Iron Deficiency Anemia In Pregnancy

Treatment

The treatment begins with oral medications. If these medicines are not tolerated well by the body, parenteral therapy is opted.

Oral medications- Iron deficiency anemia is treated with ferrous sulphate. It is cheap and the body readily absorbs ferrous sulphate. If the body does not tolerate this, the drug of choice is ferrous gluconate or fumarate.

To avoid reoccurrence of anemia, patients are advised to continue taking iron tablets for 3-6 months, after hemoglobin is within normal limits.

If iron is taken with food there is some reduction in its absorption. The staple Indian diet consists of cereals and cereals contain phytic acid. Phytate reduces iron absorption.

Addition of vitamin C in the medicine or diet enhances iron absorption.

It is best to take the iron pills on an empty stomach in order to absorb as much of the iron as possible. However, it can cause irritation to the stomach lining. It is advisable to take the tablets with water or orange juice (the vitamin C helps with absorption), but not with milk (calcium interferes with absorption). Coffee, tea, egg yolks, milk, fiber and soy protein can hinder iron absorption. It is best to avoid these substances when eating iron-rich food.

Several pregnant women with anemia who were non responsive to iron supplementation also had vitamin B6 deficiency, and anemia in these cases improved with the administration of vitamin B6.

Side effects of oral iron treatment-Iron treatment can give some side effects and these should be known before starting the treatment-

Constipation- having prune juice may help relieve the problem, also it is a good source of iron
Heartburn- avoid taking the tablet at bedtime as lying down may increase the discomfort
Abdominal discomfort
Nausea, vomiting- take the tablet near bedtime, perhaps it is easier to sleep through nausea
Diarrhea (rare)

If the above problems do not lessen then cutting back and taking less iron and gradually increasing to the required dose may be helpful. Taking the iron in divided doses throughout the day helps minimize discomfort. If this does not help, then a time-released formula may be the solution.

Parenteral Therapy- About 20% women are unable to take iron orally due to side effects (constipation/heartburn/nausea/vomiting etc). In some patients, iron is not absorbed adequately from the body. Such pregnant women have to be treated with intra-muscular iron injections.

Iron Dextran is the drug of choice. Dose is 100 mg and it is given on every alternate day for 3-weeks. Total dose should not exceed 1000mg.

Iron carboxymaltose is a new intravenous iron preparation.

Side effects of parenteral iron therapy -

Parenteral iron is expensive and can sometimes cause problems as compared to oral therapy. Side effects include -

Pain
Inflammation
Phlebitis (Inflammation of vein)
Fever
Arthralgia
Hypotension
Rarely fatal anaphylaxis

Blood Transfusion - is sought only in severe deficiency cases - Each blood unit raises the hemoglobin % by 0.51 gm.

Treatment of related conditions -

Malaria causes anemia in pregnancy due to rupture of RBCs. It leads to low birth weight babies, parasitaemia in neonates, rupture of RBCs and becomes a persistent source of infection. Therefore malaria in pregnancy should be treated without any hesitation. The preferred drug is chloroquine. Malaria prophylaxis should also be given to pregnant women in areas where malaria is endemic.
Hookworm infection causes anemia due to chronic blood loss. Albendazole or mebendazole is recommended to all pregnant women after the first trimester of pregnancy. To prevent recurrence, patients should be advised to use footwear, improve sanitation, and personal hygiene.

Severe anemia in late pregnancy (after 32 weeks) -

These patients should ideally be managed in a hospital. They may or may not present with heart failure. However, they all need urgent admission and complete bed rest with sedation and sometimes oxygen.

In case of congestive cardiac failure (CCF) patient should be given -