From the Guidelines
Severe anemia during pregnancy should be treated with oral iron supplements, typically 60 to 120 mg of elemental iron per day, to improve maternal health and birth outcomes. According to the US Preventive Services Task Force recommendation statement 1, iron supplementation in pregnant women can help reduce the risk of adverse maternal and infant health outcomes, such as postpartum hemorrhage, preterm birth, low birthweight, and perinatal death.
The treatment of iron deficiency anemia in pregnant women is similar to that in nonpregnant women and includes additional iron intake through oral iron pills, prenatal vitamins, and diet 1. The usual dose of elemental iron per day is 60 to 120 mg, which can be achieved through oral iron supplements or prenatal vitamins that contain iron.
Some key points to consider when treating severe anemia during pregnancy include:
- Regular monitoring of hemoglobin levels is essential, with checks every 2-4 weeks until improvement, then monthly
- Dietary counseling to increase iron-rich foods and avoid iron absorption inhibitors like tea and coffee with meals should complement medical treatment
- If anemia persists despite appropriate therapy, further investigation for underlying conditions like thalassemia or chronic disease is warranted
- Intravenous iron treatment may be necessary for hemoglobin levels below 7 g/dL or if oral therapy fails, and blood transfusions are reserved for hemoglobin levels below 6 g/dL or cases with cardiovascular compromise.
Overall, prompt treatment of severe anemia during pregnancy is crucial to reduce the risks of preterm birth, low birth weight, postpartum hemorrhage, and maternal mortality, and to improve maternal health and birth outcomes 1.
From the Research
Definition and Causes of Anemia in Pregnancy
- Anemia is a reduction in the concentration of erythrocytes or hemoglobin in blood, and it is the most common hematologic abnormality in pregnancy 2, 3, 4.
- The two most common causes of anemia in pregnancy and the puerperium are iron deficiency and acute blood loss 2, 3, 4.
Iron Requirements and Supplementation
- Iron requirements increase during pregnancy, and a failure to maintain sufficient levels of iron may result in adverse maternal-fetal consequences 2, 3, 4.
- Universal iron supplementation in pregnancy is controversial, with some studies suggesting it can improve hematological parameters and reduce the risk of maternal anemia, but others finding no correlation with improvement in clinical parameters in pregnant women without previous anemia 5.
Role of Vitamins in Preventing and Controlling Anemia
- Vitamins A, B12, C, and E, as well as folic acid and riboflavin, play a role in the development and control of anemia 6.
- Vitamin A can improve hematological indicators and enhance the efficacy of iron supplementation, while folate and vitamin B12 can cure and prevent megaloblastic anemia 6.
- Riboflavin enhances the hematological response to iron, and vitamin C enhances the absorption of dietary iron, although its efficacy in reducing anemia or iron deficiency is unclear 6.