Anaemia is strongly linked to death in pregnancy —Expert

Anaemia in pregnant women is common but preventable. In this report by Sade Oguntola, experts say that its incidence is on the rise and that it contributes greatly to Nigeria’s maternal and infant morbidity and mortality.

 

Kareem Haruna, 40, recalls that his wife was admitted in the hospital a number of times during her third pregnancy because the doctor said that she had a condition called anaemia in pregnancy.

She had gotten pregnant in quick successions and while she didn’t experience it in her first two pregnancies, the condition reared itself in the third.

Mr Haruna became scared when he learnt that anaemia in pregnancy has led to the death of some pregnant women and their babies whether it is their first pregnancy or they have had other pregnancies before.

The World Health Organisation (WHO) has defined anaemia in pregnancy as the haemoglobin (Hb) concentration of less than 11 grammes per decilitre or blood-packed cell volume (PCV) that is less than 33 per cent.

Anaemia, which is characterised by a lack of healthy red blood cells, affects 32 million pregnant women worldwide and up to half of all pregnant women in low and middle-income countries (LMICs).

It is one of the most common medical problems pregnant women encounter in low and high income countries due to higher rates of dietary iron deficiency inherited blood disorders, nutrient deficiencies and infections such as malaria, Tuberculosis, HIV and hookworm.

But contributions of each of the factors that cause anaemia during pregnancy vary due to geographical location, dietary practice, and season.

In women who attended the antenatal clinic of General Hospital, Etinan, a sub-urban area in Akwa Ibom State, for instance, researchers found 70.67 per cent of anaemia among them at booking.

Anaemia was more in women in the rural area with low educational status that did not go for antenatal care or with low family income.

Also, it is more common among married women, those with fewer children or that had not used contraception, slept under insecticide-treated nets, or who had a recurrent fever.

This cross-sectional descriptive study that was published in the Asian Journal of Medicine and Health involved 375 pregnant women seen at the antenatal (booking) clinic of General Hospital, Etinan, between April and October 2018.

Currently, Nigeria is contributing a large number to the cases of anaemia in pregnancy in Africa and one common form of anaemia among pregnant women is iron-deficient anaemia.

Iron deficiency anaemia is caused by a shortage of iron in the body. Without adequate iron, your body cannot produce enough haemoglobin for red blood cells.

”Studies have put the prevalence of anaemia in pregnancy in Nigeria at between 35 and 75 per cent, depending on where the survey was carried out,” Dr Olayinka Ogunbode, a consultant obstetric and gynaecologist, University College Hospital (UCH), Ibadan, Oyo State, said.

At the UCH, Ibadan, at least one pregnant woman with anaemia in pregnancy is admitted once in two days, and sometimes coexisting with malaria.

He added, “There has been a marginal increase in the incidence of anaemia in pregnancy in the past three years at the hospital because many could not afford medical care.”

Dr Ogunbode said that anaemia in pregnancy is caused by many factors, but inadequate intake of diets rich in iron or poor nutrition is the commonest in Nigeria.

Severity of anaemia may vary from one woman to another. It can be mild when the PCV is more than 27 per cent but less than 30 per cent; moderate when it is between 18 and 27 per cent, and severe when it is less than 18 per cent.

Women with mild or moderate anaemia often tend to feel no symptom and anaemia is detected on screening alone. But as anaemia advances, the symptoms of fatigue, weakness, shortness of breath, frequent sore throats, headache, pica (unusual craving) and decreased appetite may occur.

Other symptoms can occur, depending on whether it is coexisting with vitamin B deficiency; they could have tingling sensation along their extremities.

If untreated, it can increase the risk of serious complications such as fainting spells, preterm delivery and postpartum haemorrhage (excessive bleeding after childbirth).

In addition to postpartum haemorrhage, anaemia also increases the risk of other life-threatening conditions, such as pre-eclampsia, placental abruption and cardiac failure.

Women who are anaemic are twice as likely to go into labour early and three times as likely to deliver a baby with low birth weight.

But much more, pregnant women with anaemia are twice as likely to die during or shortly after pregnancy compared to those without the condition.

According to a major international study, led by Queen Mary University of London,  if a woman develops severe anaemia at any point in her pregnancy or in the seven days after delivery, she is at a higher risk of dying, making urgent treatment even more important.

The research, published in the journal The Lancet Global Health with over 300,000 women participating from 29 countries, Nigeria inclusive, was a report of about 4,189 women who had severe anaemia (a blood count of less than 70 grammes per litre of blood) and was matched with 8,218 women without severe anaemia.

This analysis is the first to take into account factors that influence the development of anaemia in pregnancy such as blood loss or malaria infection, which may have been skewing the results of previous studies.

The study results showed that when all known contributing factors are controlled, the odds of maternal death are doubled in mothers with severe anaemia.

Also, in another study, corroborating that anaemia in pregnancy is better prevented, experts pointed out that pregnant women with anaemia are twice as likely to need blood transfusions after caesarean delivery as those without the condition.

The study presented at the ANESTHESIOLOGY® 2019 annual meeting said that most pregnant women should be screened early in their pregnancy for iron deficiency, which can lead to anaemia.

Often, women who are iron deficient but not anaemic early in pregnancy can become anaemic due to their increasing need for iron during pregnancy. Their anaemia often isn’t discovered until late in pregnancy, becoming more difficult to treat quickly and efficiently.

In the study, researchers analysed a prospective clinical registry as well as the electronic health records of 5,527 women who had a planned caesarean delivery during a four-and-a-half-year period.

Of these, 1,276 (23 per cent) tested positive for anaemia when they were admitted to the hospital for delivery. Of the women who had anaemia, 107 (8.4per cent) had blood transfusion as against 187 of the 4,251 women who didn’t have anaemia (4.4 per cent).

According to Dr Ogunbode, their babies are also more likely to be iron-deficient and experience delayed growth; and if this is not addressed appropriately, the baby can die. That is called intrauterine foetal death.

The choice of treatment for anaemia on pregnancy, he declared depends on the severity of anaemia or the duration of pregnancy and time available for delivery.

According to him, while good diet, iron tablets, folic acid and vitamin C are prescribed in mild to moderate cases, pregnant women with severe anaemia will require blood transfusion.

Dr Ogunbode added, “in their treatment too, we must treat any other underlying condition.”

He declared also that because the possibility of anaemia is higher in pregnant women that frequently vomit, such women are advised to take frequent small meals and to avoid meals or things that make them vomit.

He added that the prevention and treatment of anaemia in pregnancy include food fortification with iron, improving access to antenatal care in remote areas, hookworm treatment and providing access to transfusion services.