What is the effective treatment for anaemia (anemia) in pregnancy?

Treatment of Anemia in Pregnancy

The most effective treatment for anemia in pregnancy is oral iron supplementation at a dose of 60-120 mg/day of elemental iron, with monitoring after 4 weeks to assess response. 1

Diagnosis and Screening

• Screen for anemia at the first prenatal visit using hemoglobin concentration or hematocrit appropriate for the stage of pregnancy 2
• Confirm positive screening results with repeat hemoglobin or hematocrit testing 2
• If the pregnant woman is not acutely ill, a presumptive diagnosis of iron deficiency anemia can be made and treatment initiated 2, 1
• Use stage-specific anemia criteria during pregnancy:
  • First trimester: Hemoglobin < 11.0 g/dL 1, 3
  • Second/third trimester: Hemoglobin < 10.5-11.0 g/dL (depending on guideline) 3

Primary Prevention

• Start oral low-dose (30 mg/day) iron supplements for all pregnant women at the first prenatal visit, even without anemia 2
• Encourage consumption of iron-rich foods and foods that enhance iron absorption 2, 1
• Guide pregnant women with low dietary iron intake in optimizing their iron consumption 2, 1

Treatment Algorithm

First-line Treatment

• For iron deficiency anemia in pregnancy, prescribe oral iron at 60-120 mg/day of elemental iron 2, 1
• Counsel patients about correcting iron deficiency through diet alongside supplementation 2, 1

Monitoring Response

• Assess treatment response after 4 weeks 2, 1
• Adequate response is defined as:
  • Hemoglobin increase of ≥1 g/dL or
  • Hematocrit increase of ≥3% 2, 1
• When hemoglobin/hematocrit normalizes for gestational stage, decrease iron dose to 30 mg/day 2

Non-response to Treatment

• If anemia persists after 4 weeks despite compliance with oral iron:
  • Perform additional testing including MCV, RDW, and serum ferritin 2
  • Consider alternative causes, especially in women of African, Mediterranean, or Southeast Asian ancestry (thalassemia minor or sickle cell trait) 2

Severe Anemia

• If hemoglobin < 9.0 g/dL or hematocrit < 27.0%, refer to a physician specialized in anemia during pregnancy 2
• For severe anemia, intolerance to oral iron, or lack of response to oral therapy, intravenous iron therapy should be considered 3, 4

Special Considerations

• Daily oral iron supplementation reduces the risk of maternal anemia (RR 0.30) and iron deficiency at term (RR 0.51) compared to placebo 5
• Oral iron supplementation may reduce the incidence of low birthweight infants (RR 0.84) 5
• For patients who cannot tolerate daily dosing due to gastrointestinal side effects, intermittent dosing may be as effective with fewer side effects 3
• Folic acid supplementation is also important during pregnancy for prevention of neural tube defects, though its primary role is not in treating iron deficiency anemia 6

Postpartum Management

• Screen women at risk for anemia at 4-6 weeks postpartum 2
• Risk factors include:
  • Anemia continued through third trimester
  • Excessive blood loss during delivery
  • Multiple birth 2
• For mild postpartum anemia, use oral iron therapy 4
• For moderate to severe postpartum anemia (Hb < 95 g/L), consider intravenous iron therapy 4
• If no risk factors for anemia are present, supplemental iron should be stopped at delivery 2

Common Pitfalls and Caveats

• Gastrointestinal side effects are common with oral iron and may lead to poor compliance 7, 8
• High hemoglobin levels (>15.0 g/dL) or hematocrit (>45.0%) during second or third trimester should prompt evaluation for pregnancy complications related to poor blood volume expansion 2
• When using intravenous iron, select products studied in well-controlled clinical trials in pregnancy for safety reasons 4
• While anaphylactic reactions are extremely rare with non-dextran iron products, close monitoring during administration is recommended 4