This document provides biographical information about Dr. Kirtan Vyas and discusses anaemia during pregnancy. It notes that anaemia is a major cause of maternal death in India, contributing to 19% of deaths. It then discusses iron deficiency anaemia in depth, including causes like dietary habits, intestinal infections, menorrhagia. It explains the increased iron demands during pregnancy and outlines methods for diagnosing and treating anaemia, including oral iron supplementation. The document also introduces heme iron polypeptide as a new approach to anaemia management that has higher absorption than ferrous sulfate with fewer side effects.

1. Anaemia in PregnancyAnaemia in Pregnancy
The Silent KillerThe Silent Killer
Dr. Kirtan Vyas
Assistant Professor
P. D. U. Medical College, Rajkot.

2. Gujarat Uni. First-Gold medallistGujarat Uni. First-Gold medallist
Gujarat Public Service Commission(GPSC) firstGujarat Public Service Commission(GPSC) first
Fellow in Gynec Endoscopy(Mumbai)Fellow in Gynec Endoscopy(Mumbai)
Fellow in Ultrasonography(FOGSI)Fellow in Ultrasonography(FOGSI)
Publications in various International JournalsPublications in various International Journals
Presented Scientific Papers and Chaired Sessions at State andPresented Scientific Papers and Chaired Sessions at State and
National conferencesNational conferences
Faculty at State and National ConferencesFaculty at State and National Conferences
Local Joint Secretary of SOGOG-Gujarat State Org of Ob Gy 2015Local Joint Secretary of SOGOG-Gujarat State Org of Ob Gy 2015
 Organizing Secretary for the First Rajkot Obstetrics and GynecOrganizing Secretary for the First Rajkot Obstetrics and Gynec
Society Annual Conference 2015 and Committee Member at State andSociety Annual Conference 2015 and Committee Member at State and
National conferencesNational conferences
Organizing secretary for the West Zone Yuva Fogsi 2016, RajkotOrganizing secretary for the West Zone Yuva Fogsi 2016, Rajkot
Faculty at FOGSI-JOGI PICSEP Scientific Program 2016 at RajkotFaculty at FOGSI-JOGI PICSEP Scientific Program 2016 at Rajkot
Presently an Assistant Professor at P.D. U. Medical College, RajkotPresently an Assistant Professor at P.D. U. Medical College, Rajkot
Dr. Kirtan VyasDr. Kirtan Vyas
M.S.(Ob/Gy)M.S.(Ob/Gy)

3.  WOMEN’S HEALTHWOMEN’S HEALTH is an important parameter of nation’s
development
 MATERNAL MORTALITYMATERNAL MORTALITY is more than a tragic irony; its
prevalence in the poorest countries contributes to instability and often
is the result of denial of basic human rights
Major causes
 Haemorrhage (29%)
 hypertension (8%)
 anaemia (19%)
 puerperal sepsis (16%)
 obstructed labour (10%) and
 abortion related deaths (9%)
Anaemia is not only an important cause of death but also an aggravating factor
in haemorrhage, sepsis and pregnancy induced hypertension.

4. ANAEMIAANAEMIA is not only causes
death but also an aggravating
factor in
•HaemorrhageHaemorrhage
•SepsisSepsis
•HypertensionHypertension

5. IDAIDA
• How common is the problem?
(Epidemiology)
• Why is it a problem? (Pathophysiology)
• How to recognize? (Diagnosis)
• What can we do about it? (Management)

6. ANAEMIA IN PREGNANCYANAEMIA IN PREGNANCY
• DEFINITION
– Decrease in oxygen carrying capacity in the
blood
• WHO STANDARDWHO STANDARD Hb < 11.0g/ dl or PCV < 33%Hb < 11.0g/ dl or PCV < 33%
• Incidence in India varies between 40% - 90%
• Anaemia contributes to directly to 20% of
maternal deaths and indirectly to 20%

7. SEVERITY OF ANAEMIASEVERITY OF ANAEMIA
ICMR categories
CategoryCategory SeveritySeverity Hemoglobin levelHemoglobin level
g/dlg/dl
1 Mild 10.0-10.9
2 Moderate 7-10.0
3 Severe < 7.0
4 Very severe < 4.0
Prevalence of Anaemia
Globally - 51%
India - 87.5%

8. Percentage of anemia in Pregnant
women
I

9. Milman N 2008

10. IRON DEFICIENCY ANAEMIAIRON DEFICIENCY ANAEMIA
•Leading single nutrient deficiency in the worldLeading single nutrient deficiency in the world
CAUSESCAUSES
1. DIETARY HABITS1. DIETARY HABITS
• Consumption of low bioavailability dietConsumption of low bioavailability diet
• Low level of enhancers of absorptionLow level of enhancers of absorption
• High level of Inhibitors of iron absorptionHigh level of Inhibitors of iron absorption
2. DEFECTIVE IRON ABSORPTION2. DEFECTIVE IRON ABSORPTION
• High prevalence of intestinal infestationHigh prevalence of intestinal infestation
• Hypochlorhydria (due to malnutrition)Hypochlorhydria (due to malnutrition)
3. IRON LOSS3. IRON LOSS
• Hookworm infestationHookworm infestation
• MenorrhagiaMenorrhagia
• HaemorrhoidsHaemorrhoids

11. DURING PREGNANCYDURING PREGNANCY
1. INCREASED DEMAND1. INCREASED DEMAND
• During first 20 weeks of pregnancy daily iron requirement – same as for
the non pregnant women.
• At about 20 weeks and thereafter iron requirement increases from
0.8mg to 7.5 mg/day.
2. DIMINISHED INTAKE OF IRON2. DIMINISHED INTAKE OF IRON
• Anorexia and vomiting
3. EXCESS DEMAND3. EXCESS DEMAND
• Multiple pregnancy (2 folds)
• Rapidly recurring pregnancy within 2 years

13. IDAIDA
•Diagnosis –
– Hb estimation,
– peripheral blood smear
– blood indices
–Estimation of S.Iron,
–TIBC and
–Ferritin are rarely indicated

14. IDA : Why is it a problem ?IDA : Why is it a problem ?

15. • Treatment of Iron Deficiency Anemia – Oral
200 mg elemental iron + 5.0 mg Folate per day
• Oral Iron is the treatment of choiceOral Iron is the treatment of choice
• Consider Parenteral Iron Therapy – if oral
iron cannot be tolerated, patient non-
compliant, or patient comes late in pregnancy
• Blood transfusion is rarely
required

16. Should Iron supplementation be started
in ALL pregnant women?

17. Absorption - only 10% to 15%
Haem iron more readily absorbed
DIETARY ADVICE?DIETARY ADVICE?

18. Do’s
Empty stomachEmpty stomach

19. Don’t
Don’t

20. Nausea,vomiting
Heart burn
Abdominal
discomfort
Constipation

21. Heam Iron Polypeptide
• Heme iron is found in foods that contained hemoglobin.
Heme Iron is extracted from hemoglobin, a naturally
occurring iron source found in red meat and poultry
Heme iron sources used, do not contain common
allergens, such as milk or wheat products, gluten, or
significant amounts of oils or fats
• Unlike traditional iron supplements like ferrous sulfate,
it is readily absorbed by the body and is generally free of
side-effects like heartburn and constipation
NEW ASPECT OF ANEMIANEW ASPECT OF ANEMIA
MANAGEMENTMANAGEMENT

22. ABSORPTION OF HAEM IRON
POLYPEPTIDE
Non Haem Haem
Absorption Rate 1-15 % 20-35 %
Absorption Process Simple diffusion Receptor mediated
endocytosis
Saturation Saturable Increases with intake
progressively
Effect of pH in absorption Alkaline pH has negative
effect
No effect

23. MECHANISM OF ABSORPTION &
METABOLISM
1. Absorbed over several hours after oral administration
2. Heme attaches to apical brush border of the absorptive
enterocyte.
3. Heme moiety binds to transferrin
4. Carried across brush border into the cytosol intact
5. Peak change in serum iron from a single dose is seen in 2
-4 hours & gently slopes thereafter for up to ten hours
*Seligman et al

25. HEME IRON POLYPEPTIDEHEME IRON POLYPEPTIDE
• Oral tablet containing 6/12 mg of
elemental iron as heme iron
polypeptide (HIP),
– With polypeptides of varying
molecular weights, porphyrin rings
• Peptides & amino acids are cleaved
during processing to increase the
concentration of the bioavailable iron
• *Bjorn-Rasmussen et al
26

26. Comparison of Heme Iron andComparison of Heme Iron and
Ferrous Sulphate – ReproductiveFerrous Sulphate – Reproductive
aged womenaged women
Women without IDA Women with IDA

27. EFFICACY OF HEME IRON POLY
PEPTIDE

28. • Pregnant women in the second half of pregnancy randomized into 3
groups
• Heme iron group- a combination of heme and non-heme iron
• Non heme iron group - non-heme iron with vitamin C
• Placebo group- placebo
These women were tested for red cell indices and iron status markers
(serum ferritin, serum Iron, total iron binding capacity and
erythrocyte protoporphyrin) throughout pregnancy and 8 and 24
weeks postpartum
The Haem Iron Group revealed superior response at all stages
COMPARATIVE IMPROVEMENT IN IRON STORES WITH
HEME IRON , NONHEME IRON AND PLACEBO TREATMENT
IN PREGNANT WOMEN

29. ADVANTAGES OF HEME IRON
Heme Iron Uses
• GI tolerability
comparable to IV iron,
• Reduced GI distress
• Higher Bioavailability
• Higher serum Fe,
Ferritin
Recommended Use
• One tab three times
daily
• With or without meals
Ideal alternative to traditional
iron therapy