What is prescribed during pregnancy with anemia. Anemia during pregnancy

Anemia or anemia is a pathological condition in which the level of hemoglobin and the number of red blood cells (erythrocytes) in the blood decreases.

Anemia during pregnancy can be dangerous for both mother and baby.

What is anemia

Anemia during pregnancy is not uncommon. After all, the mother's body is rebuilt to meet all the needs of a growing and developing fetus.

You can read about how a baby develops in the article Development of a child in the womb >>>.

In addition to hormonal changes, blood volume increases. A significant increase is observed already at week 10, but the maximum rate is reached at 36 weeks.

But an increase in total blood volume does not mean that all components increase equally.

Plasma volume increases the most, about 35 to 50 percent from baseline;
The volume and number of red blood cells increases to a lesser extent, by about 12-15 percent;
The viscosity of the blood decreases. Beginning in the second trimester, blood test results may be below normal. But this does not mean that anemia is immediately diagnosed.

Most doctors use WHO standards and only take into account the level of hemoglobin to make a diagnosis. Anemia is characterized by a decrease in this indicator below 109 g / l.

But every body is different. Unfortunately, doctors do not always take into account the woman's condition, weight, well-being, test results before pregnancy.

In more modern clinics, in addition to the level of hemoglobin, the number of red blood cells, their average volume and distribution width are taken into account.

Know! This is a more correct approach, because most often the concentration of iron in erythrocytes does not change. In this case, a woman does not need iron supplements, because the ability of red blood cells to carry oxygen is not reduced.

If there is a decrease in hemoglobin production by red blood cells, they become smaller and lighter. Then the diagnosis is iron deficiency anemia.

Degrees of anemia

There are three degrees of anemia during pregnancy. Namely:

Easy or 1 degree. It occurs in many pregnant women, most often it is asymptomatic and is detected only by the results of the analysis. The hemoglobin level in this case is from 110 to 90 g/l.;
Average or 2 degree. This degree of the disease already has symptoms and is felt physically. The indicator is at the level of 90-70 g / l .;
Severe degree (3). Hemoglobin drops to 70 g/l and below. This degree poses a threat to both the woman and the baby. Corrected in stationary conditions under the supervision of a doctor.

Mild anemia during pregnancy may not affect the mother's body in any way. But it can bring great harm to the baby, so treatment is necessary.

Causes of anemia

Depending on the reasons that led to the development of the disease, several types of anemia can be distinguished:

iron deficiency (from a lack of iron);
folic acid deficiency (lack of folic acid);
aplastic (impaired hematopoiesis);
hemolytic (with increased destruction of red blood cells);
posthemorrhagic (appears due to bleeding).

During the bearing of a child, in most cases, an iron deficiency type of anemia is diagnosed. Other types of the disease are rare.

Reasons for the development of iron deficiency anemia:

Decreased production of red blood cells due to hormonal changes in the body;
Lack of vitamins, proteins, nutrients in the diet, poor nutrition. This item most often applies to women who are often on various diets;
Diseases of the gastrointestinal tract. With such diseases, the level of assimilation of nutrients from food is reduced;
Low immunity;
Great loss of blood.

If doctors during pregnancy diagnosed anemia of the 1st degree, you need to start the correction with your diet.

Sometimes additional sources of iron will be required, but not in the form of pharmaceutical tablets, but in the form of natural syrups. They are also great for mild anemia.

See the book for recommendations on natural dietary modification to get rid of anemia during pregnancy. Follow the link: The secrets of proper nutrition for the expectant mother >>>

Symptoms of anemia

The severity of symptoms of anemia during pregnancy depends on the speed of its occurrence. If the disease develops rapidly, then the symptoms are more pronounced. The main manifestations of the disease include:

Rapid fatigue, weakness, drowsiness;

This symptom occurs due to the fact that oxygen is supplied to the muscles, tissues, organs in insufficient quantities.

Increased heartbeat, shortness of breath;

These symptoms appear as a result of hypoxemia (lack of oxygen in the blood). At first, symptoms appear after exercise, but as the disease progresses, they can also occur at rest.

Dizziness. And for the deterioration of the condition is characterized by the appearance of headaches, tinnitus, blackouts in the eyes and loss of consciousness.

These symptoms apply to all types of anemia. But also each species has its own. For example, with iron deficiency anemia during pregnancy, in addition to the above symptoms, the following are present:

dry skin, which may develop cracks;
dull hair, brittle nails;
low immunity;
thinning of the oral mucosa;
digestive problems (heartburn, nausea, diarrhea).

With folate deficiency anemia, the symptoms are similar to those of iron deficiency. But to the above signs, you can add: loss of appetite, abdominal pain, inflammation of the mouth, tongue and gums.

Aplastic anemia has the following symptoms (in addition to the general ones):

nosebleeds;
bruising (spontaneous);
decrease in immunity.

With the hemolytic form of the disease, the spleen and liver increase, a yellow tint of the mucous membrane and skin (jaundice) appears.

Posthemorrhagic form of anemia is characterized by the presence of acute pain in the abdomen, radiating to the lower back. There is also bleeding from the vagina.

With a large blood loss, pallor of the skin, weakness, dizziness and fainting appear.

Consequences of the disease

Important! Even mild anemia during pregnancy can be dangerous for the baby. After all, it grows and develops quickly and needs a sufficient supply of nutrients and oxygen.

Particular attention should be paid to your lifestyle: food, walks (read

During pregnancy, almost all expectant mothers face physiological problems. In medical practice, anemia during pregnancy is a fairly common phenomenon. This physiological condition is recognized as a disease that requires timely and qualified treatment.

Iron deficiency anemia is a rather serious pathological change in which there is a decrease (sharp or gradual) in the level of hemoglobin in the blood. You can determine the decrease in hemoglobin by a general blood test - it reduces the number of red cells (erythrocytes). The main task of hemoglobin is the "supply" of oxygen to tissues, as well as internal organs. Therefore, if the level of hemoglobin decreases, then the body begins to suffer from oxygen starvation. This condition can negatively affect the well-being of the expectant mother, as well as the health and even the life of the baby.

For expectant mothers, normal hemoglobin levels are 110 g / l. For a non-pregnant woman, this figure is 120 g / l. The decrease in hemoglobin in all pregnant women is due to physiological changes. The blood of expectant mothers circulates faster through the vessels, liquefies, respectively, the level of hemoglobin naturally decreases. If there is a decrease in the level of hemoglobin below 110 g / l, then this is already recognized as a pathological change, which is dangerous for both the woman and her baby.

Iron deficiency anemia is classified into 3 degrees.

Light. For mild anemia during pregnancy, hemoglobin values from 90 to 110 g / l are acceptable.
Average. With an average degree of anemia - from 70 to 89 g / l.
Heavy. The most dangerous degree of the disease is when the hemoglobin level drops to 40-69 g / l.

Self-diagnosis

You can independently determine the development of the disease. A woman should be attentive to her well-being and monitor the pathological changes taking place in her body. The first "signal" that indicates that negative changes begin in the body of the expectant mother is the blanching of the skin. If a woman notices that her skin has turned pale, weakness and other negative signs appear, then she urgently needs to contact her attending gynecologist.

They help to prevent and timely detect negative changes in the composition of the blood and regular testing. A blood test can indicate not only a decrease in hemoglobin levels, but also the development of other pathological changes.

During the period of bearing a baby, a woman should regularly visit a gynecologist and take tests prescribed by a specialist (especially urine and blood tests). If pathological changes are detected, appropriate therapeutic actions must be taken immediately. It is necessary to determine that anemia (especially severe and moderate) can adversely affect the health of the pregnant woman and the fetus, as well as adversely affect the course of the birth process.

Anemia during pregnancy

Anemia is rare in the first trimester of pregnancy. During this period, the body is just beginning to “prepare” for bearing a baby and a fetus, so minor changes do not become pathological.

A sharp decrease in the level of hemoglobin in the blood is often observed in pregnant women in the second trimester. Gynecologists call the period from 29 to 36 weeks of pregnancy the most dangerous period. Such changes are explained by the fact that during the period of gestation, the need for iron increases dramatically. It is this microelement that is needed for the production of blood cells (and a normal level of hemoglobin). A decrease in hemoglobin levels negatively affects the well-being of the pregnant woman and the physiological development of the fetus. And if the consumption of iron in the body of the expectant mother is much greater than the intake of this microelement, then the development of anemia begins.

Anemia needs to be treated. Negligent attitude to pathological changes can negatively affect the health of a woman, as well as the life of a baby.

Why is anemia dangerous during pregnancy?

development in late pregnancy. A very dangerous condition for a pregnant woman. In addition to unpleasant symptoms, toxicosis also negatively affects the physiological state of the fetus. An increase in blood pressure, swelling of the extremities, heartburn and other signs of toxicosis can provoke fetal hypoxia and other negative (and often irreversible) complications.
Risk of preterm birth. Normally, the gestation period lasts 40 weeks. Premature birth is a risk to the life and normal physical development of the baby.
Bleeding during childbirth. The risk of heavy bleeding during childbirth is due to impaired blood clotting function. Bleeding during childbirth is a dangerous condition for the health, and often the life of a woman.
Violation of the process of lactation after childbirth. Often, untreated anemia in a timely manner negatively affects the production of mother's milk.
Decreased blood pressure.
ahead of time.

For a baby, anemia is no less dangerous, it can lead to the following pathological changes:

delay and lag in physical development;
hypoxia;
lack of nutrients and, as a result, the development of pathologies;
hypotrophy.

In young mothers who did not treat anemia in a timely manner, children are often born prematurely, weak, with low weight, with weak immunity. Such babies are more likely to suffer from infectious, viral and respiratory diseases. In children of the first year of life, anemia is often diagnosed, which requires long-term treatment.

Causes

During the period of gestation, all incoming nutrients are "spent" not only on the "needs" of the woman, but also on the needs of her fetus. Iron is "responsible" for the process of hematopoiesis. Accordingly, if this microelement enters the woman’s body along with food or certain vitamin supplements, then it is distributed to the baby’s body too.

The active consumption of iron in the body of a pregnant woman begins at 16-20 weeks. During this period, the hematopoietic system in the fetus begins to form, so iron is actively consumed on it. Starting from the 29th week, if a woman has not taken preventive measures against anemia in a timely manner, she begins to have an iron deficiency. The reserves of this trace element become thinner, the body begins to experience an acute shortage of iron, the level of hemoglobin drops, and anemia begins to develop.

Other causes of anemia during pregnancy have been identified:

Insufficient amount of meat in the diet of a pregnant woman. It is meat that contains a large amount of iron.
Deficiency of vitamins C, as well as group B. The listed vitamins are "responsible" for the normal absorption of iron. If there are no foods enriched with these nutrients in the diet, then iron enters the body in an incomplete ratio.
Some diseases that provoke the development of protein deficiency in the body. These diseases include gestosis.
early toxicosis. Known signs of toxicosis are loss of appetite, nausea, and vomiting. In this state, the pregnant woman refuses to eat, respectively, the necessary nutritional components do not enter her body.
Frequent childbirth, between which there is a small interval. After childbirth, the woman's body must recover. If this does not happen, then subsequent pregnancy often proceeds with complications.

Who is exposed

The risk of developing anemia is observed in almost all pregnant women. But the following groups of expectant mothers are more susceptible to the development of this pathological phenomenon:

with multiple pregnancy;
if a woman has already had a sufficient number of births (more than 3);
women whose menstruation (before pregnancy) was more than 5 days;
multiparous women who had already experienced signs of anemia during pregnancy;
pregnant women with signs of early or late toxicosis;
women with chronic diseases of the gastrointestinal tract, liver;
pregnant women suffering from infectious diseases;
vegetarians and those women who adhere to strict diets during pregnancy.

Any future mother should carefully monitor her own well-being. If possible, it is necessary to use preventive measures for the development of anemia during the period of gestation. And when the first signs of a serious illness are found, contact a gynecologist and strictly follow his recommendations.

signs of anemia

During pregnancy, the female body's need for vital elements increases by about 33%. If a woman does not receive the necessary components in the recommended amount, then the development of pathological changes begins.

The first signs of mild anemia are similar to the symptoms of hypoxia:

physical weakness;
moral emptiness;
fatigue, even if you do not perform physical actions;
violation of the quality of sleep: in the daytime, drowsiness appears, and at night, on the contrary, insomnia begins;
frequent and prolonged headaches;
dizziness;
the appearance of noise or ringing in the ears;
development of shortness of breath;
increased heart rate;
faintness or fainting.

In the future, the woman's general condition worsens even more, the following symptoms begin to appear:

change in the skin, dry skin, peeling, cracking;
the formation of jams and cracks in the corners of the lips;
the structure of the nails is disturbed, they become brittle, exfoliate;
the condition of the curls worsens, they begin to fall out, dandruff appears, the ends of the hair split.

What to pay attention to

Often women do not pay attention to early pathological changes. This becomes their main mistake. Hair loss, peeling and dry skin, weakness - these are not the signs that always accompany the period of bearing a baby. The listed pathological changes indicate the development of negative phenomena, and special attention should be paid to them.

With a decrease in hemoglobin levels, pathological changes begin in all women. But not all pregnant women pay attention to them. The symptoms of anemia are different. In some pregnant women, the skin turns yellow or paler, hair begins to fall out, shortness of breath appears. Other pregnant women show other symptoms - “strange” gastronomic addictions begin (there is a desire to eat chalk or smell the aroma of burnt rubber), the lower limbs swell. With any changes, it is important to consult a doctor in a timely manner.

It is important for all pregnant women to regularly donate blood for analysis. It is this analysis that is an indicator of all the phenomena occurring in the body of a pregnant woman. With a decrease in the level of hemoglobin, it is necessary to immediately take therapeutic action.

For the period of recovery of the female body after anemia, 2-3 years can “leave”. In order to prevent pathological consequences, it is important to prevent the development of negative changes in a timely manner.

Anemia treatment

If the diagnosis of anemia during pregnancy is confirmed, then it is necessary to start therapy as soon as possible. Treatment of iron deficiency anemia is a fairly lengthy process. To restore the body and maintain a normal level of hemoglobin in the blood, several methods are used.

Therapeutic diet

A huge role in the treatment of anemia "plays" a therapeutic diet. A healthy menu should be aimed at replenishing the deficiency of an important trace element in the body.

The main mistake of expectant mothers is that they begin to consume fruits and vegetables in large quantities, assuming that these products contain the maximum ratio of iron. But nutritionists say that only apples, carrots or pomegranate juice will not be able to normalize the level of hemoglobin in the blood.

In the diet of a pregnant woman, fresh fruits and a variety of vegetables must be present without fail, but with anemia, she should not “occupy” most of the diet. What helps to normalize the level of hemoglobin is meat and meat dishes. Meat by-products will also bring benefits to the body. If we compare the iron content in plant and animal foods, then plants contain no more than 0.2% of an important trace element, and about 6% in meat. The iron contained in meat is better absorbed by the body, respectively, to be of great benefit to the body of the expectant mother and her baby.

There is an opinion that after heat treatment, meat loses most of its nutritional components. This opinion is wrong. It is strictly forbidden to eat raw meat or liver. Heat treatment of meat must be present, and after appropriate processing, useful substances in the product are not lost.

Products

The leaders in iron content are the following products:

beef liver, as well as pork (used stewed or boiled);
cocoa (it is recommended to prepare a drink based on milk, if a woman has an allergy to milk protein, then the drink is prepared on water);
chicken egg yolk (this product in the diet should be present no more than 3 times a week);
beef heart (the product is used boiled);
Rye bread;
apricots (pregnant women are allowed to eat ripe soft fruits);
almond;
turkey meat (the product is used boiled);
spinach (a fresh product will bring benefits to the body).

A pregnant woman should carefully monitor her own diet. It is impossible to transfer, it is also forbidden to starve. The recommended calorie intake for a woman is 2700 kcal.

The diet should contain foods containing proteins, carbohydrates and fats.

In the second half of pregnancy, the calorie intake increases to 3000 kcal. During this period, the body's need for proteins and carbohydrates also increases. The main sources of protein are lean sea fish, lean meat, a variety of nuts, and legumes. A high content of carbohydrates is present in whole grain cereals, various vegetables, fresh fruits.

Iron preparations

It is impossible to normalize the level of hemoglobin in the blood with nutrition alone. In combination with a healthy diet, iron supplements should be used, which can be taken by pregnant women only as directed by a doctor.

Iron from meat products is absorbed by the body by 6%, and an important trace element from medicines - by 30%. After the start of the course of taking medications, an increase in the level of blood cells (and, accordingly, an increase in the level of hemoglobin) begins on the 9-12th day. It is impossible to interrupt treatment after the normalization of hemoglobin levels, it is important to complete the entire course of treatment prescribed by the attending physician. A persistent increase in the content of blood cells in the blood is observed 6-8 weeks after the start of therapy.

Effective iron preparations prescribed by a doctor for the treatment of anemia:

Aktiferrin. The active ingredient is ferrous salts. The drug is available in the form of tablets, capsules or liquid solution.
Totem. Analogue Aktiferrin. The drug can only be purchased in the form of a liquid solution.
Hemopher. Analogue Aktiferrin. The drug is produced in the form of a liquid solution.
Hemohelper. The active substance is iron salts. An additional component is ascorbic acid. The drug is available in the form of tablets.
Ferroplex. Analogue Hemohelper.
Ferlatum. The active ingredient is ferric iron succinylate protein. The drug can be purchased in the form of a solution.
Ferum Lek. The active compound is ferrum hydroxide. The drug is available in the form of a liquid solution.
Maltofer. Analog Ferum Lek. The product is available in the form of chewable tablets.

These drugs are taken orally. Also, for women, the doctor may prescribe funds that are intended for parenteral administration.

You should stop taking medication if you experience side effects:

allergic symptoms (rashes on the skin, runny nose, cough, etc.);
indigestion (appearance of heartburn, belching, pain in the abdomen);
hematoma formation after injection of the drug.

In all of these cases, it is important to urgently contact the attending gynecologist.

Prevention

Starting from the period of planning a child, a woman should foresee all possible negative manifestations that may appear during the period of bearing a baby. To prevent iron deficiency anemia, it is recommended to improve nutrition, eat foods and dishes high in iron.

It is important for a pregnant woman to see a gynecologist. It is recommended to register early. The doctor will be able to prevent the development of negative complications in a timely manner, and if any, prescribe qualified treatment.

Absolutely all pregnant women (who are registered in the antenatal clinic) in the second half of the period of bearing a baby are prescribed iron preparations. The goal of therapy is to maintain the level of iron in the blood and prevent the development of anemia. The choice of an iron-containing drug is the prerogative of the attending gynecologist.

To prevent anemia, the same medicines are shown that are prescribed by doctors for the treatment of this disease. For prevention, iron-containing preparations are recommended to be taken in a small dosage. The duration of the event is set by the doctor, but most often the pregnant woman takes medication throughout the rest of the pregnancy.

Anemia is common in pregnant women. The detected disease is easily treatable. If anemia is diagnosed in a severe degree, then the risk of developing negative consequences for both the pregnant woman and her fetus increases dramatically.

- Premature detachment of a normally located placenta (due to circulatory disorders in the "mother - placenta - fetus" system).

- Chronic placental insufficiency leading to fetal hypoxia and fetal developmental delay (supplying the baby with blood with insufficient oxygen saturation leads to constant oxygen starvation).

- Premature birth (due to chronic placental insufficiency and depletion of resources at a certain stage of gestation).

In the postpartum period, women with anemia have a higher incidence of hypotonic and atonic bleeding (which further aggravates the degree of anemia), purulent-septic complications and lactation disorders.

Effects of anemia on the fetus

Birth with low body weight, delayed physical development of the fetus.

Belated falling off of the umbilical cord, slow healing of the umbilical wound.

The development of anemia in a child in the neonatal period.

Delayed psychomotor development.

Reduced immunity, low resistance to infections.

Diagnostics:

- CBC (general blood test) is the first method for diagnosing an iron deficiency state. According to the result of the KLA, you can find out the level of hemoglobin, the number of erythrocytes (red blood cells), hematocrit, color index. Monitoring the state while taking iron supplements is also carried out according to the KLA.

UAC norms:

hemoglobin 110 - 140 g/l
hematocrit 36 - 42%
erythrocytes 3.7 - 4.7*10 12/ml
color index 0.8 - 1.0

In the KLA, a change in the size and shape of erythrocytes is also determined: small erythrocytes (microcytosis), deformation of erythrocytes (poikilocytosis), the presence of separate fragments of erythrocytes (schizocytosis).

- Total serum iron-binding capacity (TIBC). OZhSS in normal women has the following indicators: 38.0-64.0 microns / l. with anemia, this figure increases.

Blood iron. Normally, in women, blood iron is in the range of 12 - 25 µmol / l.

- Transferrin saturation with iron. Transferrin is a protein that transports iron to organs and tissues. If an iron deficiency begins to be noted in the body, then this indicator is depleted first of all, transferrin gradually loses the iron molecules attached to it. Normally, this figure is 16 - 50%, with anemia it decreases.

If necessary, consultations of doctors - specialists (gastroenterologist, hepatologist, hematologist, rheumatologist and others).

Although the range of studies is very wide, as a rule, the diagnosis of anemia in a pregnant woman is based on a detailed blood test, which, if correctly deciphered, provides almost all the necessary information.

Treatment of anemia during pregnancy:

1. Diet

The first step towards restoring normal hemoglobin levels is a special diet. Anemia can appear even in those who, it would seem, eat enough and varied. But nutrition may not include exactly those right foods that are rich in easily digestible iron.

Meat products and offal contain a large amount of iron compounds, and in addition, it is absorbed as completely as possible (up to 25 - 30%). Sausage, sausages and similar meat products are very conditional, but they contain a record amount of salt and starch, so eating them will not bring any benefit.

Iron from other animal products (fish and seafood) is more difficult to absorb, about 15-20%.

Only about 2-5% of the iron they contain is absorbed from plant products.

Featured Products(arranged in descending order of iron enrichment): pork liver, cocoa, egg yolk, heart, veal liver, toasted bread, apricots, almonds, turkey, spinach, veal and others.

The absorption of iron from animal products is facilitated by foods that are rich in zinc, copper, cobalt. You will find these elements in the liver, cocoa, seafood (shrimp, mussels and other seafood).

You can increase the absorption of iron from animals, and especially from herbal preparations, if you introduce foods rich in ascorbic, succinic, citric acids and fructose (tomatoes, kiwi, strawberries, strawberries, cauliflower, bell peppers, honey) into the diet.

So, for example, it is better to combine buckwheat porridge with stewed vegetables (tomatoes, cauliflower, peppers), season beef and heart after cooking with tomato sauce or sauce with lemon juice.

Approach to the composition of the diet should be deliberate, because an excess of acids will adversely affect the condition of the gastric mucosa and esophagus, and will also make calcium absorption more difficult.

Folic acid (vitamin B9), which is certainly useful for pregnant women in terms of preventing fetal deformities, will also help in preventing anemia. Folates help iron to be more easily absorbed and metabolized in the body. Foods rich in folic acid: spinach, lettuce, fresh parsley, cabbage, turnips, mustard greens, asparagus, dried apricots, broccoli, citrus fruits, raspberries, strawberries, beans, peas, lentils, seeds and nuts (sunflower seeds, flax seeds, sesame seeds and peanuts; sesame, moreover, the champion in calcium content).

Difficult absorption of iron dairy and sour-milk products, caffeine, tannin and foods rich in phytic acid (corn, soy). Also, they do not contribute to the absorption of a large amount of fat in food.

The difference in taking such antagonistic (counteracting) products should be at least two hours.

By the way, coffee and tea make it difficult to absorb almost all vitamins and microelements from food, so these healthy drinks should always be consumed separately, then the benefits of green or herbal tea, natural coffee or mate are preserved, and useful nutrients are absorbed from food.

2. Iron preparations for the treatment of anemia

Iron preparations are available in the form of tablets, solutions for internal use and solutions for intravenous administration. Previously used intramuscular iron preparations are no longer recommended due to the frequency of complications (post-injection hematomas, abscesses and allergic reactions).

The treatment of anemia is started with tablet preparations, they are usually well tolerated and easily dosed.

Sorbifer durules(combined preparation containing 100 mg of iron and 60 mg of ascorbic acid), 1-2 tablets per day are used in the treatment of mild anemia and for the prevention of iron deficiency, with moderate anemia, up to 4 tablets per day are used in 2 divided doses. The duration of treatment is determined individually depending on the severity of anemia and the effect of treatment.

Fenyuls 100 (iron 100 mg, ascorbic acid 60 mg) for prevention 1 tablet 1 time per day, for treatment 1 tablet 2 times a day. The duration of the reception is also individual.

Ferretab (iron 50 mg, folic acid 500 mcg) 1 capsule per day, up to a maximum of 2-3 capsules per day in 2 divided doses, is taken until the hemoglobin level is restored, then prophylactic administration on an individual basis.

Maltofer (in one tablet / 40 drops of solution / 10 ml of syrup 100 mg of iron) is available in three dosage forms, taking 40-120 drops / 10-30 ml of syrup / 1-3 tablets per day in 1-2 doses. The duration of admission is determined individually.

Totem (a combined preparation of iron, copper and manganese) 2-4 ampoules per day, the solution is diluted in 1 glass of water, the duration and frequency of administration are determined individually, during the course of treatment the dose of the drug may vary depending on the blood picture.

The intake of iron tablets is sometimes accompanied by complications from the gastrointestinal tract (stomach discomfort, heartburn, constipation), this should not serve as a contraindication to further intake.

It is necessary to follow some rules: take iron with meals (excluding those foods that interfere with its absorption in this meal), try to normalize the stool (use of dried apricots and prunes, a sufficient amount of fiber, situational rectal suppositories with glycerin at night).

Injectable drugs are used exclusively in the hospital, as there is a possibility of developing anaphylactic shock.

Intravenous iron preparations are now beginning to be used in pregnant women. In particular, the drug Ferrinject, a solution for intravenous administration or in the dialysis system, is used. Its introduction should be strictly according to indications, under the supervision of a physician. The dose of the drug is calculated individually, based on the level of hemoglobin and the weight of the patient. As the treatment progresses, the dose is reduced. The course of treatment is individual, after injectable iron, a transfer is made to taking iron tablets.

- Transfusion (transfusion of blood components) is performed with severe anemia, according to strict indications and in a hospital.

If treatment with iron preparations does not lead to an increase in hemoglobin levels, there is no positive dynamics in the symptoms of anemia, then other causes of anemia should be excluded.

A short list of diagnostic measures (performed strictly according to indications): an extended biochemical blood test, ultrasound of internal organs and kidneys, FGDS, sternal puncture (analysis of bone marrow from the sternum), consultations of doctors - specialists according to indications.

Prevention of anemia in pregnancy

You should know that you need to prepare for pregnancy and have a normal level of hemoglobin, and in the presence of anemia, find out its cause.

For the prevention of anemia and other complications of pregnancy, it is recommended to take multivitamin complexes containing at least 60 mg of iron and at least 250 mcg of folic acid (elevit pronatal, vitrum prenatal). Keep in mind that taking multivitamins can only PREVENT iron deficiency conditions, anemia that has already developed should be treated with higher doses of iron.

Taking multivitamins should begin 3 months before the intended conception and continue until at least 12 weeks of pregnancy, and then according to indications.

We examined the most common condition that complicates the course of pregnancy, but it can and should be fought. Anemia in pregnant women with timely and proper treatment is a “grateful” state, that is, a positive effect in the blood test and improvement in well-being, we expect quite quickly. Do not avoid visiting the antenatal clinic and listen to the recommendations of your doctor. Look after yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

Content

Anemia has the ICD code D50. The disease is characterized by insufficient concentration of iron in the body. Under such conditions, there is a violation of the synthesis of red blood cells in the blood. Anemia and pregnancy are incompatible concepts, since the disease can harm the fetus and mother.

What is anemia during pregnancy

Anemia during gestation is an iron deficiency during pregnancy. The disease begins to manifest itself by the second trimester, reaching the peak of its development by 29-36 weeks. The mechanism of the formation of the disease is based on the increasing need of the mother's body for iron, since thanks to it, blood hemoglobin is produced. If the element is supplied in insufficient volume, then there is an imbalance between its consumption and expenditure. Anemia must be treated to avoid negative consequences for the mother and child.

Causes of anemia can be:

chronic inflammatory diseases of the genital organs;
hereditary predisposition (with a genetic disease);
insufficiently balanced menu;
alcohol, smoking;
changes in liver diseases;
neoplasms;
early re-pregnancy (hypochromia develops);
violation of the functioning of enzymes;
hormonal disruptions.

Iron deficiency anemia in pregnant women

The element iron plays an important role in the formation of hemoglobin. If there is a shortage, the transfer of oxygen from the lungs to the tissues of the organs is disrupted. Iron deficiency anemia during pregnancy (should be distinguished from thalassemia) can be caused by a failure in the absorption of an important substance or a decrease in its intake. The expectant mother can get iron only with food, since the element is not synthesized by the body. In order for proper absorption to occur, there must be no malfunction of the liver and small intestine, since the molecules move due to the proteins of these organs.

Gestational anemia during pregnancy

The definition of "gestation" is translated from Latin as "pregnancy". The disease affects up to half of expectant mothers. The period from the process of the introduction of a fertilized egg into the uterine wall is calculated, which is less than the period set by obstetricians. Gestational anemia during pregnancy refers only to this period, if the disease occurred before or after, then it is diagnosed differently.

The disease provokes failures in the process of strengthening the child in the uterine cavity, hypoxia of placental tissues, and the development of defective cells of the inner layer of the uterus. In the second trimester, the oxygen starvation of the fetus in the womb can increase due to thrombosis of small capillaries that connect the mother's circulatory system with the placenta.

What is dangerous anemia during pregnancy

The disease is an iron deficiency in the body of the expectant mother. Anemia can lead to serious consequences for both the woman herself and the fetus. The disease can cause toxicosis in the second half of the childbearing period. Iron deficiency during pregnancy is also dangerous because it can create conditions for premature birth. This scenario of events is often provoked by severe bleeding during the birth of the fetus (posthemorrhagic anemia). This is explained by the fact that the disease reduces the ability of blood to coagulate.

If left untreated, anemia can lead to loss of milk supply after childbirth. A child whose mother during the period of gestation had a low iron content in the body receives few resources for proper development. Such disorders are caused by a lack of oxygen and nutrients. Significantly increases the risk of hypoxia and fetal hypotrophy. As a result, the baby may be born with an underweight, not formed immune system.

Anemia 1 degree during pregnancy

The mild stage of this disease is diagnosed in almost all pregnant women. The internal organs can only assimilate their iron norm, although much more is required. Anemia during pregnancy of the 1st degree can occur with virtually no symptoms, it is detected when taking a blood test, a test for the level of serum iron. However, diagnosis and timely treatment is necessary to prevent complications and consequences for mother and baby. The fetus, even in the absence of manifestations of the disease in a woman, experiences slight hypoxia.

Anemia 2 degrees during pregnancy

At this stage, the lack of iron content becomes more pronounced. Moderate anemia during pregnancy gives a woman some discomfort that can affect the health of the fetus. There are external signs, having discovered which, you need to consult a doctor:

the appearance of cracks in the corners of the mouth;
hair becomes dry, brittle, falls out strongly;
the nail plate is deformed, loses its hardness and elasticity.

Anemia 3 degrees during pregnancy

The last stage of the disease requires immediate medical attention and inpatient treatment. Anemia of the 3rd degree during pregnancy can cause irreparable harm to the development of the fetus. Under such circumstances, premature birth, miscarriage or stillbirth are possible. If an ailment at this stage is detected when planning children, then doctors regard it as a clinical indication for treatment.

Signs of anemia during pregnancy

Symptoms of anemia in pregnant women occur during the transition of the disease to the second stage, they are expressed by the following manifestations:

an increase in the frequency of heart beats;
increased fatigue, drowsiness and general weakness in the body;
the appearance of irritability and nervousness;
pain in the region of the heart;
loss of appetite;
dizziness, nausea, vomiting;
metabolic disorders, malfunctions of the digestive system;
a drop in concentration;
fainting;
numbness of the limbs;
dryness and blanching of the skin;
fragility of nails and hair;
peeling of the skin in the area of the palms and feet;
the appearance of cracks in the corners of the lips.

Treatment of anemia during pregnancy

Depending on the stage of development, symptoms and type of disease, specialists establish the treatment of anemia in pregnant women. The set of activities includes:

food according to a special diet;
taking iron tablets;
the use of injections (for stomach ulcers, heartburn);
the use of folk remedies.

Drugs for anemia in pregnant women

Drug treatment of the disease is selected individually for each woman, based on the etiology and stage of the disease. Drugs for anemia in pregnant women can be useful for the fetus, but have a harmful effect on the mother's body. Popular medicines are:

Ferroceron;
Ferroplex;
Ferrocal;
Conferon;
Tardiferon.

What to eat with anemia during pregnancy

An anemia diet is aimed at compensating for iron deficiency. Eating with anemia during pregnancy should be certain foods. The following describes what is best to consume with an ailment, what are the features:

The element is best absorbed from meat (pork liver, heart, turkey, beef).
Seafood (fish, mussels, shrimp).
Vegetables and fruits (spinach, apricots, tomatoes, cauliflower, bell peppers, strawberries, kiwi, apple).
Cereals (for example, buckwheat).
Folic acid will help in the prevention of anemia (turnips, cabbage, lentils, citrus fruits, lettuce, broccoli, dried apricots, raspberries, nuts).
Vitamin B12 is found in eggs, legumes, and meat.

Contraindications for anemia

In some cases, contraindications for anemia consist in the recommendation of doctors to terminate the pregnancy. The decision is made at the council, may take effect up to 12 weeks. However, the final choice belongs to the woman. The following types of anemia can become a contraindication to pregnancy:

severe degree of chronic iron deficiency;
hemolytic (in which red blood cells break down);
aplastic;
sickle cell;
an ailment that occurs against the background of leukemia;
if the disease accompanies Werlhof's disease.

Prevention of anemia in pregnant women

Before getting pregnant, a woman must carefully prepare. You need to pay attention to the level of hemoglobin in the blood. If anemia is found, then it is necessary to find out its cause. Prevention of anemia in pregnant women is to take multivitamin preparations. Suitable complexes should contain iron and folic acid. These medications should only be taken as a preventive measure, as they contain too little of a substance for treatment.

The use of a complex of vitamins should be started 3 months before the intended conception. During pregnancy, the intake of nutrients should occur up to 12 weeks. However, each woman needs her own time, so it is important to get expert advice. In no case do not neglect the advice of a doctor and constantly visit a antenatal clinic so that the disease can be detected in time.

Video: anemia during pregnancy

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Diagnosis of anemia during pregnancy

Diagnose anemia during pregnancy pretty simple. This requires only one complete blood count. At the same time, the identification and elimination of the causes of its occurrence may be associated with certain difficulties, which will require additional laboratory studies.

For the timely detection of anemia (and other possible complications), it is recommended that all women during pregnancy undergo a preventive examination by a gynecologist at least three times.

Preventive visits to the gynecologist are carried out:

Up to 12 weeks of pregnancy. In this period, the general condition of the woman is assessed, and an ultrasound examination (ultrasound) is performed in order to detect abnormalities in the development of the fetus. If, according to the results of the tests, anemia is found in a woman, it is definitely not related to the onset of pregnancy, that is, its causes must be sought in other organs and systems.

Up to 27 weeks of pregnancy. At this stage, the general condition of the woman and the developing fetus is also assessed. A general blood test may reveal initial signs of iron or other trace element deficiency. Severe clinical signs of anemia are rare, but this does not eliminate the need for preventive treatment.
From 28 to 42 weeks of pregnancy. Anemia at this stage of pregnancy can be observed only in the case of improper preventive treatment (or if the woman did not visit the gynecologist at all during the entire pregnancy and did not take any treatment). During the examination, the general condition of the woman and the fetus is assessed and a decision is made on the method of delivery (through the natural birth canal or by caesarean section). The fact is that with severe anemia, the female body (in particular, the cardiovascular and respiratory system) may not be able to withstand the increasing loads, which can cause weakness in labor activity and even lead to the death of the mother or fetus during childbirth. In this case, if the duration of pregnancy allows, preventive treatment of anemia can be performed, after which (in case of a positive effect) it will be possible to give birth through the natural birth canal. If severe anemia is diagnosed late in pregnancy (40 weeks or later), the doctor recommends a caesarean section (also after appropriate preoperative preparation).

To identify the cause of anemia during pregnancy, your doctor may:

poll;
clinical examination;
general blood analysis;
blood chemistry;

Poll

The survey is an important step in the diagnosis, during which the doctor may suspect a particular cause of anemia.

During the interview, the gynecologist may ask:

How long ago was the pregnancy?
Have there been pregnancies before?
If there were, how did they proceed (in particular, the doctor is interested in whether the woman suffered from anemia and what treatment she took about this)?
How long ago was the last pregnancy?
How does a woman eat?
Does the woman suffer from any chronic diseases (hepatitis, cirrhosis, etc.)?
Does the woman abuse (or did she abuse before) alcoholic beverages?
Has the woman ever suffered from anemia (even unrelated to pregnancy)?
How long ago did the woman have her last medical examination (including a complete blood count) and what were the results?
Have you noticed any taste deviations recently (desire to eat some inedible foods, feeling unusual tastes or smells in their absence, and so on)?

Clinical examination

During the examination, the doctor tries to identify the first signs of anemia, as well as to assess the condition of other organs and systems that may be affected in one form or another of the disease. Since more than 90% of anemias during pregnancy are iron deficiency, special attention is paid to signs of iron deficiency in the body.

When examining a patient, the doctor evaluates:

skin color;
skin moisture;
skin elasticity;
mucous membrane of the oral cavity;
the state of the language;
the condition of the nails;
hair condition;
the degree of development of subcutaneous fat;
blood pressure (may be lowered with anemia);
the size of the liver (by probing and tapping);
the size of the spleen (normally it cannot be determined);
the muscle strength of the patient;
exercise tolerance (a woman is asked to walk around the office several times or perform a couple of simple exercises, assessing the severity and duration of shortness of breath that occurs).

A complete blood count is the main test that detects anemia. The essence of this method is to take a small amount of the patient's blood and study it in the laboratory in order to determine the amount of all cellular elements, as well as their structure and composition.

This study does not require any special preparation. The night before, a light dinner is recommended for a woman, and a light breakfast in the morning (nothing fatty, fried or smoked).

Blood sampling for a general analysis is made from a finger (for this, capillary blood is taken, usually from the ring finger of the left hand) or from a vein. Today, more and more preference is given to the second method, although capillary blood is also quite suitable for this study. To take blood from a vein, the patient sits on a chair and exposes her arm to the shoulder, after which she places it on the back of the chair with the elbow surface up. The nurse evaluates the condition of the superficial veins and decides which vein to take blood from. To do this, a special tourniquet is applied to the lower third of the shoulder, which leads to squeezing of the blood vessels located there and overflowing with blood of the downstream veins.

After identifying a suitable vein, the nurse several times treats the skin in the area of the proposed puncture with cotton wool soaked in a 70% alcohol solution (in order to prevent infection) and the last time with a dry sterile swab, and then pierces the vein. In this case, the needle should be inserted towards the patient's shoulder, as this contributes to faster healing of the wound in the vascular wall after the procedure.

While inserting the needle, the nurse slightly pulls back on the plunger of the syringe. At the moment of puncture of the venous wall, dark red venous blood will enter the syringe. At this point, the nurse should stop advancing the needle, remove the tourniquet from the shoulder, and draw a few milliliters of blood into the syringe. After that, the needle is removed, and an alcohol swab is applied to the puncture site. Within 5-10 minutes after the end of the procedure, the patient is recommended to sit on the couch in the treatment room, since side effects (dizziness, loss of consciousness) may occur at this time.

You can examine the received blood using a conventional microscope (for this, smears are prepared and special dyes are used). However, today most laboratories have special counting chambers (hematological analyzers) that allow, within a few minutes, to calculate the quantitative and qualitative composition of cells in the blood under study, as well as to determine many other parameters.

Complete blood count for anemia

Indicator

What does it mean?

The norm in women

Iron-deficiency anemia

folate deficiency anemia

The concentration of mature erythrocytes

(RBC)

A decrease in the number of mature erythrocytes in the peripheral blood is the main diagnostic criterion for anemia.

3.5 - 4.7 x 10 12 / l

Below the norm.

Average erythrocyte volume

(MCV)

The volume of red blood cells may vary depending on the cause of the anemia.

75 - 100 cubic micrometers ( µm 3)

Under normal conditions, more than 90% of the erythrocyte volume is filled with hemoglobin. As a result of violation of the formation of this substance, its total amount decreases, which leads to a decrease in the size of the erythrocytes themselves less than 70 µm 3.

Also, characteristic changes in the KLA can be observed with more rare anemia, namely:

With aplastic anemia- there is a decrease in the number of all blood cells, as well as a decrease or complete absence of reticulocytes in the peripheral blood.
With hemolytic anemia Minkowski-Choffard- there is a decrease in the total number of erythrocytes and hemoglobin with a simultaneous increase in the level of reticulocytes (a compensatory reaction aimed at restoring the normal level of blood cells), as well as a characteristic change in the shape of erythrocytes (round, enlarged cells).
With posthemorrhagic anemia- there is also a decrease in the level of erythrocytes and hemoglobin with a simultaneous increase in the level of reticulocytes, however, all blood cells have a normal shape and normal size.

Biochemical blood test for anemia

This study evaluates the concentration of various chemicals in the blood. Each type of anemia is characterized by certain biochemical changes, which makes it possible to confirm or refute the diagnosis with a high degree of probability.

To identify the cause of anemia in pregnant women, the doctor may prescribe:

analysis of the level of serum iron;
analysis of the level of ferritin in the blood;
analysis of the total iron-binding capacity of blood serum;
determination of the concentration of erythropoietin in the blood;
determination of the level of folic acid in the blood;
determination of the level of vitamin B12 in the blood;
determination of the level of bilirubin in the blood.

Serum iron analysis
This study allows you to identify iron deficiency in the patient's blood. However, it is worth noting that in the initial period of the development of anemia, false-negative results can be obtained, since iron will be released from the depot organs (liver and others), as a result of which its concentration in the blood will be normal.

The normal level of serum iron in women is 14.3 - 17.9 micromoles / liter.

Analysis of the level of ferritin in the blood
Ferritin is a protein complex that binds and stores iron in the body. With a lack of iron, it is primarily mobilized (released) from ferritin, and only after its depletion begins to be released from the depot organs. That is why the determination of the level of ferritin allows you to identify iron deficiency at an earlier stage.

The normal level of ferritin in the blood in women is 12 - 150 nanograms / milliliter.

Analysis of the total iron-binding capacity of blood serum
As mentioned earlier, free iron entering the blood immediately binds to the transport protein transferrin, which delivers it to the red bone marrow and other organs. However, each transferrin molecule binds to iron by only 33%. With the development of iron deficiency in the body, the compensatory synthesis of transferrin in the liver is activated (in order to capture as many iron molecules from the blood as possible). The total amount of this protein in the blood increases, but the amount of iron associated with each molecule decreases. By determining how much iron is bound to each transferrin molecule, the degree of iron deficiency in the body can be assessed.

The normal level of total iron-binding capacity of blood serum in women is 45 - 77 micromoles / liter.

Determination of the concentration of erythropoietin in the blood
Erythropoietin is a special substance that is secreted in the kidneys and activates the formation of red blood cells in the red bone marrow. The synthesis of erythropoietin is stimulated by an insufficient amount of red blood cells and hemoglobin in the blood that passes through the renal vessels. These conditions occur with almost any anemia, so an increased concentration of erythropoietin in the blood will only confirm the presence of the disease, but will not help to recognize its cause.

The normal level of erythropoietin in a woman's blood is 10 - 30 international milliunits / milliliter. It is also worth noting here that this compensatory reaction starts only after a certain period of time after the onset of anemia (a few days later), therefore, a normal level of erythropoietin in the blood does not exclude the presence of posthemorrhagic or hemolytic anemia.

Determination of the level of folic acid in the blood
A decrease in the level of folic acid can be observed with the development of folic acid deficiency anemia even before the onset of clinical manifestations of the disease. Usually, already in the 2nd trimester of pregnancy, women may experience a slight decrease in its concentration (provided that there were sufficient reserves of folic acid in the body before pregnancy).

The normal level of folic acid in the female body is 3 - 6 nanograms / liter.

Determination of the level of vitamin B12 in the blood
B12-deficiency anemia rarely develops during pregnancy, since the reserves of this vitamin in the body are relatively large (the presence of other contributing and predisposing factors is necessary for the development of anemia). However, this vitamin is necessary for the normal conversion of folic acid in the body, and if it is deficient, clinical manifestations similar to those of folate deficiency anemia can also develop.

The normal level of vitamin B12 in the blood of women is 200 - 900 picograms / milliliter.

Determination of the level of bilirubin in the blood
An increase in the concentration of free bilirubin (normal 4.5 - 17.1 µmol / l) will indicate increased destruction of red blood cells in the spleen, which occurs with hemolytic anemia. At the same time, an increase in the bound fraction of bilirubin (normal 0 - 3.4 µmol / liter) is a sign of impaired biliary tract patency and has nothing to do with anemia. That is why, in the presence of jaundice, it is necessary to determine not only the total amount of bilirubin (the norm of which is 3.4 - 20.0 μmol / l), but also the concentration of its individual fractions.

Puncture of the bone marrow

A bone marrow puncture involves a puncture of the spongy bone of the body and the sampling of a part of the hematopoietic tissue located in it, which is subsequently processed in a special way, stained and examined under a microscope. With the help of this study, it is possible to assess the degree of hematopoiesis in the red bone marrow, which allows you to confirm or refute the diagnosis of aplastic or other anemia.

The procedure itself is quite painful due to the fact that the puncture of the bone (sternum, pelvic bone) is performed without anesthesia (the introduction of local anesthetics can damage the bone marrow under study and distort the results). That is why this study is prescribed only as a last resort, when other diagnostic methods have not given positive results.

Degrees of anemia during pregnancy

Based on the clinical manifestations of the disease and laboratory test data, the degree of anemia is determined, which is necessary to select a more correct treatment strategy.

During pregnancy, a woman may be diagnosed with:

Anemia of mild severity. It is characterized by a hemoglobin level of 90 to 115 grams / liter. Clinical manifestations of anemia in this case depend on its type and rate of development. So, for example, with the slow development of iron deficiency or folate deficiency anemia, a decrease in hemoglobin levels to 90 g / l can be tolerated relatively well by a woman (patients may complain of weakness, poor exercise tolerance, and so on). At the same time, with a rapid decrease in the level of hemoglobin (for example, with blood loss), the body does not have time to adapt to a sharply reduced level of oxygen delivery, as a result of which loss of consciousness may occur. In any case, if a woman is diagnosed with this degree of anemia, she is recommended to undergo additional examinations to identify the cause.
Anemia of moderate severity. It is characterized by a hemoglobin level of 70 to 90 g/liter. In this case, there is a high risk of developing complications from the internal organs (primarily from the brain, which is extremely difficult to tolerate lack of oxygen). The risk of damage to the fetus also increases, since the provision of oxygen to it is entirely carried out at the expense of oxygen from the mother's blood. Women with this level of hemoglobin must be hospitalized without fail in the department of pathology of pregnancy for diagnosis and observation.
Anemia of severe severity. In this case, the hemoglobin level drops below 70 g/L. This condition threatens the life of the mother and fetus, so women with severe anemia should be urgently admitted to the intensive care unit for treatment and observation.

What diseases should iron deficiency anemia be distinguished from?

Despite the fact that more than 90% of anemia during pregnancy are iron-deficient, in other cases, the cause of anemia lies in another pathology. Incorrect or untimely diagnosis of the cause of anemia can adversely affect both the health of the mother and the developing fetus. That is why it is always necessary to confirm the diagnosis of anemia with the help of laboratory tests and not rely on the clinical picture of the disease alone.

Iron deficiency anemia that occurs during pregnancy should be distinguished:

from folate deficiency anemia. These two pathologies have similar symptoms, but with a simple blood test, they can be easily distinguished. With iron deficiency anemia, red blood cells are reduced in size and the total level of hemoglobin is reduced, while with folate deficiency anemia, the opposite data are noted. Also, an assessment of the level of iron and folic acid in the blood will help to make the correct diagnosis.
from hemolytic anemia. The need for differential diagnosis (differentiation of symptoms) between hemolytic and iron deficiency anemia is due to the fact that during hemolytic crises (conditions in which a large number of red blood cells are destroyed in a short period of time), compensatory reactions are activated in the red bone marrow. As a result, a large number of new erythrocytes are synthesized, for which a large amount of iron is consumed. In this regard, when examining peripheral blood and conducting a biochemical analysis, signs of an iron deficiency state (a decrease in the concentration of serum iron) can be detected. To make the correct diagnosis in this case, the study of the level of free bilirubin, which will be elevated in hemolytic anemia and normal in iron deficiency anemia, will help.

It is also necessary to distinguish iron deficiency anemia that developed as a result of pregnancy (that is, due to the transfer of part of the iron from the mother's body to the body of the developing fetus) from iron deficiency conditions that occurred before pregnancy. The main distinguishing feature in this case will be the time of appearance of clinical and laboratory signs of iron deficiency. If this condition is due to pregnancy, iron stores in the mother's body will be depleted no earlier than a few months after its onset. If, at the very first examination by a gynecologist (which is carried out before the 12th week of pregnancy), a woman shows signs of anemia and severe iron deficiency, another cause of this pathology should be sought.

In addition to pregnancy, iron deficiency anemia can be caused by:

Chronic blood loss- for example, in women during menstruation, in the presence of a bleeding ulcer in the gastrointestinal system, with frequent (more than 3-4 times a year) blood donations (one dose of donor blood contains about 150 mg of iron, which the body will need to replenish less than 3 months).
Iron malabsorption- observed in chronic inflammatory diseases affecting the mucous membrane of the stomach or duodenum of the small intestine, as well as with partial or complete removal of these anatomical areas.
malnourished- iron deficiency can develop with insufficient consumption of meat products rich in iron.
Liver diseases- with cirrhosis of the liver, the process of iron deposition in it is disrupted, and the level of transport protein transferrin, which is formed in the liver and is responsible for the delivery of iron to depot organs, decreases.

Treatment of iron deficiency anemia during pregnancy

Treatment of iron deficiency anemia should be carried out immediately after its detection, regardless of the period of pregnancy it is diagnosed (that is, it is caused by the pregnancy itself or other pathological conditions). This is explained by the fact that a progressive iron deficiency can adversely affect not only the condition of the woman herself, but also the development of the unborn child. If anemia is detected in the first trimester of pregnancy, after the start of treatment, a more in-depth diagnosis can be made to identify the cause of its occurrence.

Treatment for iron deficiency anemia may include:

the use of drugs;
dieting;

Drugs for the treatment of iron deficiency anemia during pregnancy

The appointment of iron supplements is a key point in the treatment of iron deficiency anemia. Restoring and maintaining a normal level of this substance in the blood contributes to the normalization of hematopoiesis and the regression (gradual disappearance) of other symptoms of iron deficiency.

Iron preparations can be administered both enterally (in the form of tablets) and parenterally (in the form of intravenous droppers or intramuscular injections). The first option is preferred, as it is more physiological. At the same time, in severe anemia or in violation of the process of iron absorption in the gastrointestinal tract (for example, in patients after surgery to remove part of the stomach or duodenum), iron preparations are administered intravenously.

Drug treatment of iron deficiency anemia in pregnant women

Name of the drug	Mechanism of therapeutic action	Dosage and administration	Evaluation of the effectiveness of treatment
*Ferrocal*	An iron preparation that compensates for the lack of this substance in the blood, thereby stimulating the formation of red blood cells in the red bone marrow.	Inside, 2-6 tablets every 8 hours after meals.	*The positive effect of the therapy will be indicated by:* Improvement in the general condition of the woman within 1 week after the start of treatment. An increase in the concentration of iron in the blood plasma the next day after the start of treatment. An increase in the level of reticulocytes in the general blood test 5 to 7 days after the start of treatment. An increase in hemoglobin levels, noted no earlier than 3 weeks after the start of treatment. Normalization of hemoglobin levels 9-10 weeks after regular treatment.
*Ferroplex*	Combined preparation consisting of iron and ascorbic acid. The latter is needed for a more active and complete absorption of iron in the intestine.	Take 3 times a day inside, do not chew, drink a glass of warm boiled water. For treatment, 100-200 mg of iron per day is prescribed for 3-6 months. With the normalization of peripheral blood parameters and saturation of the iron depot in the body, they switch to a maintenance dose ( up to 100 mg per day).
*Conferon*	Contains iron and other substances that improve the process of its absorption in the intestine.	Inside, without chewing, 1-2 capsules every 8 hours.
*Ferrum Lek*	This drug is used when it is impossible to prescribe iron inside.	It can be administered both intramuscularly and intravenously. Dose, frequency and duration of application are calculated depending on the degree of iron deficiency in the body. In the second half of pregnancy, the drug is prescribed only when absolutely necessary, as it can have a negative effect on the developing fetus.

Diet for iron deficiency anemia in pregnant women

Diet along with drug therapy is one of the main therapeutic measures for iron deficiency anemia during pregnancy. The main task of diet therapy in this case is to provide the female body with a sufficient amount of products containing an easily digestible form of iron.

The daily requirement for iron during pregnancy increases to 30-35 mg. However, it is immediately worth noting that not all iron-rich foods are good sources of this trace element. So, for example, only 30% of the iron that is part of meat products is absorbed in the intestines. At the same time, no more than 5% of iron is absorbed from plant products. That is why, when calculating the daily ration, the bulk of iron should be provided by meat products.

The amount of iron in 100 grams of product ( mg)

Pork liver

Calf's liver

Beef brains

beef tongue

Turkey meat

chicken meat

beef tongue

Mutton

Cow's milk

Iron content in some plant foods

It is also worth considering that many foods and medicinal substances significantly reduce the rate of iron absorption in the intestine. At the same time, other substances contribute to the absorption of iron (both included in food and taken in the form of drugs).

Foods and medicines that affect the rate of iron absorption in the intestine

Treatment of iron deficiency anemia during pregnancy with folk remedies

Many herbs and other plants contain specific iron stores that can be used to treat iron deficiency anemia. At the same time, it is worth remembering that, along with iron, they contain many other chemicals and compounds that can have certain (including negative) effects on the fetus. That is why during pregnancy, self-medication with all kinds of infusions and decoctions without consulting a doctor is highly undesirable and even contraindicated.

Relatively safe folk remedies for iron deficiency during pregnancy are:

Freshly squeezed cranberry juice. It should be taken orally 100 ml (half a glass) 2-3 times a day during or after meals.
Infusion of rose hips. To prepare it, 100 grams of rose hips should be placed in a thermos, pour 1 liter of hot boiled water and infuse for 7-8 hours, then strain and take half a cup inside 1-2 times a day before meals.
Raspberry tea. Raspberries are also relatively high in iron. At the same time, drinking raspberry tea 1 cup 3-4 times a day will not harm either the mother or the developing fetus.
Cornel compote. 100 grams of cornelian fruit contains more than 4 mg of iron. Drinking 1-2 cups of dogwood compote per day will help reduce the risk of developing iron deficiency anemia during pregnancy, and will also help replenish the deficiency of this substance in an already developed iron deficiency.

Treatment of folate deficiency anemia during pregnancy

Folate deficiency anemia requires timely and complete treatment, otherwise it is possible to develop many complications from the developing fetus. It is worth noting that with this form of the disease, prevention of the development of a folate deficiency state is much more effective, and serious medical interventions are required only if preventive measures are carried out incorrectly (or if they are completely absent).

Drug treatment of folate deficiency anemia during pregnancy

The main step in the treatment of folic acid deficiency anemia is the appointment of folic acid preparations, which should be taken orally. With a pronounced deficiency of folic acid, the doctor may prescribe up to 5 mg of the drug per day (for 1 dose) for 20 to 30 days in a row. The first changes for the better are noted on the 5th - 7th day after the start of the drug. At this stage, the so-called "reticulocyte crisis" is noted, characterized by the release into the peripheral bloodstream of a large number of reticulocytes formed in the red bone marrow. In this case, the general condition of the woman improves in 1-2 weeks after the start of treatment (depending on the severity of the previous anemia).

In severe cases, when it is not possible to accurately confirm the diagnosis, it is recommended to prescribe vitamin B12 simultaneously with folic acid, which is administered intramuscularly at 500-1000 micrograms 1 time per day. This is explained by the fact that the clinical manifestations of these two anemias are almost identical, and therefore, without special biochemical studies, it is quite difficult to distinguish them from each other in the early stages of development.

Diet for folate deficiency anemia during pregnancy

Diet is also an important point in the treatment of folate deficiency anemia in pregnant women. At the same time, it is worth noting that this vitamin is found in many foods included in the daily diet of most people, therefore, with a balanced diet, the daily requirements for folic acid (which are about 400 micrograms per day in pregnant women) are usually completely covered.