What is the treatment for anemia in pregnancy?

Treatment of Anemia in Pregnancy

For iron deficiency anemia in pregnancy, the recommended treatment is oral iron supplementation at a dose of 60-120 mg of elemental iron daily, with routine screening at the first prenatal visit and appropriate follow-up to monitor response. 1

Screening and Diagnosis

• Screen all pregnant women for anemia at the first prenatal care visit using hemoglobin/hematocrit levels appropriate for gestational age 2, 1
• Confirm positive screening results with repeat hemoglobin/hematocrit testing 2
• If hemoglobin is <9.0 g/dL or hematocrit is <27.0%, refer to a physician familiar with anemia during pregnancy 2
• Consider additional testing (MCV, RDW, serum ferritin) if anemia doesn't respond to iron treatment after 4 weeks 2

Treatment Algorithm

Prevention (All Pregnant Women)

• Start low-dose oral iron supplements (30 mg/day) at first prenatal visit 2, 1
• Encourage consumption of iron-rich foods and foods that enhance iron absorption 2

Treatment of Iron Deficiency Anemia

1. First-line treatment: Oral iron 60-120 mg elemental iron daily 2, 1

   • Consider taking supplements between meals or at bedtime to optimize absorption 1
   • Monitor for gastrointestinal side effects (nausea, constipation, diarrhea) 1

2. Follow-up after 4 weeks of treatment:

   • If hemoglobin increases by ≥1 g/dL or hematocrit by ≥3%: Continue treatment 2
   • When hemoglobin/hematocrit normalizes: Decrease dose to 30 mg/day 2
   • If no response despite compliance: Further evaluate with MCV, RDW, and serum ferritin 2

3. For severe anemia, intolerance to oral iron, or lack of response:

   • Consider intravenous iron therapy, particularly in advanced pregnancy when rapid correction is needed 3
   • Ferric carboxymaltose is preferred for safety reasons based on clinical trials in pregnancy 3

Special Considerations

• Women with African, Mediterranean, or Southeast Asian ancestry with mild anemia unresponsive to iron therapy may have thalassemia minor or sickle cell trait 2
• Women on vegetarian diets may require almost twice as much iron due to lower absorption of non-heme iron 1
• During the second or third trimester, if hemoglobin >15.0 g/dL or hematocrit >45.0%, evaluate for pregnancy complications related to poor blood volume expansion 2
• Continue monitoring postpartum, especially for women with risk factors (anemia through third trimester, excessive blood loss during delivery, multiple birth) 2, 1

Cautions and Contraindications

• Folic acid supplementation should be considered alongside iron therapy, but doses above 0.1 mg daily may obscure pernicious anemia 4
• Iron supplementation may cause gastrointestinal side effects, which are often dose-related 1, 5
• Avoid blood transfusions except in cases of circulatory instability due to postpartum hemorrhage 6

Postpartum Considerations

• Screen women at risk for anemia at 4-6 weeks postpartum 2
• For mild postpartum anemia: Continue oral iron therapy 6
• For moderate to severe postpartum anemia (Hb <95 g/L): Consider intravenous iron therapy 3, 6
• If no risk factors for anemia are present, supplemental iron can be stopped at delivery 2

The evidence clearly demonstrates that treating iron deficiency anemia in pregnancy reduces the risk of low birthweight infants and improves maternal health outcomes 7. Early detection and appropriate treatment are essential to prevent complications for both mother and baby.