Anemia During Pregnancy

Anemia facts

*Anemia facts medical author: William C. Shiel Jr., MD, FACP, FACR

• Anemia is a medical condition in which the red blood cell count or hemoglobin is less than
  
  normal.
• For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.
• Anemia is caused by either a decrease in production of red blood cells or hemoglobin, or an increase in loss or destruction of red blood cells.
• Some patients with anemia have no symptoms. Others may feel tired, easily fatigued, appear pale, a feeling of heart racing, short of breath, and/or worsening of heart problems.
• Anemia can be detected by a simple blood test called a complete blood cell count (CBC).
• The treatment of the anemia varies greatly and very much depends on the particular cause.

What is anemia?

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml. These definitions may vary slightly depending on the source and the laboratory reference used

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow.

Anemia is caused essentially through two basic pathways. Anemia is caused by either:

1. a decrease in production of red blood cells or hemoglobin, or
2. an increase in loss or destruction of red blood cells.

A more common classification of anemia (low hemoglobin) is based on the Mean Corposcular Volume (MCV) which signifies the average volume of individual red blood cells.

1. If the MCV is low (less than 80), the anemia is categorized asmicrocytic anemia (low cell volume).
2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume).
3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).

Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as to what could be the most common reason for anemia in each patient.

Anemia During Pregnancy

The wonder and joy of pregnancy is matched by the body's ability to adapt to looking after the growing baby. In addition to the mother's physiologic needs, there is the additional need to provide the building blocks to optimally grow baby. All this construction requires energy and oxygen as the fuel that helps drive the engine.

Oxygen in the air that we breathe is delivered to the cells of the body by hemoglobin, a protein molecule found in red blood cells. The normal ranges for hemoglobin depend on the age and, beginning in adolescence, the gender of the person. For example, the normal ranges of hemoglobins for background comparison are:

• Newborns: 17 to 22 gm/dl
• Babies 1 week of age: 15 to 20 gm/dl
• Babies 1 month of age: 11 to 15 gm/dl
• Children: 11 to 13 gm/dl
• Adult men: 14 to 18 gm/dl
• Adult women: 12 to 16 gm/dl
• Men after middle age: 12.4 to 14.9 gm/dl
• Women after middle age: 11.7 to 13.8 gm/dl

Anemia is a decrease in the amount of hemoglobin and red blood cells. Anemia is a relatively normal finding in pregnancy. Plasma is the watery, noncellular component of blood. In pregnancy, there is an increase in plasma volume of the blood in order to help supply oxygen and nutrients to mother and baby. There can be a 20% increase in the total number of red blood cells but the amount of plasma increases even more causing dilution of those red cells in the body. A hemoglobin level of pregnancy can naturally lower to 10.5 gm/dL representing a normal anemia of pregnancy.

Nevertheless, the body needs a minimum amount of hemoglobin to supply the oxygen needs of the body and if it is lacking, the symptoms of anemia may occur. Symptoms of anemia include feeling increasingly tired, weak,short of breath with activity or at rest, a rapid heart rate, and a pale appearance to the skin. Lightheadedness or dizziness may occur when standing up too quickly or trying to physically exert. Symptoms occur because the body's oxygen requirements cannot be met by a decreased amount of hemoglobin contained in the fewer number of red blood cells.

If the pregnant mother had heavy prepregnancy menstrual flow, she may be anemic entering the pregnancy and the normal physiology of carrying a growing baby may make the anemia more pronounced. If there are two pregnancies close together, the mother's body may not yet have recovered, increasing the chances for anemia. It also can be difficult getting enough nutrition and iron with morning sickness. And the risk of anemia in pregnancy is even greater with multiple pregnancies, such as twins or triplets.

Anemia in pregnancy is common, but it is also frequently preventable through optimal diet and nutrition. The key is loading up on foods that are high in iron content like dark green leafy vegetables, eggs, and meat. As well, many foods like cereals and bread are iron fortified. If that doesn't work the health care professional may suggest an iron supplement to help replenish the body's stores. But in addition to iron, the body needs other building blocks to help make red blood cells including folic acid, which is an important vitamin to take to prevent potential damage to the growing baby's brain and spinal cord (neural tube defects).

A mother's physiology usually adapts well to the needs of a growing baby. Eating wisely can help the body cope with the physiology changes that are required. Eating wisely can, as a result, prevent the tiredness and weakness that can often accompany anemia. Basically, a healthy mother makes a healthy baby.

Can anemia be hereditary?

Yes, anemia may be genetic. Hereditary disorders can shorten the life span of the red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary disorders can also cause anemia by impairing the production of hemoglobin (for example, alpha thalassemia and beta thalassemia).

Depending on the degree of the genetic abnormality, hereditary anemias may cause mild, moderate, or severe anemia. In fact, some may be too severe to be compatible with life and may result in death of the fetus (unborn infant). On the other hand, some of these anemias are so mild that they are not noticeable and are incidentally revealed during a routine blood work.

What are the symptoms of anemia?

Some patients with anemia have no symptoms. Others with anemia may feel:

• Tired
• Fatigue easily
• Appear pale
• Develop palpitations (feeling of heart racing)
• Become short of breath

Additional symptoms may include:

• Hair loss
• Malaise (general sense of feeling unwell)
• Worsening of heart problems

It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

How is anemia treated?

Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.

In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.

If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor.

Reference.

Skin and hair problems in pregnancy

Hormonal changes taking place in pregnancy will make you nipples and the area around them go darker. Your skin color may also darken a little, either in patches or all over.

Birthmarks, moles and freckles may also darken. Some women develop a dark line down middle of their stomach. These changes will gradually fade after the baby is born, although your nipples may remain a little darker.

Stretch marks

These are pink or purplish lines that usually appear on your tummy or sometimes in your upper thighs or breasts. Some women get them and some don’t. it depends on your skin type, as some people skin is mare elastic, after your baby is born, the marks should gradually fade and become less noticeable.

It is very doubtful whether oils or creams help to prevent stretch marks.

You are more likely to get stretch marks if you weigh gain is more than average. Most women gain between 10kg and 12.5kg (22-28 lb) in pregnancy, although weigh gain varies a great deal and depends on your weight before pregnancy.

It’s important that you don’t diet, but eat healthily in pregnancy.

If you are concerned about your weight, talk to your midwife or GP. They may give you advice if you weight more than 100kg (about 15.5 stone) or less than 50kg (about 8 stone).

Itching

Mild itching is common in pregnancy because of the increased blood supply to the skin. In late pregnancy the skin of the abdomen is stretched and this may also cause itchiness.

Avoiding itching

Wearing loose clothes may help prevent itching, you may also want to avpid synthetic materials and go for natural ones, such as cotton, instead.

• See your doctor if:
• Your itching become severe.
• You develop jaundice (yellowing of the whites of the eyes and skin)

Hair growth can also increase in pregnancy, and your hair may be greasier. After the baby is born it may seem as if you are losing a lot of hair but you are simply losing the extra hair.

Faintness and headaches in pregnancy

Pregnant women often feel faint and get a lot of headaches. This is because of hormonal changes occurring in your body during pregnancy.

 Fainting happens if your brain is not getting enough blood and there for not enough oxygen. If your oxygen level get  too low, it may cause you to faint.

You are most likely to feel faint if you stand too quickly from a chair or out from a bath, but it can also happen when you are lying on your back.

Avoiding feeling faint

Here are some tips to help you cope:

•  Try to get up slowly after sitting or lying down
• If you feel faint when standing  still, find a seat quickly and the faintness should pass, if it doesn’t lie down on your side.
• If you feel faint while lying on your back, turn on your side.

How to cope with headaches

Try to get more regular rest and relaxation.

Paracetamol in the recommended does is generally considered safe for pregnant women, but there are some painkillers that you should avoid in pregnancy, such as those containing codeine.

Speak to your pharmacist, midwife, GP nurse or health visitor about how much paraceamol you can take and for how long.

When to seek help

If you often have bad headaches, tell your midwife or doctor so that they can advice you. Severe of headaches can be a sign of high blood pressure and you should seek urgent advice, as this could indicate a serious condition called pre-eclampsia.

Backache and pelvic joint pain

As your baby grows, the hollow in your back may become more pronounced, and this can cause backache. During pregnancy, your ligmaent become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause backache.

To avoid backache:

To help prevent backache, there are some tips listed here will  help you to protect your back, try to do them every day:

1. avoid lifting heavy objects
2. bend your knees and keep your back straight when lifting or picking up something from the floor
3. work at a surface high enough to prevent you stooping
4. try to balance the weight between two bags when carrying shopping
5. wear flat shoes as these allow your weight to be evenly distributed
6. sit with your back straight and well supported
7. move your feet when turning round to avoid twisting your spine
8. make sure you get enough rest, particularly later in pregnancy

When to get help

If you backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital, they can give you advice and may suggest some helpful exercises.

Pain in pelvic joints
If during or after pregnancy you have pain in your pelvic joints when walking, climbing stairs or turning in bed, you could have pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). this is a slight misalignment or stiffness of your pelvic joints at either the back or front of your pelvic. It affects up to one in four pregnant women to a lesser or greater extent. Some women have minor discomfort, other may find that it affects their ability to get around.

When to get help for pelvic joint paint

• Getting diagnosed as early as possible can help to keep the pain to a minimum and avoid long-term discomfort.
• Treatment usually involves gently pressing on or moving the affected joint so that it works normally again.
• Ask a member of your maternity team for a referral to a manual physiotherapist, osteopath or chiropractor who is experienced in treating pelvic joint problems.

Beware of obesity with pregnancy!

Woman weight Should not be more than 12 kilograms during the nine months of pregnancy , and at the same time she should not work for the loss of weight, this is achieved by maintaining on how many calories she eat each day, ranging from 100 to 300, for obesity  details affects pregnant and their effects, we'll provide some information:

Obesity by the World Health Organization (W.H.O) as accumulation of a large amount of fat in the body that lead to risks and many healthy problems, where this increase can be measured using «BMI» Body Mass Index, which is calculated by dividing weight 'kilogram' by the square of the height in 'meter', if the B.M.I equals 25 or more is considered overweight, and if 30 or more is considered obese, and if it reaches 40 or more they become too obese 

:To avoid excess weight  we advise pregnant women the following

- Commit to reducing sugars and sweets, biscuits and high-fat foods during the first months of pregnancy, and make your preferred food is milk, natural fruit and vegetables; They give a satiety sense, and save you from constipation often occurs for pregnant women.

- In the second half of pregnancy you should follow a balanced diet taking into account the interest of food, and do not eat greedily until no more weight abnormally; so you need to eat small meals at frequent intervals; So as not your stomach is growing.

Causes of Obesity1 - a genetic predisposition .
2 - Some diseases such as diabetes and Cushing's disease.
3 - use of certain drugs, such as cortisone and Steroids and antidepressants.
4 - Excessive food with do not appropriate movement to burn fat.

Gravity

1- Abortion, where it become proportion of overweight larger than usual.

2- Increased rate of birth defects in embryos as a result of genetic reasons.

3 - Diabetes, where increased complications during pregnancy, whether if the disease was discovered during pregnancy, or if known in advance before pregnancy.

4 - A higher infection of heart disease, high blood pressure or pre-eclamptic.

5 -  Dystocia as a result of the large size of the baby, and may lead to death if there is no potential fast for the birth by Cesarean section. and that rate rises a lot in such cases.

6 - The birth of a large baby weight (more than 4 kilograms) may continue until the child becomes obese.

7 - More exposure to give oxytocic as a result the growth of the child delayed within the womb.

8 - Clots after birth and Cesarean section; as a result of the inability of the obese mother movement, and exposure to the formation of veins clots may affect vital organs such as the brain, heart and lungs.

9 – There is difficulty in wound healing after delivery.

10 - Anesthesiology problems; whether full anesthesia to the difficulty of entering the anesthesia tube, or half of it to the difficulty of adapting obese pregnant with the right situation to make anesthesia injection, as well as take care of it after the operation; may need to enter in the intensive care unit.

11 - Feeling insomnia carrier is unable to sleep in a comfortable position, has up to a sense of depression, which may extend to after birth.

also read:How to be graceful after giving birth?