If an iron deficiency begins to be noted in the body, then this indicator is depleted first of all, transferrin gradually loses the iron molecules attached to it. Normally, this figure is 16 - 50%, with anemia it decreases.
If necessary, consultations of doctors - specialists (gastroenterologist, hepatologist, hematologist, rheumatologist and others).
Although the range of studies is very wide, as a rule, the diagnosis of anemia in a pregnant woman is based on a detailed blood test, which, if correctly deciphered, provides almost all the necessary information.
Treatment of anemia during pregnancy:
1. Diet
The first step towards restoring normal hemoglobin levels is a special diet. Anemia can appear even in those who, it would seem, eat enough and varied. But nutrition may not include exactly those right foods that are rich in easily digestible iron.
Meat products and offal contain a large amount of iron compounds, and in addition, it is absorbed as completely as possible (up to 25 - 30%). Sausage, sausages and similar meat products are very conditional, but they contain a record amount of salt and starch, so eating them will not bring any benefit.
Iron from other animal products (fish and seafood) is more difficult to absorb, about 15-20%.
Only about 2-5% of the iron they contain is absorbed from plant products.
Featured Products(arranged in descending order of iron enrichment): pork liver, cocoa, egg yolk, heart, veal liver, toasted bread, apricots, almonds, turkey, spinach, veal and others.
The absorption of iron from animal products is facilitated by foods that are rich in zinc, copper, cobalt. You will find these elements in the liver, cocoa, seafood (shrimp, mussels and other seafood).
You can increase the absorption of iron from animals, and especially from herbal preparations, if you introduce foods rich in ascorbic, succinic, citric acids and fructose (tomatoes, kiwi, strawberries, strawberries, cauliflower, bell peppers, honey) into the diet.
So, for example, it is better to combine buckwheat porridge with stewed vegetables (tomatoes, cauliflower, peppers), season beef and heart after cooking with tomato sauce or sauce with lemon juice.
Approach to the composition of the diet should be deliberate, because an excess of acids will adversely affect the condition of the gastric mucosa and esophagus, and will also make calcium absorption more difficult.
Folic acid (vitamin B9), which is certainly useful for pregnant women in terms of preventing fetal deformities, will also help in preventing anemia. Folates help iron to be more easily absorbed and metabolized in the body. Foods rich in folic acid: spinach, lettuce, fresh parsley, cabbage, turnips, mustard greens, asparagus, dried apricots, broccoli, citrus fruits, raspberries, strawberries, beans, peas, lentils, seeds and nuts (sunflower seeds, flax seeds, sesame seeds and peanuts; sesame, moreover, the champion in calcium content).
Difficult absorption of iron dairy and sour-milk products, caffeine, tannin and foods rich in phytic acid (corn, soy). Also, they do not contribute to the absorption of a large amount of fat in food.
The difference in taking such antagonistic (counteracting) products should be at least two hours.
By the way, coffee and tea make it difficult to absorb almost all vitamins and microelements from food, so these healthy drinks should always be consumed separately, then the benefits of green or herbal tea, natural coffee or mate are preserved, and useful nutrients are absorbed from food.
2. Iron preparations for the treatment of anemia
Iron preparations are available in the form of tablets, solutions for internal use and solutions for intravenous administration. Previously used intramuscular iron preparations are now not recommended due to the frequency of complications (post-injection hematomas, abscesses and allergic reactions).
The treatment of anemia is started with tablet preparations, they are usually well tolerated and easily dosed.
Sorbifer durules(a combined preparation containing 100 mg of iron and 60 mg of ascorbic acid), 1-2 tablets per day are used in the treatment of mild anemia and for the prevention of iron deficiency, with moderate anemia, up to 4 tablets per day are used in 2 divided doses. The duration of treatment is determined individually depending on the severity of anemia and the effect of treatment.
Fenyuls 100 (iron 100 mg, ascorbic acid 60 mg) for prevention 1 tablet 1 time per day, for treatment 1 tablet 2 times a day. The duration of the reception is also individual.
Ferretab (iron 50 mg, folic acid 500 mcg) 1 capsule per day, up to a maximum of 2-3 capsules per day in 2 divided doses, is taken until the hemoglobin level is restored, then prophylactic administration on an individual basis.
Maltofer (in one tablet / 40 drops of solution / 10 ml of syrup 100 mg of iron) is available in three dosage forms, taking 40-120 drops / 10-30 ml of syrup / 1-3 tablets per day in 1-2 doses. The duration of admission is determined individually.
Totem (a combined preparation of iron, copper and manganese) 2-4 ampoules per day, the solution is diluted in 1 glass of water, the duration and frequency of administration are determined individually, during the course of treatment the dose of the drug may vary depending on the blood picture.
The intake of iron tablets is sometimes accompanied by complications from the gastrointestinal tract (discomfort in the stomach, heartburn, constipation), this should not serve as a contraindication to further intake.
It is necessary to follow some rules: take iron with meals (excluding those foods that interfere with its absorption in this meal), try to normalize the stool (use of dried apricots and prunes, a sufficient amount of fiber, situational rectal suppositories with glycerin at night).
Injectable drugs are used exclusively in the hospital, as there is a possibility of developing anaphylactic shock.
Intravenous iron preparations are now beginning to be used in pregnant women. In particular, the drug Ferrinject, a solution for intravenous administration or in the dialysis system, is used. Its introduction should be strictly according to indications, under the supervision of a physician. The dose of the drug is calculated individually, based on the level of hemoglobin and the weight of the patient. As the treatment progresses, the dose is reduced. The course of treatment is individual, after injectable iron, a transfer is made to taking iron tablets.
- Transfusion (transfusion of blood components) is performed with severe anemia, according to strict indications and in a hospital.
If treatment with iron preparations does not lead to an increase in hemoglobin levels, there is no positive dynamics in the symptoms of anemia, then other causes of anemia should be excluded.
A short list of diagnostic measures (performed strictly according to indications): an extended biochemical blood test, ultrasound of internal organs and kidneys, FGDS, sternal puncture (analysis of bone marrow from the sternum), consultations of doctors - specialists according to indications.
Prevention of anemia in pregnancy
You should know that you need to prepare for pregnancy and have a normal level of hemoglobin, and in the presence of anemia, find out its cause.
For the prevention of anemia and other complications of pregnancy, it is recommended to take multivitamin complexes containing at least 60 mg of iron and at least 250 mcg of folic acid (elevit pronatal, vitrum prenatal). Keep in mind that taking multivitamins can only PREVENT iron deficiency conditions, anemia that has already developed should be treated with higher doses of iron.
Taking multivitamins should begin 3 months before the intended conception and continue until at least 12 weeks of pregnancy, and then according to indications.
We examined the most common condition that complicates the course of pregnancy, but it can and should be fought. Anemia of pregnant women with timely and proper treatment is a “grateful” state, that is, a positive effect in the blood test and improvement in well-being, we expect quite quickly. Do not avoid visiting the antenatal clinic and listen to the recommendations of your doctor. Look after yourself and be healthy!
Obstetrician-gynecologist Petrova A.V.
Content
The period of bearing a child for a woman is associated with a number of physiological changes occurring inside her body. Anemia in pregnant women is formed if the amount of hemoglobin contained in the mother's blood does not cover the needs of her and the child in it. Oxygen deficiency arising against this background can provoke negative changes in the body of a woman and an unborn baby. At the first sign of anemia, you should consult a doctor.
Why does anemia develop during pregnancy?
Gestational anemia is a specific condition of a woman, characterized by a decrease in the level of hemoglobin in the blood during pregnancy. The lack of the required concentration of this protein compound leads to dysfunction of the internal organs caused by oxygen deficiency. Anemia during pregnancy often manifests itself in the 2nd and 3rd trimester.
There is a pathology, because when carrying the fetus of the future mother, more red blood cells are required for the normal supply of the child with nutrients, ensuring his breathing. The presence of an ailment complicates the course of pregnancy, in some cases it becomes an indication for its termination. Manifestations of anemia are dangerous for the mother and fetus, so it must be diagnosed and treated in a timely manner.
Causes
Anemia occurs under the influence of pathophysiological and external causes. Experts identify the following factors that contribute to the development of the disease in pregnant women:
- Reducing the amount of iron ingested with food - malnutrition for social reasons, anorexia, adherence to veganism, vegetarianism, the use of low-calorie diets for weight loss, starvation.
- Heredity - the risk of anemia is high if the mother of the pregnant woman suffered from the disease, the woman was born with this disease or prematurely. If a child was born with iron deficiency, his hematopoietic apparatus undergoes pathological changes, the level of absorption of the element remains low all his life.
- Inflammation of a chronic course - iron begins to accumulate in the lesion. Special preparations make up for the deficiency for a short time.
- Diseases of the gastrointestinal tract (ulcer, colitis, gastritis) - lead to a deterioration in the absorption of protein, iron, increase the risk of developing dysbiosis.
- Pregnancy with a complicated course - the presence of placenta previa, preeclampsia, severe toxicosis, bearing several children at the same time.
- A history of abortion, miscarriage, bleeding.
- The risk of developing anemia increases in young (up to 16-18 years), mature (after 30 years) primiparous, multiparous, pregnant women who are breastfeeding a previous child.
Degrees
The severity of anemia in pregnant women depends on the amount of hemoglobin in the blood. Experts have developed the following classification of the disease:
- Anemia of the first degree during pregnancy does not pose a direct threat to the unborn baby or his mother if timely treatment is started. Symptoms at this stage of the development of the disease are mild. Stage 1 anemia can be diagnosed with a blood test. Mild anemia during pregnancy is diagnosed when the amount of hemoglobin is 110-91 g / l. Therapy consists in the correction of nutrition, the elimination of beriberi.
- The second degree worsens the condition of a pregnant woman, the manifestations of anemia intensify, and tangible discomfort appears. The hemoglobin level at this stage varies between 90-71 g/l. If discomfort occurs, a pregnant woman should immediately consult a doctor. With anemia of the second stage, the level of hemoglobin is restored with vitamin preparations.
- The third degree is severe anemia with severe symptoms. Hemoglobin values in the blood test are below 70 g/l. Therapy of a pregnant woman is carried out only in a hospital, under the supervision of specialists. Prescribed drugs are determined in accordance with the risks to the health of the expectant mother and fetus. At this stage in the development of anemia, a woman may lose a child.
Kinds
There are several types of disease that occur during gestation. Experts offer the following classification of anemia in pregnant women:
- Iron deficiency is a pathological condition in which the formation of red blood cells and hemoglobin is disrupted due to iron deficiency. On average, a woman's body contains about 3-4 g of this trace element. Iron is part of hemoglobin, thanks to which red blood cells can transport oxygen to all tissues. A certain part of the trace element is excreted from the body with feces, urine and menstrual blood. If the amount of iron lost is not covered by the volume absorbed in the intestine, anemia develops. A pregnant woman needs 2 times more of this element, since part of it passes to the fetus. The iron supplied with food is not enough to meet the increased needs, so its concentration inside the body is significantly reduced. This imbalance leads to failures in the formation of red blood cells and hemoglobin. Symptoms of iron deficiency anemia mainly appear in the 3rd trimester of gestation. It must be differentiated from thalassemia, hemoglobinopathy.
- Folate deficiency is a pathology characterized by a violation of the process of formation of red blood cells in the bone marrow. The disease occurs when there is a lack of folic acid inside the body, which is involved in the synthesis of DNA, which is necessary for the division of living cells. The body of an adult woman normally contains 10-15 mg of the vitamin, the daily requirement for it is 100-200 mcg per day. If the substance stops entering the body, its reserves will last only 2-3 months, then anemia will begin to develop. With the onset of pregnancy, the expectant mother needs a large amount of folate to ensure the normal development of the cells and tissues of the fetus. At the same time, with increasing needs, the level of absorption in the intestine remains the same. Under such conditions, folate deficiency anemia develops in a pregnant woman 4-6 months after conception.
- Aplastic - characterized by damage to the bone marrow. In this structure, erythrocytes, leukocytes, blood platelets are formed. If the aplastic form develops in a pregnant woman, the prognosis is negative for the mother and fetus. In some cases, it is possible to eliminate the symptoms, restore hematopoiesis by abortion. More than half of patients with this diagnosis die. The mechanisms of the occurrence of pathology have not been reliably determined. According to experts, it is caused by a combination of a hereditary factor, adverse environmental conditions, the use of certain drugs with metabolic and hormonal disorders. For the treatment of the aplastic form, bone marrow transplantation is used, a lifelong therapy aimed at suppressing the immune system.
- Hemolytic - is an increased destruction of red blood cells, a significant decrease in their number. With the progression of the pathology, the compensatory mechanisms of the body cannot compensate for the lack of red blood cells. Clinical manifestations are the syndrome of hemolytic jaundice, myocardial dystrophy, general weakness, shortness of breath, and an increased tendency to cholelithiasis. In pregnant women, the hemolytic form develops during exacerbation of congenital anomalies. A common variant of the disease is Minkowski-Choffard disease. Its essence lies in the incorrect formation of erythrocyte membranes due to a defect in the structural protein. Red blood cells acquire a spherical shape, lose plasticity, the ability to pass through the thin capillaries of the spleen. Cells are retained inside the vessel, destroyed by macrophages. Removal of the spleen will help eliminate signs of pathology.
- Posthemorrhagic - a decrease in the level of hemoglobin, the number of red blood cells that occurs after bleeding (nasal, gastric, intestinal, from the genital tract). The body can stop the development of this form of pathology on its own due to the compensatory mechanisms of the spleen, liver, and kidneys. Anemia in pregnant women occurs with placenta previa or premature detachment of the placenta.
Signs of anemia during pregnancy
Clinical manifestations of iron deficiency in pregnant women are due to anemia, lack of certain enzymes, hemoglobin. The following pathology syndromes are distinguished:
- Anemic. It is caused by insufficient supply of oxygen to tissues. The syndrome is characterized by the following symptoms:
- fatigue, general weakness;
- darkening in the eyes, dizziness;
- heart palpitations with moderate exercise;
- noise in the head, sensation of pulsation in the ears, temples;
- decrease in working capacity;
- headache;
- pallor of mucous membranes, skin.
- Sideropenic. The syndrome is manifested by trophic disorders. It is characterized by several symptoms:
- dryness, hyperpigmentation, peeling of the skin;
- cracks on the palms, heels, a slight yellowish tinge of the hands;
- jaggedness, brittleness, striation, delamination of nails;
- hair loss;
- perversion of taste, olfactory predilections;
- predisposition to caries;
- atrophy of the mucous membrane of the esophagus, tongue;
- blue tint of the sclera;
- decreased ability to adapt.
- Visceral. It is a violation of the digestive system, brain, liver. The syndrome is expressed by several symptoms:
- colitis, gastritis, lack of appetite, bloating, diarrhea, constipation;
- fatty hepatosis, biliary dyskinesia;
- decreased concentration of attention, memory, isolation, apathy, irritability.
What is dangerous anemia during pregnancy
During gestation, folic and iron deficiency anemia often develops in pregnant women. Aplastic, hemolytic and posthemorrhagic are rare. All types of illness have a negative impact on both organisms, affecting the fetus to a greater extent, since its tissues need a constant supply of oxygen and nutrients. Mild and moderate severity of the pathology may not affect the condition of the woman, but cause serious disorders in the child. The severity of the consequences depends on the type, stage of the disease, gestational age.
For a child
Anemia of the fetus during pregnancy becomes a consequence of the presence of this pathological condition in the expectant mother. The child has the following disorders:
- Delay in the formation of organs - in the early stages, differentiation of pluripotent cells occurs, their active reproduction. From the accumulations of such structures, located in a certain order, the organs and systems of the body are formed. If oxygen deficiency is observed at this stage, the process is delayed. Tanya and organs do not develop or form incorrectly. A child under such conditions is born with congenital anomalies.
- Slowdown of development - a decrease in the concentration of oxygen in the peripheral blood as a result of a decrease in the content of hemoglobin leads to inhibition of metabolic processes in the developing tissues. Such pathological changes cause congenital anomalies, lagging behind the child in physical and intellectual development.
- Disorders of the nervous system - with a lack of oxygen (hypoxia), provoked by a pathological condition, the development of brain tissues slows down. This phenomenon can cause organic and functional diseases of the child (hydrocephalus, mental retardation).
- Defects in the formation of the skeletal system - are observed in the folate-deficient form, due to a decrease in the intake of vitamin B9 to the fetus. In the presence of such an ailment in a pregnant woman, children are born with malnutrition, non-closure of the canal of the femur, humerus, tibia and other tubular bones.
- Weakening of the immune system - a child during the first year of life falls ill with ARVI 10 times more often than healthy children.
For mother
The occurrence of severe iron deficiency in a pregnant woman causes damage to various organs and systems. Experts distinguish the following consequences of the development of the disease for the mother:
- Disorders of the cardiovascular system - an increase in the volume of circulating blood, body weight leads to an increase in heart rate. The presence of pathology makes the body work with even greater efficiency. Prolonged exercise, combined with a lack of oxygen, causes the development of heart failure.
- Premature birth - associated with underdevelopment of the placenta. They can be spontaneous or caused artificially for medical reasons. Such a need arises in heart failure, aplastic anemia, and other organ pathologies that cannot be eliminated during pregnancy.
- Placental insufficiency - hypoxia leads to underdevelopment of the placenta, lack of full saturation of the fetus with nutrients, oxygen.
- Postpartum infections - the process of giving birth to a child is often accompanied by the occurrence of perineal injuries. To restore the integrity of tissues, good blood supply, the presence of nutrients, and the right amount of oxygen are necessary. With anemia, the rate of wound healing slows down significantly, and the risk of infection increases. Since the body is weakened after childbirth, infections are difficult to treat, complications form.
Diagnostics
Based on its results, the level of hemoglobin, the number, shape and size of red blood cells, and the color index are determined. To establish the causes of the pathology, the doctor conducts additional studies:
- questioning the patient to clarify her well-being;
- clinical examination;
- blood chemistry;
- bone marrow puncture.
If necessary, the expectant mother will need to consult a hepatologist, gastroenterologist, hematologist, rheumatologist and other specialists. For a timely diagnosis, a pregnant woman needs to undergo a preventive examination by a gynecologist. A visit to the doctor is required for the following periods:
- Up to the 12th week - to assess the general condition, conduct an ultrasound examination. If iron deficiency is detected at this time, the pathology is not associated with the onset of pregnancy. The causes of the disease must be sought in organismal systems.
- Until the 27th week - a general blood test may reveal a lack of iron during pregnancy, a deficiency of other important substances. In this case, preventive treatment is prescribed.
- From the 28th to the 42nd week - anemia at this stage of gestation is observed with incorrect preventive therapy or its complete absence. During the examination, the condition of the patient and the child is assessed, a decision is made on the method of delivery (through natural routes, using a caesarean section).
Treatment of anemia during pregnancy
Therapy of a pathological condition must begin immediately after its detection, regardless of how long the disease was detected. The basis of treatment is taking medications containing iron, folic acid. Restoration and maintenance of the necessary concentration of these substances inside the body contributes to the gradual regression of the pathology, normalization of the hematopoietic function, and improvement of the patient's condition. The absorption of iron occurs faster under the action of ascorbic acid, therefore, this vitamin is prescribed together with drugs.
At the first stage of the development of the disease, a diet will help to eliminate its signs. The use of products containing iron contributes to the intake of this element into the body of a pregnant woman in a form that is easily absorbed. Therefore, proper nutrition often contributes to the speedy improvement of well-being. With anemia, it is important to adhere to complex therapy, without neglecting one of the components of treatment. Certain foods can impair iron absorption and should be avoided.
Nutrition
Anemia of the 1st degree during pregnancy is eliminated with the help of proper nutrition. The basis of a woman's diet should be foods rich in iron. It is recommended to use:
- meat, offal (beef, chicken, rabbit, turkey, liver);
- fish (pink salmon, sturgeon, mackerel, red caviar);
- cereals (rice, buckwheat, wheat);
- vegetables, fruits, berries (beets, cabbage, parsley, dill, peaches, cherries, plums, apples, strawberries, citrus fruits).
It is important to remember that some foods reduce the absorption of iron. When treating with drugs containing this element, it is recommended to exclude from the diet or limit food and drinks rich in magnesium, calcium, oxalic acid, phosphates, caffeine, tannin. With anemia, together with iron, you should not use:
- dairy products;
- soy, nuts, corn;
- Tea coffee;
- spinach, sorrel, blueberries;
- products with high fat content.
vitamins
Vitamins are prescribed to eliminate the negative effects of anemia. They are used in conjunction with medications and diet. According to the results of a blood test, a substance is determined, the lack of which needs to be filled:
- ascorbic acid - helps the absorption of iron obtained from food;
- vitamin B12 - its deficiency leads to the progression of anemia, complicates treatment;
- folic acid - helps the absorption of other beneficial compounds, normalizes the functioning of fetal cells;
- vitamin E - takes part in the construction, normalization of the state of the placenta;
- vitamin B6 - helps to stimulate the metabolic processes of cells.
Iron preparations
For the full treatment of gestational anemia, it is necessary to take iron-containing drugs. Medications are important for the normalization of hemoglobin levels. To eliminate anemia in pregnant women, the following drugs are used:
- Salts of ferrous iron. Representatives of the group include Aktiferrin, which is available in the form of tablets, capsules and solution. You can take its analogues (Totem, Hemofer).
- Ferrous salt and ascorbic acid. This combination is the basis of preparations Hemohelper, Ferroplex.
- Ferric iron succinylate protein is the active substance of the Ferlatum solution.
- Ferric hydroxide is contained in the medicines Maltofer, Ferrum Lek.
Iron preparations are preferably taken orally. Intravenous administration is indicated only in the presence of ailments of the gastrointestinal tract, since this method has a wide range of side effects:
- allergic reactions;
- the appearance of hematomas, infiltrates at the injection site;
- disruption of the digestive process;
- syndrome of disseminated intravascular coagulation.
Prevention of anemia in pregnant women
When planning a pregnancy, a woman needs to see a doctor to assess her condition and identify the risk of developing anemia. In order for the baby to be born healthy, the following preventive measures are necessary:
- Reception of multivitamin complexes, which include at least 60 mg of iron. Suitable drugs are Vitrum Prenatal, Elevit Pronatal. Vitamin complexes can only be used for prevention. If anemia is already developing, higher doses of iron will be needed.
- For the prevention of pathology, it is recommended to take folic acid even at the stage of pregnancy planning. Vitamin should be consumed 1-2 months before the intended conception at a dose of 25-50 mg daily. For a pregnant woman, the amount of folic acid should be increased to 400 mg/day. Such a measure will satisfy the child's need for this substance, and prevent the occurrence of anomalies in the fetal nervous system.
- A pregnant woman should eat 3-5 different fruits daily. Such nutrition contributes to the favorable development of the child during his gestation.
Video
Anemia is one of the most common conditions associated with pregnancy today. And, as a rule, during the bearing of a baby, a woman encounters iron deficiency anemia - a disease that is characterized by oxygen transport to organs and tissues, and, accordingly, a decrease in the number of red blood cells - erythrocytes. Anemia has three forms of difficulty - mild, moderate and severe. And its insidiousness lies in the fact that the mild form practically does not manifest itself in any way: there are practically no symptoms signaling any changes in the body. Anemia can be suspected if the skin of a pregnant woman is pale. Therefore, regular blood tests are of great importance: they will help specialists determine the presence or absence in time, 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 already 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 both the expectant mother and the fetus need. If iron is consumed at a faster rate than it enters the body of a pregnant woman, anemia occurs, which necessarily requires treatment. The fact is that if anemia is not “eliminated”, very adverse consequences are possible. Among them - the development of the second half of pregnancy, increased risk. In this case, the birth process may be accompanied by heavy bleeding, because anemia disrupts the function of blood clotting. After childbirth, "untreated" anemia can remind of itself by a decrease in milk production. For a baby, iron deficiency in the mother's body is dangerous by intrauterine growth retardation due to insufficient supply of oxygen and nutrients. In addition, the risk of development and malnutrition increases significantly. A baby can be born weak, underweight, with a weak immune system, and therefore more prone to infectious diseases.
Signs of anemia during pregnancy
So, the fact that anemia requires mandatory treatment is a fact. In addition to the fact that this disease is fraught with consequences, it also greatly affects the general condition of a pregnant woman.
So, weakness, fatigue, dry skin become companions of anemia; in more severe forms - hair loss, palpitations and frequent fainting. These are the so-called anemic signs associated with a reduced amount of hemoglobin in the blood and are caused by oxygen starvation, as well as a decrease in the amount of energy produced.
Another conditional group of symptoms of anemia is called sideropenic. They can manifest themselves against the background of violations of the functions 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 "jam" in the corners of the lips, dryness and brittle hair. In addition, a sign of anemia may be some “deviation-perversion” of a woman’s tastes: when, for no reason, the expectant mother suddenly wants to eat chalk or earth, raw fruits (for example, potatoes), which she did not observe before pregnancy.
Treatment of anemia during pregnancy
For the prevention and treatment of anemia, foods containing iron and animal proteins must be present in the diet of a pregnant woman. First of all, these are meat, liver and fish, dairy and sour-milk products, a large number of vegetables and fruits, some of which must be eaten raw (carrots, apples, cabbage), buckwheat porridge. But, since you can’t manage with one diet to eliminate anemia, in addition to good nutrition for the treatment of the disease, they also resort to iron-containing preparations, which are absolutely safe for the fetus. The fact is that it will not be possible to compensate for the lack of iron exclusively with food: if only a little more than 6% of iron is absorbed from food, then drugs 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 dragees, which must be taken orally. The duration of treatment is several months, although an increase in hemoglobin content begins approximately from 2-3 weeks. Despite the fact that the level of hemoglobin is gradually stabilizing, this by no means means that the iron stores in the body have already been replenished. Therefore, interrupting treatment at the first favorable changes is by no means recommended. 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 the baby continues.
Especially for- Tatyana Argamakova
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 ulcer and duodenal ulcer, hemorrhoids, as well as intestinal diverticulosis, ulcerative colitis, helminthic invasion lead to anemia of 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 the 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.