Anemia is common during pregnancy, affecting 37% of women in Jordan. It can cause complications for both mother and baby. The most common types are iron deficiency anemia and folic acid deficiency anemia. Key steps in managing anemia in pregnancy include screening all pregnant women, supplementing with iron and folic acid, treating identified cases, and educating women about nutrition. Treatment may involve oral or intravenous iron, blood transfusions, and managing underlying conditions like sickle cell anemia. Close monitoring is needed throughout pregnancy and delivery.

1. Anemia with pregnancy

2.  Definition
 Is defined as a haemoglobin concentration less than
10.5gm /dl , or if hematocrit falls to less than 30%.( WHO)
 Problem in the Jordan
 Anemia during pregnancy and breast feeding is 37%.
 23%-24% have mild anemia , 13.5% have moderate ,1% have
sever anaemia.
 Degree: Mild: 8-10gm%Degree: Mild: 8-10gm%
Moderate: 7-8gm%Moderate: 7-8gm%
Severe: <7gm%Severe: <7gm%
 According to UNICEF its found that more than 28% of women
of child bearing age were anaemic in Jordan.

3.  Causes and predisposing factors:
1- low iron intake
 low intake of iron-rich food
 nausea and vomiting
2- Increased demand
 heavy mens
 High parity
 bleeding haemorrhoids
3- Inadequate absorption /utilization of iron
 food that have a strong inhibiting effect on iron absorption , tea ,
coffee, egg, ca++ rich foods.
 Malabsorption syndrome.
 Decreased HCL.

4. 4- increased iron requirements:
 Increased demand from growing fetus , placenta.
 Low internal between 1st
and 2nd
pregnancy
 Effects of anemia on pregnancy :
 Maternal :
 abruptio placenta may be associated with maternal anaemia.
 high risk for PPH.
 High risk for infection puerperal sepsis.
 Poor lactation is often a consequence of anaemia.
 High risk of developing shock and death if Hge occur during
child birth (potential threat to life) .
 Reduced enjoyment of pregnancy and mother hood of to
fatigue.

5.  Fetal :
- increased of still birth neonatal deaths if
maternal Hb% decreased 8%.
-Increased incidence of pre-term labour.
-increased incidence of IUGR and hypoxia
** Note : the most common forms of anemia
are caused by deficiencies in iron and folic
acid.

6. Nurse role in the assessment of
women with anemia in pregnancy
 History taking: hx of any of the predisposing
factors.
 symptoms of anemia :
 C.V.S palpitation.
 C.N.S headache , visual disturbance , weakness ,
fatigability , drowsiness.
 R.S breathlessness.
 G.I.S anorexia , nausea , vomiting.
 G.U.S loss of libido.

7. Conjunctival PallorConjunctival Pallor

8.  Physical exam :
 General exam  pallor of the skin and mucous of
membrane , tachycardia, tiredness.
 Abdominal exam fundal height : less than the
gestational age
 Investigations :
 Laboratory investigation
 CBC and RBC
 HB < 10.5 gm/dl.
  RBC concentration < 5x10^6 /mm^3
  hypochromic & microcytic.

9. Normal Iron Requirements
 Iron requirement for normal pregnancy is 1gm
200 mg is excreted
300 mg is transferred to fetus
500 mg is need for mother
 Total volume of RBC inc is 450 ml
1 ml of RBCs contains 1.1 mg of iron
450 ml X 1.1 mg/ml = 500 mg
 Daily average is 6-7 mg/day

10.  Blood film.
 Reticulocytic count.
 Serous ferritin level.
 Ultrasound to check gestational age ,
placental site , amount of liqour & any
congenital fetal malformation.

11.  Normal hemoglobin by gestational age inNormal hemoglobin by gestational age in
pregnant women taking iron supplementpregnant women taking iron supplement
 12 wks12 wks 12.2 [11.0-13.4]12.2 [11.0-13.4]
 24wks24wks 11.6 [10.6-12.8]11.6 [10.6-12.8]
 40 wks40 wks 12.6 [11.2-13.6]12.6 [11.2-13.6]

12. Intervention in pregnant women with
anemia
 Prophylactic
 Importance of antenatal visits
 Encourage to attend the scheduled antenatal visit and explain
the importance of preventing & treating anemia in pregnancy.
 Educate the mother regarding the sources of food rich in iron &
folic acid , sea food , fruit , meat, egg , green vegetables.
 Advice to avoid poor eating habits & intake of enhancers of iron
absorption such as fruit , vegetables , vit C
 Iron supplementation  is very important during pregnancy & it
should be emphasized on all antenatal visits.

13. TreatmentTreatment
 Prophylactic: Supplement Fe – 60 mg: Supplement Fe – 60 mg
elemental Fe with Folic Acidelemental Fe with Folic Acid
 CurativeCurative: 200mg FeSo4 3 times daily till: 200mg FeSo4 3 times daily till
Hb level becomes normal, thenHb level becomes normal, then
maintenance dose of 1 tab formaintenance dose of 1 tab for
100 days100 days

14.  WHO recommended for iron supplementation
for any pregnant women :
 All pregnant women should be given the
standard dose of iron or folate (tab of 30 mg
iron + 400 mg folic acid/day ) every day  for
women with normal iron stores for 6 months
during pregnancy and continuing post partum
 Avoid iron supplement during 1st
trimester and
give after nausea subsided.

15. Curative and management of anemia
 Oral supplementation ferrous sulphate
 Parenteral iron therapy.
1. When diagnosed late in pregnancy
2. Malabsorption
3. Gastric intolerance to oral iron
 Blood transfusion
 During blood transfusion :monitor uterine activity ,
FM , FHR
 Plus routine observation

16. Natal and post natal care:
 Assess the Hb prior to delivery
 Give blood if Hb% decreased 10.5 mg/dl.
 Prevent infection.
 Insure adequate hydration.
 Practice an active management of 3rd
stage.
of labour advise to seek contraception.

17. Sickle cell anemia
 An inherited disorder caused by abnormal Hb% in
the blood (abnormal shape) lead to hypoxia ,
dehydration ,infection , fatigue crisis
 Effect on the pregnancy :
 Effect on the organs and placenta blockage of
vessels & infarcts in organs , blockage to the
placenta , circulation occurs lead to fetal death &
increase risk for abortion.

19. Management
 Blood transfusion to maintain hematocrit
increased 30%.
 Management during labour
 O2 supplement
 I.V fluid
 fetal monitoring
 antibiotic if C/S birth

20. Effects on pregnancyEffects on pregnancy
 Increase incidence of abortion, prematurity,Increase incidence of abortion, prematurity,
IUGR and Fetal loss.IUGR and Fetal loss.
 Perinatal mortality is high.Perinatal mortality is high.
 Incidence of pre-eclampsia, postpartumIncidence of pre-eclampsia, postpartum
hemorrhage and infection is increased.hemorrhage and infection is increased.

21. Thalasemia
 Abnormal Hb  haemolysis
 Risk for infection.
 Avoid iron accumulation by using
chelating factor.
 Monitor fetal and maternal condition.

22. Folic acid deficiency anemia
(megaloplastic anemia(
 Folic acid is needed for increased cell growth of both mother
and fetus (necessary in all body cells synthesis DNA)
 Occurs as a result of inadequate intake , poor absorption ,
increased use & poor cooking habits.
 Decreased folic associated with decreased B12 vit
 Decreased folic acid associated with decreased iron mainly
 Occurs in the last trimester due to increased demand &
decreased intake

23. Pernicious anemia (vit B12 deficiency(
 In adequate intake  vegetarian
 Common in elderly person & females