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anemia in pregnancy; gestational anemia

Physiology: - gestational anemia (physiologic) results from an increase in plasma volume proportionately larger than the increase in erythrocyte production - this reduces viscosity of blood delivered to the placenta & fetus [1] Laboratory: - complete blood count (CBC) - blood hemoglobin > 10.5-11 g/dL - blood hemoglobin < 11 g/dLin the 1st trimester & < 10 g/dL in the 2nd & 3rd trimesters should prompt an investigation for causes of anemia [1] - iron studies* - reticulocyte count - serum vitamin B12, serum folate - reticulocyte count - anemia workup in pregnant women indicated for a) marked anemia b) other cytopenias c) abnormal reticulocyte count d) abnormal RBC indices [1] * USPSTF concludes not enough evidence to recommend either for or against screening for iron-deficiency anemia in asymptomatic pregnant women [3] Complications: - iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, & perinatal mortality. - severe anemia with maternal hemoglobin (Hgb) levels < 6 g/dL has been associated with abnormal fetal oxygenation resulting in fetal heart rate abnormalities, diminished amniotic fluid volume, fetal cerebral vasodilatation, & fetal death Management: - prenatal vitamins including folate 1 mg/day - folate requirement nearly doubles during pregnancy - folate supplementation reduces risk for neural tube defects [1] - iron supplementation a) iron-deficiency anemia b) empiric iron therapy appropriate for women with microcytosis, hyochromia & anisocytosis [1] c) iron supplementation decreases the prevalence of maternal anemia at delivery d) USPSTF concludes not enough evidence to recommend either for or against routine iron supplementation in asymptomatic pregnant women [3] - maternal transfusion should be considered for severe anemia for the benefit of the fetus

General

pregnancy disorder; obstetric disorder; pregnancy complication anemia

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol. 2008 Dec;87(12):949-59 PMID: 18641987
  3. Siu AL et al for the U.S. Preventive Services Task Force Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnant Women to Improve Maternal Health and Birth Outcomes: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 8 September 2015 PMID: 26344176 http://annals.org/article.aspx?articleid=2434620
  4. Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci. 2000;900:125-36. PMID: 10818399