Anemia in pregnant women: causes, how to treat and prevent it

Changes in the body of pregnant women will affect health conditions. You will need twice as much fresh blood as before. If this blood requirement is not fulfilled, pregnant women will be prone to anemia. Anemia in pregnant women should not be ignored because it can harm yourself and the fetus in the womb.

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Types of anemia in pregnant women that are often experienced

1. Iron deficiency anemia

As described above, anemia in pregnant women is most often caused by iron deficiency problems. This anemia is known as iron deficiency anemia.

Iron is needed to help the body produce fresh red blood cells that are rich in oxygen and nutrients.

Blood flow, oxygen, and nutrients are very important to support fetal growth and development and maintain optimal placental condition.

The main cause of iron deficiency is eating less iron-rich foods, such as animal protein, from before and during pregnancy.

However, getting iron from food alone will not be enough to meet your needs throughout pregnancy.

In fact, when pregnant the blood volume will increase by up to 50 percent to be able to meet the needs of yourself and the growing fetus.

That is why the body's daily iron needs must also be met through iron supplements, in order to avoid conditions of deficiency of red blood cells.

2. Folate deficiency anemia

Folic deficiency anemia occurs when the body lacks folic acid (vitamin B9) from food. This type of anemia can also occur due to malabsorption.

Malabsorption means that the body is unable to absorb folic acid as effectively as it should. This is usually caused by indigestion, such as celiac disease.

Folic acid is a vitamin that is important for maintaining health in order to avoid this condition.

The function of folic acid is to form new proteins in the body that produce red blood cells and form DNA in the fetus.

Meeting the needs of folic acid can prevent the risk of babies born with neural tube defects such as spina bifida and anencephaly by up to 72 percent.

3. Vitamin B12 deficiency anemia

Vitamin B12 is needed by the body to help produce red blood cells. If pregnant women do not eat foods high in vitamin B12, symptoms of anemia in pregnant women can appear as a result.

Digestive disorders such as celiac and Crohn's disease can also interfere with the body's proper absorption of vitamin B12.

In addition, the habit of drinking alcohol during pregnancy can also cause anemia in pregnant women with vitamin B12 deficiency.

Signs and symptoms of anemia in pregnant women

Symptoms of anemia in pregnant women can be invisible so they are often ignored. However, as you get older, the symptoms can get worse.

So, recognize and watch out for symptoms of anemia in pregnant women such as:

• The body feels weak, tired and lethargic all the time
• Dizzy
• Hard to breathe
• Fast or irregular heartbeat
• Chest pain or pain
• The color of the skin, lips, and nails becomes pale
• Cold hands and feet
• Difficulty concentrating

Above are the characteristics of anemia in pregnant women that need to be watched out for.

Causes of anemia in pregnant women

Anemia is a condition that occurs when the body lacks red blood cells, which are lower than the normal limit.

Reporting from the Mayo Clinic, this condition can also occur if red blood cells do not contain enough hemoglobin which is responsible for distributing oxygen throughout the body.

Lack of red blood can cause fatigue or weakness quickly because the organs in the body do not receive enough oxygen and nutrients. You may also experience other symptoms, such as shortness of breath, dizziness, or headaches.

This condition is generally caused by malnutrition problems in pregnant women and is influenced by changes in body hormones that change the process of producing blood cells.

Several health conditions besides anemia such as bleeding, kidney disease, and immune system disorders can also cause the body to lack red blood cells.

Factors that increase the risk of anemia in pregnant women

Anemia can happen to anyone, but pregnant women are among the most vulnerable to experience it.

All pregnant women are at risk of developing anemia. Anemia is caused by the body not being able to meet the needs of more blood, iron and folic acid during pregnancy.

Anemia is also most at risk in mothers who have the following conditions:

• Are pregnant with twins. The more babies are contained, the more blood is needed.
• Two pregnancies in the near future.
• Vomiting and nausea in the morning (morning sickness).
• Pregnant in adolescence.
• Lack of consuming foods rich in iron and folic acid.
• Already have anemia since before pregnancy.

The danger of anemia in pregnant women and the fetus

This is one of the most common health problems in pregnant women, but should not be underestimated.

This disease, which is often referred to as lack of blood, is not a condition that can heal by itself.

If the number of red blood cells in the body is too low, the mother and the fetus can become deprived of nutrients and oxygen which will jeopardize their safety.

Severe anemia in the first trimester is reported to increase various problems such as:

• The risk of a slow fetus or the fetus not developing in the womb
• Babies are born prematurely
• Have a low birth weight (LBW)
• Low APGAR score

Severe anemia in pregnant women can also cause damage to vital organs such as the brain and heart to death.

In addition, anemia is also associated with the risk of miscarriage, although there is really no valid research to confirm this.

Anemic conditions that are allowed to continue without treatment will increase the risk of the mother losing a lot of blood during childbirth.

Conditions that make pregnant women need blood transfusions

When is the right time for pregnant women to receive blood transfusions? Anemia is said to be in a severe stage and needs to be taken to the ER when the Hb level is less than 7 g / dL.

Pregnant women with an Hb level of around 6-10 g / dL are also recommended to get blood transfusions immediately if they have a history of postpartum bleeding or previous haematological disorders.

Transfusions are needed if anemia causes a pregnant woman's Hb level to drop drastically below 6 g / dL and you will give birth in less than 4 weeks.

Common transfusion targets for pregnant women are:

• Hb> 8 g ​​/ dL
• Platelets> 75,000 / uL
• Prothrombin time (PT) <1.5x control
• Activated Prothrombin Time (APTT) <1.5x control
• Fibrinogen> 1.0 g / l

But it must be remembered, the doctor's decision to perform a blood transfusion is not solely by looking at your Hb level alone.

If the doctor thinks that your pregnancy is stable, aka not at risk, even though your Hb level is less than 7 g / dL, you don't need a blood transfusion.

This is quoted from the Joint United Kingdom Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC).

How to diagnose anemia in pregnant women

The risk of anemia in pregnancy can be determined through a blood test during a pregnancy check in the first trimester.

This test is also highly recommended for pregnant women who are at risk or never show symptoms of anemia in early pregnancy.

Blood tests usually include a hemoglobin test (measures the amount of Hb in the blood) and a hematocrit test (measures the percentage of red blood cells per sample).

The World Health Organization (WHO) and the CDC in the United States say that pregnant women are said to have anemia if their hemoglobin (Hb) levels in the first and third trimesters are less than 11 g / dL or their hematocrit (Hct) is less than 33 percent.

Meanwhile, anemia in the second trimester occurs when the Hb level is less than 10.5 g / dL or the Hct is less than 32 percent after being tested.

Your doctor will likely need to run other blood tests to determine if anemia is due to iron deficiency or other causes.

The Ministry of Health of the Republic of Indonesia recommends that every pregnant woman undergo a blood test, including checking Hb levels.

Ideally, once during the first gynecological examination in the second trimester and again in the third trimester. This is to find out if you have anemia, which often occurs in pregnant women.

The obstetrician may also refer you to a hematologist, a doctor who specializes in blood problems and diseases. A hematologist can help and control anemia.

How to deal with anemia in pregnant women

To overcome anemia in pregnancy, here are a few things that need to be done, namely:

1. Eat special nutritious foods

Your doctor may recommend that you eat nutritious and highly nutritious foods, especially those rich in iron and folic acid, every day.

Initially you will only need an additional 0.8 mg of iron per day in the first trimester, up to 7.5 mg per day in the third trimester.

Meanwhile, the increase in folic acid intake per trimeser usually ranges from 400 - 600 mcg per day, depending on doctor's recommendations.

Launching from the American Pregnancy Association page, foods that are high in iron to treat anemia in pregnant women, namely:

• Cooked lean meat (beef or poultry)
• Cooked seafood such as fish, squid, shellfish and prawns
• Cooked eggs
• Green vegetables, such as spinach and kale
• Peas
• Pasteurized dairy products
• Potato
• Wheat

While foods high in folate for anemia in pregnant women include:

• Green leafy vegetables, such as spinach, broccoli, celery, chickpeas, turnip greens, or lettuce
• Citrus family
• Avocado, papaya, banana
• Nuts, such as peas, kidney beans, soybeans, green beans
• Sunflower seeds (kuaci)
• Wheat
• Egg yolk

2. Consume more vitamin C

This condition is overcome by consuming vegetables and fruits high in vitamin C, such as oranges, strawberries, kiwi, broccoli, cauliflower, tomatoes, and peppers.

Vitamin C helps the body absorb iron from food more efficiently.

Daily vitamin C needs can also be met by taking vitamin C supplements, but you should first consult a doctor so that treatment is well controlled.

However, fulfilling nutritional intake from food alone may not be enough for pregnant women. So, you need to take the next step to reduce risk.

3. Take supplements

As a first step in treating anemia in pregnant women, your doctor will advise you to start taking supplements of iron, vitamin B12, and folic acid in addition to prenatal vitamins.

Take the first dose of the supplement preferably in the morning so as not to aggravate the nausea and vomiting sensation morning sickness,plus due to anemia in pregnant women.

If you have to drink it after eating, wait an hour before swallowing your vitamins so you don't feel nauseous.

Pregnant women can also take supplements before bed to reduce the risk of nausea afterward. Don't forget to drink plenty of water after ingesting vitamins to reduce anemia in pregnant women.

The CDC recommends that pregnant women with anemia take iron supplements as much as 30 mg per day from the first time they check their womb to prevent iron deficiency anemia.

Meanwhile, for anemia folate supplements in pregnant women, WHO and the Indonesian Ministry of Health recommend drinking a dose of 400 mcg / day.

It is advisable to do this as soon as possible as soon as you plan for pregnancy and continue for up to 3 months after delivery.

How to prevent anemia in pregnant women

Reporting from the Maternal and Child Health Integrated Program, one of the effective ways to prevent anemia in pregnant women is to take iron supplements.

In addition, prevention of anemia during pregnancy can be started by adjusting your diet for the better, such as:

• Take folic acid and iron supplements (60 mg iron and 400 mcg folic acid).
• Eat foods that are high in iron (meat, chicken, fish, eggs, and wheat).
• Eat foods rich in folic acid (dried beans, oats, orange juice, and green vegetables).
• Take supplements and foods that contain vitamin C (fresh fruits and vegetables).

Also note that iron from animal food sources, such as meat, can be absorbed by the body better than iron from vegetables or fruit.