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MEDICAL SCIENCES / «@®LL®@UMm-J0y©MaL » #9№®2X 2024
MEDICAL SCIENCES
Kostiv Sofiia Ivanivna
5th year student Bukovian State Medical University 5thyear student of higher medical education, Bukovinian State Medical University Chernivtsi, Ukraine Yurieva Lilia Mykolaivna Candidate of Medical Sciences, Associate Professor of Higher Educational Establishment Department of Obstetrics, Gynecology and Perinatology Bukovinian State Medical University Chernivtsi, Ukraine DOI: 10.24412/2520-6990-2024-9202-36-38
ANEMIA IN PREGNANCY
Abstract.
Currently, anemia is a major problem that accompaniespregnancy.Anemia in pregnancy is a global health problem that the entire world faces today, especially in developing countries. Anemia during pregnancy is an important cause of maternal morbidity and mortality, as well as low birth weight, whic h in turn can contribute to increased Anemia during pregnancy is an important cause of maternal mortality/disease, as well as low birth weight, which in turn can contribute to increased infant mortality. ny disorder that leads to anemia poses an increased risk of abnormal pregnancy and greater maternal and infant morbidity and mortality. According to the World Health Organization (WHO), anemia is associated with 40% of maternal deaths worldwide.
Keywords: anemia, pregnancy, hemoglobin, deficiency of iron, treatment.
Introduction. Worldwide, about 500 million women of reproductive age are anaemic and 20 million are severely anaemic [WHO Anaemia]. Pregnant women are a population sub-group at greatest risk of anemia and its adverse health consequences. Severe anaemia in pregnancy increases the risk of maternal and infant death [Daru J, Young MF. 2018 Omotayo MO 2021].
The aim of the study. Make systematic literature review attempts to appraise scientific data about the causes of anemia in pregnancy, its perinatal outcomes, and modern approaches for its treatment.
Materials and methods. A review of international recommendations on the etiology and negative consequences of pregnancy was conducted based on the analysis of scientific research data on PubMed, MEDLINE, PMC, Scopus, SCIE (Web of Science) and others.
Research results and discussion. Anemia is a common problem in obstetrics and perinatal care. Any hemoglobin level below 10.5 g/dL can be considered true anemia, regardless of gestational age. Center of Disease Control (CDC) defines anemia as pregnancy hemoglobin less than 11 g/dl (Hemato-crit;{Hct} < 33%) in the first and third trimester and less than 10.5 g/dl (Hct < 32%) in the second trimester while World Health Organisation (WHO) defines anemia in pregnancy as Hb values less than 11gm/dl [Centers for Disease Control (CDC). , WHO (2001)].
The incidence of anemia in pregnant women is 1580%, with iron deficiency anemia in 9 out of 10 women.
The most common causes of anemia are poor nutrition, deficiencies of iron, micronutrients deficiencies including folic acid, vitamin A and vitamin B12. Well-known non-nutritional causes of anemia in pregnancy such as malaria, hookworm infestation and schistosomiasis, HIV infection and genetically inherited hemoglobinopathies, such as thalassemia.[ACOG. (2018). ACOG Practice Bulletin No. 95: Anemia in Pregnancy. Obstetrics & Gynecology, 112]
Causes of anemia during pregnancy are mainly nutritional deficiencies, parasitic and bacterial diseases, and congenital red blood cell disorders such as thalas-semia. The main cause of anemia in obstetrics is iron deficiency, which has a worldwide prevalence of approximately 20-80% and affects mainly the female population. The stages of iron deficiency are iron depletion, iron deficiency erythropoiesis without anemia, and iron deficiency anemia, the most severe form of iron deficiency.[Breymann, C. (2011).]
The association between anaemia and poor maternal, fetal and neonatal outcomes is now well established [Benson CS,. 2021]. Anemia during pregnancy can be exacerbated by various conditions, such as uterine or placental bleeding, gastrointestinal bleeding, and perinatal blood loss. In addition to the general consequences of anemia, there are specific risks to the mother and fetus during pregnancy, such as intrauterine growth retardation, prematurity, fetal-placental ratio, and increased risk of perinatal blood transfusion. [Chow-dhury S, Rahman M, Moniruddin ABM, 2014].
Anemia during the prenatal care period is an important predictive factor of adverse outcomes, possibly
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for PPH and mortality, warranting intensive follow-up [Omotayo MO 2021].
In addition to the importance of preventing iron deficiency, the main treatment options for anemia during pregnancy are oral iron supplementation and intravenous iron supplementation.
Pregnant women's iron deficiency is a condition caused by a decrease in iron content in the blood serum, bone marrow and depots due to its significant expenditure on the fetoplacental complex and its redistribution in the woman's body in favor of the the fetus.
According to current data, iron deficiency in full-term pregnancy develops in all women without exception in latent or overt form This is due to the fact that pregnancy is accompanied by additional iron consumption: 320-500 mg of iron is consumed for hemoglobin growth and cellular metabolism, 100 mg - for the construction of the placenta, 50 mg - for increasing the size of the uterus, 400-500 mg - for the needs of the of the fetus. As a result, taking into account the reserve fund, the fetus is provided with sufficient iron, but at the same time at the same time, pregnant women often develop iron deficiency states of varying severity. states of varying severity. [HEALTH SERVICE King Edward Memorial Hospital, 2018].
The most common studies of iron metabolism in in obstetric practice is the determination of a number of peripheral blood parameters, namely: hemoglobin, red blood cells, color index, hematocrit. The main criteria of the GDM that that distinguish it from other pathogenetic variants of anemia are low color index, erythrocyte hypochromia, decreased serum iron content, increased total iron-binding capacity of the serum and clinical signs of hyposiderosis. Serum ferritin is also used to assess iron stores in the body. In healthy women, the serum ferritin level is 32-35 p,g/l, in case of PWD - 12 p,g/l or less. It should be noted that the serum ferritin content does not always reflect the actual actual iron reserves in the body. This circumstance also depends on on the rate of ferritin release from tissues and blood plasma. [Centers for Disease Control and Prevention. (2020)].
The biological importance of iron is determined by its participation in in tissue respiration. Since oxygen consumption increases by 15-33% during pregnancy, even a slight iron deficiency in pregnant women leads to progressive hemic hypoxia with the subsequent development of secondary metabolic disorders. Pregnant women with severe iron deficiency develop not only tissue and hemic, but also circulatory hypoxia, which is caused by the development of dystrophic changes in the myocardium, impaired contractility ability, development ofhypokinetic type of blood circulation.[National Institute for Health and Care Excellence. (2018)].
According to various studies, in case of iron deficiency pregnant women are more susceptible to infectious diseases because iron is involved in collagen synthesis, porphyrin metabolism, terminal oxidation and oxidative phosphorylation in cells, and immune system function. In 59% of cases even in the case of latent iron deficiency, an unfavorable pregnancy course is noted in the form of a threat of abortion. In addition, with pro-
longed anemia, placental function is impaired, placental insufficiency develops with the possible development of hypoxia, fetal hypotrophy and delayed fetal development [7]. In 40-50% of cases, the course of pregnancy on the background of anemia is complicated by the occurrence of preeclampsia. preeclampsia, preterm birth is recorded in 11-42% of cases. of cases, weakness of labor activity is noted in 10-15% of deliveries, hypotonic bleeding during labor occurs in 10% of women in labor, and purulent septic diseases in the postpartum period are observed in postpartum period are observed in 12% of cases.[Young MF., 2018].
WHO guidelines for pregnant women recommend daily oral iron and folic acid supplementation with 30 to 60 mg of elemental iron and 0.4 mg folic acid during pregnancy to prevent maternal anemia and related adverse outcomes (e.g., postpartum hemorrhage, low birthweight, and preterm birth) [WHO 2020].
There are a large number of medications for the treatment of GA, which differ in doses, form of administration, and chemical composition (content of ferrous or trivalent iron). To date, discussions about the benefits of ferrous or trivalent iron is still being debated. Ferrous iron is easily and well absorbed along the concentration gradient, but the negative property of these drugs is irritation of the digestive tract. The following side effects often occur, heartburn, nausea, heaviness in the epigastric region, metallic taste, vomiting, and impaired of bowel movements. In this regard, many patients refuse to use the drug because of these side effects. Another type of drugs is trivalent iron preparations iron preparations based on a hydroxide-sucrose complex, which are absorbed more slowly, through more complex mechanisms than diffusion, along a concentration gradient, but unlike ferrous iron, such preparations have fewer side effects. side effects.[Pavord S., Daru J. October 2019].
Thus, the optimal antianemic drug should have a minimal number of side effects, an acceptable regimen of use, the best ratio of efficacy and quality with an optimal iron content. From this point of view, the hydroxide-sucrose iron (III) complex is of great clinical inter-est.[WHO 2020].
Based on the analysis of the scientific literature, it can be concluded that timely diagnosis and adequate treatment of iron deficiency anemia in pregnant women can prevent the development of a significant number of complications during pregnancy and childbirth, and improve the health of pregnant women. Iron (III) hydroxide-sucrose complex has shown high clinical efficacy in the treatment of iron deficiency anemia in pregnant women. Rapid normalization of hemoglobin content, low incidence of side effects allow us to recommend iron (III) hydroxide-sucrose complex for the correction of iron deficiency conditions in pregnant women, especially in case of intolerance, ineffectiveness or lack of compliance with the conditions of regular use of oral iron preparations, in the presence of active inflammatory diseases ofthe digestive tract. [WHO. (2016)].
Conclusion. The available evidence suggests that iron deficiency anemia contributes substantially to the women's health even today. Severe anemia during
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MEDICAL SCIENCES / «@®LL®@UMm-J0y©MaL» #92023, 2024
pregnancy is an important contributor to maternal mortality and morbidity. Iron deficiency anemia is the most frequent form of anemia in pregnancy and can have serious consequences for both the mother and fetus. The majority of women do not have adequate iron stores to meet the dramatic increase in requirements during the second and third trimester of pregnancy. Anemia remains to be a problem with multifactorial causes. Hence, intervention only with iron and folic supplements is not adequate to tackle this problem Therefore, there is a need to use multiple interventions, comprehensive approaches for addressing major preventable causes of anemia.
References :
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4. Breymann, C. (2011). Iron deficiency and anemia in pregnancy: modern aspects of diagnosis and therapy. The American Journal of Clinical Nutrition, 94
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6.Centers for Disease Control and Prevention. (2020). Anemia.
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10. HEALTH SERVICE King Edward Memorial Hospital, Perth Western Australia, 2018.
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