What is anemia?

Pregnant women need more iron and often become anemic as a result.

Anemia is a lack of red blood cells, which can lead to a lack of oxygen-carrying ability, causing unusual tiredness. The deficiency occurs either through the reduced production or an increased loss of red blood cells. These cells are manufactured in the bone marrow and have a life expectancy of approximately four months. To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anaemia will develop.

What are red blood cells?

Red blood cells are the cells that circulate in the blood plasma (fluid) and give blood its red colour. Through its pumping action, the heart propels the blood around the body through the arteries. The red blood cells obtain oxygen in the lungs and carry it to all the body's cells. The cells use the oxygen to fuel the combustion (burning) of sugar and fat, which produces the body's energy. During this process, called oxidation, carbon dioxide is created as a waste product. It binds itself to the red blood cells that have delivered their load of oxygen. The carbon dioxide is then transported via the blood in the veins back to the lungs where it is exchanged for fresh oxygen by breathing.

Causes of anaemia during pregnancy

Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased. The mother must increase her production of red blood cells and, in addition, the foetus and placenta need their own supply of iron, which can only be obtained from the mother.

In order to have enough red blood cells for the foetus, the body starts to produce more red blood cells and plasma. It has been calculated that the blood volume increases approximately 50 per cent during the pregnancy, although the plasma amount is disproportionately greater. This causes a dilution of the blood, making the haemoglobin concentration fall. This is a normal process, with the haemoglobin concentration at its lowest between weeks 25 and 30. The pregnant woman may need additional iron supplementation, and a blood test called serum ferritin is the best way of monitoring this. Other causes include:

a diet low in iron. Vegetarians, and dieters in particular, should make sure their diet provides them with enough iron lack of folic acid in the diet, or more rarely, a lack of vitamin B12 loss of blood due to bleeding from haemorrhoids (piles) or stomach ulcers anaemia is more common in women who have pregnancies close together and also in women carrying twins or triplets.

What are the symptoms of anaemia during pregnancy?

If the woman is otherwise healthy, she will rarely have any symptoms of anaemia unless her haemoglobin (red pigment) is below 8g/dl.

The first symptoms will be tiredness and paleness. Palpitations the awareness of the heartbeat, breathlessness and dizziness can occur, though they are unusual. If the anaemia is severe (less than 6g of haemoglobin per decilitre of blood), it may cause chest pain (angina) or headaches.

What can be done to avoid anaemia during pregnancy?

Be sure to get a varied diet. If planning a pregnancy, talk to a doctor or midwife about food and supplements if possible, before becoming pregnant. Good sources of iron are beef, wholemeal bread and cereals, eggs, spinach and dried fruit. Supplementing the diet with iron, vitamins and especially folic acid. Taking 400 micrograms folic acid when pregnant is important to reduce the risk of having child with spina bifida. A doctor may advise taking combined iron and folic acid supplements before becoming pregnant.

To absorb the maximum amount of iron from the diet, it will help to also eat a diet rich in vitamin C. Raw vegetables, potatoes, lemon, lime and oranges are all good sources of vitamin C. Foods rich in folic acid include beans, muesli, broccoli, beef, Brussels sprouts and asparagus. A pregnant woman should take notice of her body's signals and consult a doctor if any symptoms occur. It is now routine to recommend to women planning a pregnancy to take a folic acid supplement for the first 12 weeks of pregnancy and preferably starting before conception. This reduces the risk of spinal cord defects (spina bifida) developing in the foetus.

How does a doctor diagnose anaemia during pregnancy?

Apart from the clinical symptoms, anaemia is usually detected during antenatal screening. Blood tests are usually done at the first consultation, and again in the second half of pregnancy. A description of the red blood cells their different form and colour will be included in the result of the blood test. In women of Afro-Caribbean or Mediterranean origin, additional tests are performed to screen for genetic causes of anaemia, namely sickle cell anaemia and thalassaemia.

Possible complications of anaemia

Difficulty in breathing, palpitations and angina. Severe anaemia due to loss of blood after the delivery. If this occurs, then a woman may be advised to have a blood transfusion.

How will a doctor treat anaemia during pregnancy?

A doctor will examine the expectant mother and prescribe any necessary treatment for anaemia, such as vitamins or minerals. Iron tablets can often cause constipation or diarrhoea and some women simply cannot take them. Side-effects on the gut can be resolved by taking the iron with or after food or by starting with a low dose and increasing gradually talk to your doctor about this.

Iron supplements for non-anaemic pregnant women

Anaemia in women is often associated with low birth weight and preterm births, but that does not mean that women should be taking iron pills, or any vitamin pills indiscriminately, to prevent poor pregnancy outcomes.

Women who are not suffering from anaemia should ensure that they receive proper advice on diet and nutrition from their doctors and midwives. Iron supplements may have a harmful effect on women who do not need them in the first place. Nursing Diagnosis for Anemia 1. 2. 3. 4. 5. 6. 7. Activity Intolerance Impaired oral mucous membrane Imbalanced Nutrition: Less than Body Requirements Constipation/Diarrhea Risk for Infection Risk for deficient fluid volume Deficient Knowledge regarding condition, prognosis, treatment, self-care, prevention of crisis, and discharge needs, 8. Fatigue 9. Fear 10. Ineffective coping 11. Ineffective thermoregulation. Trimester First Second Third Hemoglobin (g/dL) Hematocrit (%) <11 <33 <10.5 <32 <11 <33

Pre-pregnancy BMI Underweight Normal weight Overweight Obese

BMI Less than 18.5

Total weight gain

Rates of weight gain 2nd and 3rd trimester (average range/week) 0.5kg to 0.6kg (1lb to 1.3lb) 0.4kg to 0.5kg (0.8lb to 1lb) 0.2kg to 0.3kg (0.5lb to 0.7lb) 0.2kg to 0.3kg (0.4lb to 0.6lb)

13kg to 18kg (28lb to 40lb) 11kg to 16kg (25lb to 18.5 to 24.9 35lb) 7kg to 11kg (15lb to 25 to 29.9 25lb) 5kg to 9kg (11lb to 30 or more 20lb)

Pregnancy weight gain charts Your pre-pregnancy weight ( Pounds ) Height 5 ft 5 ft 2 ins 5 ft 4 ins 5 ft 6 ins 5 ft 10 ins underweight < 102 < 107 < 116 < 123 < 138 Your gain plan ( Pounds ) if you were . . . reasonable weight gain in Pounds. . . underweight 28 - 40 normal 25 - 35 overweight 15 - 25 obese < 15 normal 102-132 107-141 116-152 123-161 138-181 overweight 133-147 142-157 153-170 162-180 182-202 obese > 148 > 158 > 171 > 181 > 203

[ Kilos, Kg ? ] Pregnancy weight gain metric charts

Where do the pregnancy Pounds go? Maternal stores of nutrients and muscle development Increased body fluid Increased blood Breast growth Enlarged uterus Amniotic fluid Placenta 7 Pounds 4 Pounds 3 - 4 Pounds 1 - 2 Pounds 2 Pounds 2 Pounds 1.5 Pounds

Baby Total

6 - 8 Pounds 26.5 - 30.5 Pounds

Source: American College of Obstetricians and Gynecologists

Pregnancy weight gain metric chart Your pre-pregnancy weight ( Kilos ) Height 1.52 m 1.57 m 1.63 m 1.68 m 1.78 m underweight < 46 < 48.5 < 52.5 < 55.5 < 62.5 normal 46 - 60 48.5 - 63.5 52.5 - 68.8 55.6 - 72.8 62.5 - 82 overweight 60 - 66.5 63.8 - 71 69 - 77 73 - 81.5 82 - 91.5 obese > 67 > 72 > 77.5 > 82 > 92

Your gain plan ( Kilos ) if you were . . . reasonable weight gain in Kilos. . . underweight 13 - 18 normal 11 - 16 overweight 8 - 12 obese <8

[ Pounds, lb oz ? ] Pregnancy weight gain imperial charts

Where do the pregnancy Kilos go? Maternal stores of nutrients and muscle development Increased body fluid Increased blood Breast growth 3 Kg 2 Kg 1.5 - 2 Kg 600g

Enlarged uterus Amniotic fluid Placenta Baby Total

1 Kg 1 Kg 600g 3.4 - 4 Kg 11 - 16 Kg

On a Trimester Basis:

First trimester: Most women put on around 1.6kg in the first three months. Second trimester: around 0.5kg a week for the next three months (5.5 - 6.4kg) in total. Third trimester: and only around 5kg over the last three months.

On a Trimester Basis: First trimester: 1 pound per month ~ (about 4lb) in the first three months. Second trimester: 1 pound per week for the next three months ~ (12 - 14lb) in total. Third trimester: around 1 pound per week ~ (12lb) over the last three months.

Gestational age

Fundal height 1-2 finger widths below subcostal arch At costal arch Between umbilicus and xiphoid process 3 finger widths above umbilicus At umbilicus 3 finger widths below umbilicus 3 finger widths above symphysis

40 weeks 36 weeks 32 weeks 28 weeks 24 weeks 20 weeks 16 weeks

How much folic acid you need

To reduce your baby's risk of developing a neural tube defect, experts recommend that you take 400 micrograms (mcg) of folic acid per day, beginning at least a month before you start trying to get pregnant.

How much iron you need

Pregnant women: 27 milligrams (mg) of iron per day Non-pregnant women: 18 mg You don't have to get the recommended amount of iron every day. Instead, aim for that amount as an average over the course of a few days or a week.
Food sources of iron

Red meat is one of the best sources of iron for pregnant women. (Liver provides the highest concentration of iron, but because it contains unsafe amounts of vitamin A, it's best avoided during pregnancy.) If your diet doesn't include animal protein, you can get iron from legumes, vegetables, and grains. There are two forms of iron: non-heme iron, which is found in plants (as well as in meat, poultry, and fish), and heme iron, which is found only in animal products. Heme iron is easier for your body to absorb. (Iron-fortified foods and supplements provide non-heme iron.) To make sure you're getting enough, eat a variety of iron-rich foods every day. Common sources of iron: Red meat, poultry, and fish are all good sources of heme iron. (For easy reference, 3 ounces of meat is about the size of a deck of cards.)

3 ounces lean beef chuck: 3.2 mg 3 ounces lean beef tenderloin: 3.0 mg 3 ounces roast turkey, dark meat: 2.0 mg 3 ounces roast turkey breast: 1.4 mg 3 ounces roast chicken, dark meat: 1.1 mg 3 ounces roast chicken breast: 1.1 mg 3 ounces halibut: 0.9 mg 3 ounces pork loin: 0.8 mg