Anemia During Pregnancy?

Anemia is one of the things many women are screened for prenatally. The diagnosis of the disease is controversial. Here’s some food for thought:

Excerpt from Guidelines on Anemia in Pregnancy from theĀ  US Department of Health and Human Services:

“The following conclusion is based on good and consistent scientific evidence (Level A):

Iron supplementation decreases the prevalence of maternal anemia at delivery.
The following recommendations and conclusions are based on limited or inconsistent evidence (Level B):

Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality.


Severe anemia with maternal hemoglobin (Hgb) levels less than 6 g/dL has been associated with abnormal fetal oxygenation resulting in nonreassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilatation, and fetal death. Thus, maternal transfusion should be considered for fetal indications.
The following recommendations are based primarily on consensus and expert opinion (Level C):

All pregnant women should be screened for anemia, and those with iron deficiency anemia should be treated with supplemental iron, in addition to prenatal vitamins.


Patients with anemia other than iron deficiency anemia should be further evaluated.


Failure to respond to iron therapy should prompt further investigation and may suggest an incorrect diagnosis, coexisting disease, malabsorption (sometimes caused by the use of enteric-coated tablets or concomitant use of antacids), noncompliance, or blood loss.”

From Dr. Michel Odent, MD (in response to a question regarding an anemia diagnosis – excerpt):

“The most authoritative published study on this issue involved more than 150 000 thousands births (Steer P, Alam MA, Wadsworth J, Welch A. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ 1995; 310: 389-91). According to this huge study a hemoglobin concentration between 8.5 and 9.5 during the second half of a pregnancy is associated with the best possible birth outcomes. Furthermore, when the hemoglobin concentration fails to fall below 10.5 there is an increased risk of low birth weight, premature birth and pre-eclampsia.

The regrettable consequence of misinterpreting this test is that, all over the world, millions of pregnant women are wrongly told that they are anemic and are given iron supplements. There is a tendency both to overlook the side effects of iron (constipation, diarrhea, heartburn, etc.) and to forget that iron inhibits the absorption of such an important growth factor as zinc. Furthermore, iron is a powerful oxidative substance that can exacerbate the production of free radicals. The disease pre-eclampsia is associated with an ‘oxidative stress’. Pregnant women need antioxidants (provided in particular by fruit and vegetable) rather than oxidative substances.”

 

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