Anaemia in Pregnancy

- Definition

W.H.O :
Haemoglobin (Hb) concentration <11g/dL
C.D.C :
Hb < 11g/dL in 1st trimester
Hb < 10.5g/dL in 2nd trimester
Hb < 11g/dL in 3rd trimester

Postpartum : Hb < 10g/dL

 W.H.O describes it in 4 categories,
depending on Hb levels :

Category Severity Hb level (g/dL)

1 Mild 9.5 10.5
2 Moderate 8.0 -9.4
3 Severe 6.9 7.9
4 Very severe <6.9
 Anaemia in Pregnancy
- Epidemiology
The prevalence of anaemia is higher in :
teenage group
rural areas
higher parity
lower socioeconomic status groups
3-4 x higher in developing countries
compared to developed
Globally,
Prevalence : 51%
UK : 24.4% (Barroso et al 2011)

Malaysia,
Prevalence : 43.8% (Tee E Siong et al, HKL, 2007)
; Singapore : 15%
; Indonesia : 46.2%
In Pregnancy, haematological changes :
Plasma volume (50%)
Red cell mass (25%)
Disproportionate / difference in physiological
dilution with Hb and haematocrit
There should be no change in MCV / MCHC in
normal pregnancy
This dilutional anaemia :
improves utero-placental circulation
 Pathological Losses :
Roundworm / Hookworm infestation
Malabsorption
Secondary to chronic blood loss :
GIT Haemorrhage
(peptic ulcers, inflammatory bowel diseases)
Gynaecological diseases
eg menorrhagia (before pregnancy)
Nutritional Anaemia
Iron deficiency Anaemia (90%)
Folate deficiency (5%)
Vitamin B12 deficiency

Haemoglobinopathy
Thalassaemia
Sickle cell Anaemia
 Diminished intake
Poor diet
Excessive sickness
Abnormal absorption
GIT upset
Oral antibiotics
Reduced storage ability
Lack of Vit C
Abnormally excessive demand
Multiparity
Multiple pregnancy
Infection
 Normal pregnancy has :
2-3 fold in iron requirements (9x higher : see graph)
10-20 fold in folate requirements

Iron deficiency : microcytic & hypochromic

Folate deficiency : macrocytic & normochromic
Mean corpuscular volume (MCV) : micro/macro
Mean corpuscular haemoglobin concentration
(MCHC) : hypochromic/normo
 Iron Deficiency :
Represents a spectrum ranging from iron
depletion to iron deficiency
Iron Depletion
Iron Depletion
Amount of stored iron
(measured by serum ferritin level)
Amount of transport &
functional iron may not be
affected
Iron Deficiency
Iron Deficiency
Amount of stored iron
Transport & functional Iron
Hb
serum ferritin concentration
transferrin saturation
erythrocyte protoporphyrin
concentration
 Anaemia in Pregnancy :
Maternal Fetal
risk PPH Unable low birth weight
to withstand blood pre-term birth
loss HF Low apgar score
risk infection Hypoxia
risk placenta (Anaemia
abruptio aggravate
maternal mortality placental
insufficiency)
 Obstetrics Illustrated, 7th edition, 2010
Obstetrics by Ten Teachers, 19th edition, 2011
Oxford Handbook of O&G, 3rd edition, 2013
RCOG Guideline Anaemia in Pregnancy
Malaysian CPG Anaemia in Prgnancy & CKD
http://apjcn.nhri.org.tw/server/APJCN/16/3/527.pdf
http://www.omicsgroup.org/journals/iron-
deficiency-and-anaemia-in-pregnant-women-in-
malaysia--still-a-significant-and-challenging-
health-problem-2376-127X-1000168.pdf
http://www.biomedcentral.com/content/pdf/1756-
0500-6-173.pdf