Anemia in pregnancy

Campbell DM, Davidson RJ. 1970. Toxic haemolytic anemia in pregnancy due to a pica for paradichlorobenzene. J Obstet Gynaec Br Commonw 77 657-659. 

Chanarin, L, Rothman, D and Watson-Williams, E, J, (1963). Normal formiminoglutamic acid excretion in megaloblastic anemia In pregnancy. Lancet 1,1068-1072. 

An observational comparison in a rural Ghanaian hospital of 2083 pregnant women and 3084 historical controls showed no serious adverse events with chloroquine chemoprophylaxis (300 mg/week), but a high rate of pruritus (34). There was a decrease in anemia in pregnancy but no increase in perinatal mortality or birth weight in the chloroquine-treated mothers, although this was only in comparison with historical controls. 

Marchant, T., J.A. Schellenberg, T. Edgar, R. Nathan, S. Abdulla, O. Mukasa, H. Mponda, and C. Lengeler. 2002. "Socially Marketed Insecticide-Treated Nets Improve Malaria and Anemia in Pregnancy in Southern Tanzania." Trap Med Int Health 72 149-58. 

Shafi D, Purandare SV, Sathe AV. Iron deficiency anemia in pregnancy intravenous versus oral route. J Obstet Gynaecol India 2012 62(3) 317-21. 

It is noteworthy, too, that folacin fortification of corn, rice, and bread among population groups in South Africa has been shown to be an effective measure to prevent the development of macrocytic anemia in pregnancy. 

Attention to iron metabolism is particularly important in women for the reason mentioned above. Additionally, in pregnancy, allowances must be made for the growing fetus. Older people with poor dietary habits ( tea and toasters ) may develop iron deficiency. Iron deficiency anemia due to inadequate intake, inadequate utilization, or excessive loss of iron is one of the most prevalent conditions seen in medical practice. 

Methotrexate, an antimetabolite, is indicated for moderate to severe psoriasis. It is particularly beneficial for psoriatic arthritis. It is also indicated for patients refractory to topical or UV therapy. Methotrexate can be administered orally, subcutaneously, or intramuscularly. The starting dose is 7.5 to 15 mg per week, increased incrementally by 2.5 mg every 2 to 4 weeks until response maximal doses are approximately 25 mg/wk. Adverse effects include nausea, vomiting, mucosal ulceration, stomatitis, malaise, headache, macrocytic anemia, and hepatic and pulmonary toxicity. Nausea and macrocytic anemia can be ameliorated by giving oral folic acid 1 to 5 mg/day. Methotrexate should be avoided in patients with active infections and in those with liver disease. It is contraindicated in pregnancy because it is teratogenic. 

Iron deficiency is usually due to blood loss, or more rarely to inadequate iron uptake. During pregnancy, increased demand can also cause iron deficiency states. In severe cases, reduced hemoglobin synthesis can lead to anemia ( iron-deficiency anemia ). In these patients, the erythrocytes are smaller and have less hemoglobin. As their membrane is also altered, they are prematurely eliminated in the spleen. 

In most adults with anemia 100 mg elemental iron per day usually produces an adequate response. Iron supplementation in prophylactic doses of 60 mg of elemental iron daily may be justified, e.g. in pregnancy and lactation. 

Iron deficiency affects more than 1.7 billion people worldwide and has been called the most widespread health problem in the world by the World Health Organization. Due to severe iron deficiency, more than 60 000 women die in pregnancy and childbirth each year, and almost 500 million women of childbearing age suffer from anemia. Dietary iron requirements depend on mrmerous factors, for example, age, sex, and diet composition. Recommended daily intake in the USA varies dependent on gender and age. Potato is a modest source of iron. A study of cultivated varieties showed 0.3-2.3 mg of Fe in a 100 g tuber (True et al., 1978). Ranges of iron content from 6 to 158 p,g/g of DW have been reported (Andre et al., 2007 Wills et al.. 

Anyone taking diuretics for longer than six months may experience a folate, or folic acid, deficiency. Folic acid plays a part in the health and reproduction of virtually every cell in the body. It is responsible for protein metabolism, the prevention of neural tube defects in pregnancy, blood cell production, and the synthesis of neurotransmitters. Individuals with folate deficiencies may suffer from anemia, depression and other mood disorders, and may give birth to babies with neural tube defects. Supplementation with folic acid may be useful in reversing these effects. 

Adverse effects Side effects reported for oral or parenteral use of ribavirin have included dose-dependent transient anemia in Lassa fever victims. Elevated bilirubin has been reported. The aerosol may be safer, although respiratory function in infants can deteriorate quickly after initiation of aerosol treatment and therefore, monitoring is essential. Because of teratogenic effects in experimental animals, ribavirin is contraindicated in pregnancy. 

Adverse effects Colchicine treatment may cause nausea, vomiting, abdominal pain, and diarrhea (Figure 39.15). Chronic administration may lead to myopathy, agranulocytosis, aplastic anemia, and alopecia. The drug should not be used in pregnancy, and should be used with caution in patients with hepatic, renal or cardiovascular disease. 

DEFICIENCY Folate deficiency resembles B12 deficiency so far as the anemia goes, but without the neurologic abnormalities. Unlike B12, for which there are tremendous body stores, folate needs continued replacement, and poor diet is the most common cause of folate deficiency. Serum levels of folate may help establish the diagnosis. Pregnant women are encouraged to take folate in pregnancy to help prevent birth defects. 

Folale deficiency occurs in pregnancy on a wide scale. The increased utilization of the vitamin by die fetus and related tissues, as well as the secretion in milk during lactation, can place an increased demand on the dietary folates consumed by the mother. Sea ere folate deficiency leads to megaloblastic anemia. This disease, in which the synthesis of red blood cells is impaired, tends to occur with pregnancy in underdeveloped countries, but usually not in North America or Europe, Goat s milk is a poor source of folate and vitamin Bjj. Ovcrrchancc on goal s milk as a source of food for infants can result in a deficiency in these vitamins and in anemia. 

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