Anemia During Pregnancy A Call for Attention

How does anemia affect baby during pregnancy?

Having a baby is a wonderful and joyous experience for a woman. Marriage allows a man and woman to enter into a new relation, i.e. husband and wife. In the sensitive zone of this relationship, the gift of god to a woman is pregnancy. Biologically, the period of fetus development inside mother's womb is called pregnancy. A total pregnancy period is of 40 weeks or 9 months. Health problems during pregnancy is not a bad sign and quite natural for a healthy woman too. Depression, gestational diabetes, High blood pressure, anemia and many more, are common health problems in conceived women. In this article, we will discuss about anemia during pregnancy.

Plasma- A Major Blood Fluid Component Plasma is a major fluid component of the blood. At about 6 weeks of pregnancy, plasma volume begins to increase. This is a healthy sign for normal growth of the fetus and is proportional to birth weight of the baby. Increased volume of plasma does not mean that red blood cells should also increase in size. This condition is associated with overall fall in the hemoglobin concentration and red cell count.

Versatile Element Iron Element iron has versatile functions in human body Transport of oxygen, synthesis of DNA and involvement in electron transport system are different metabolic processes engaged with iron. Clinically, iron metabolic disorders lead to anemia and neurodegenerative diseases. Growing fetus requires iron for its growth and metabolism, and hence depends on the mother for complete metabolic activities. Iron levels circulating in mother's blood are the only supplement for formation of fetal hemoglobin.

How does anemia affect the body?
Anemia denotes low hemoglobin levels in the blood. Almost, more than 50% of Indian women are suffering with anemia. Major symptoms are fatigue, low physical and mental activity, leg cramps, vertigo, pagophagia (urge to consume ice and iced products), cold intolerance, mucosal paleness, koilonychias (spoon nails) and angular stomatitis. Retinal bleeding, conjunctivitis, tachycardia and splenomegaly are symptoms in extreme anemia.
How many types of Anaemia are there?
Pregnant women suffer more commonly with iron deficient anemia and folate deficient anemia. Other types of anemias such as aplastic anemia, hemolytic anemia, thalassemia and sickle cell diseases are less commonly observed.

Iron Deficient Anemia IDA is major among different pregnancy associated anemias. Diet containing iron is very essential for mother and growing fetus. Normal diet can always not fulfill complete iron needs. 60 mg/day of iron is recommended for pregnant woman. Poor iron absorption, successive gestations, chronic blood loss, teen pregnancy are different factors for IDA

Folic Acid Deficiency Anemia (FDA) It is a nutritional deficient anemia. FDA is second in occurrence, i.e. after iron deficient anemia, and mostly observed during third trimester. Folic acid is a Bcomplex vitamin. Folic acid and their derivatives are essential for DNA synthesis and amino acid production. Hence, folic acid is required for normal fetal growth and maternal erythropoiesis. Symptoms that are discussed for IDA are similar for FDA too. Roughness in skin and glossitis are additional symptoms. Erythrocyte precursor cells lose cell division capacity but can grow in size. This condition is called megaloblastic anemia, FDA is linked to megaloblastic anemia.

Aplastic Anemia (AA) Red blood cells, white blood cells and platelets are the major constituents of blood. Decreased production of all types of blood cells is termed as Pancytopenia. Complete Blood Count will provide the quantity of different cells of blood. AA is associated with pancytopenia. It is either hereditary or acquired during the life time. Infections like hepatitis or pharmacological agents may cause AA. Birth related, neonatal complications are high in this condition. AA early to the conception will become worst during the pregnancy. In extreme conditions, pregnancy will be terminated. Identifying the cause and treating cytopenia will minimize maternal and fetal side effects.

Autoimmune Hemolytic Anemia (AHA) This is relatively rare type of anemia. AHA is characterized by development of antibodies against self red blood cells. The formed antibodies can react to their own red blood cells and cause hemolysis. IgG type of auto-antibodies are able to cross placenta causing fetal hemolysis and anemia.

Thalassemia Hemoglobinopathies are post common inherited diseases. Every globin part of hemoglobin has four chains. They are two alpha() chains and two beta (B) chains. Impaired globin chain is signature in hemoglobinopathy. In thalassemic condition, partly or completely suppressed synthesis of one of the two types of polypeptide chains (a or B) are observed. Microscopically thalassemia sufferers have small sized red blood cells with low amount of hemoglobin. Functions of liver, heart, endocrine and metabolism are affected in thalassemia. Thalassemia is a high risk for both mother and fetus during pregnancy.

Sickle Cell Disease (SCD) SCD is an inherited disease. In this, red blood cells have shape of sickle, so named as sickle cell disease. Compared to healthy red blood cells, sickle shaped red blood cells have less lifespan. Globin part of hemoglobin is mutated to Hbs. Under low oxygen levels, HbS polymerize and form a fragile sickle shaped RBC. SCD is associated with restrictions in fetal growth, prenatal mortality (fetus death), and preterm labor. Prior to going for child plan,mother should go for preconceptual screening. Women and men with SCD should be encouraged to know hemoglobinopathy sta tus r before the journey of pregnancy

What can you take for anemia besides iron?
Elements Other Than Iron And Anemia, Phosphorous is second most abundant mineral in the human body. Bone and enamel of teeth contain more phosphate. In extreme phosphorous deficiency, ATP synthesis decline in erythrocytes and result in subsequent osmotic fragility.

copper is a vital trace element in the human body. It is involved in growth and metabolism. It plays an important role in electron transport, synthesis of neurotransmitters, collagen cross-linkage, melatonin production and an important factor in coagulation cascade. Copper promotes absorption of iron into the heme part of hemoglobin, thereby promoting hemoglobin formation and blood cell formation. Copper alone cannot compensate IDA but could augment iron utility in the hemoglobin synthesis. Severe iron deficiency can be easily managed by copper supplementation. Zinc is a trace element in the human body and does not have a direct role in hemoglobin formation but its low levels are found to be associated with IDA.

Key Points
Pregnancy is the period of fetus development inside a mother's womb
Health problems are not a bad sign in pregnancy and quite natural for a healthy woman too
Plasma volume increases with low Hb and red blood cell count
Clinically iron metabolic disorders lead to anemia and neurodegenarative diseases
More than 50% of Indian women are suffering with anemia
Most common anemias during pregnancy are iron deficient anemia and folate deficient anemia
Folic acid deficient anemia is linked to megaloblastic anemia
Aplastic anemia is associated with pancytopenia
IgG type of auto antibodies are able to cross placenta and cause fetal hemolysis and anemia
Compared to healthy red blood cells, sickle shaped red blood cell has less lifespan
Under low oxygen levels HbS polymerizes and forms a fragile sickle shaped red blood cell
Phosphorous and copper are important for ATP formation and iron doping into heme part of hemoglobin respectively.