Low hemoglobin during pregnancy

Low hemoglobin in pregnancy is one of the most frequent pathologies of healthy pregnant women, which can occur at any time and cause complications of not only pregnancy, but also childbirth. This pathology is important in the pathogenesis of the development of various disorders from the fetus, so a clear screening program for diagnosing this condition is needed. It is also important to know the main symptoms that occur in this pathology, and the methods of its prevention.

[1], [2], [3], [4], [5], [6]

Epidemiology

The epidemiology of this pathology is very wide. Low hemoglobin is found in every eighth woman, and as for pregnancy, every third of a pregnant woman has this pathology. This is due to the presence of a risk factor, such as pregnancy, as the demand for many useful substances and trace elements increases. As for etiology, more than 80% of all cases of low hemoglobin development in pregnancy is iron deficiency anemia.

[7], [8], [9], [10], [11], [12], [13],

Causes of the low hemoglobin in pregnancy

Hemoglobin is the main component of erythrocytes - red blood cells. Erythrocytes provide the transfer of the oxygen molecule from the lungs to all cells of the female body precisely due to the content of hemoglobin in its composition. The hemoglobin molecule itself contains a globin protein on which the heme is configured - it is a complex prostacyclic compound that contains in the center an iron molecule. It is the trace element of trivalent iron that attaches an oxygen molecule, and then gives it to the cell during oxidation. Such a complex structure of hemoglobin and provides its main function in the transfer of oxygen and maintenance of cellular respiration. Therefore, hemoglobin deficiency, especially in pregnant women, can cause serious disruption in the health of both mother and child. But for the normative index of the hemoglobin content, it is very important to have a normal level of iron as a component of the heme.

Talking about the reduction of hemoglobin in a unit of blood volume, it is a question of so-called anemia, which can have many causes. It is necessary to classify these changes and identify three main types of anemia - hemolytic, posthemorrhagic and scarce anemia. Hemolytic anemia can be congenital in nature or be acquired. In the case of its inherent etiology, a decrease in the hemoglobin content manifests itself immediately after birth and this has a hereditary character. Such anemia in pregnancy is not widespread.

Often, the reason for the low hemoglobin content in a unit of blood volume during the period of gestation is the chronic foci of blood loss, which is the basis for the development of posthemoragic anemia. In this case, the pathogenesis of this type of anemia is the constant long-term blood loss, which can not be completely compensated because of the low rate of regeneration of the erythrocyte germ of the hematopoiesis. The cause of such constant bleeding is most often peptic ulcer of the duodenum or stomach. At the same time, the focus is an ulcer that has not been treated before the period of pregnancy or it has worsened symptoms can be expressed in the form of a permanent black stool, which for diagnosis is more acceptable than the manifestation in the form of hidden blood in the stool.

In most cases, the decrease in hemoglobin during pregnancy is due to the deficiency of the structural elements necessary for the formation of the heme molecule, that is, for the normal process of myelopoiesis in the bone marrow. There can be two main reasons for the development of this condition - vitamin B ₁₂ deficiency and iron deficiency.

In ₁₂ - deficiency anemia develops when this vitamin is deficient in a woman's diet. Since the diet of a pregnant woman is slightly limited and many useful substances and vitamins come to the child, the mother organism has a deficiency of these trace elements. Therefore, when this vitamin is deficient in the diet, there is a sharp deficit with the development of pathology. Also, the development of B ₁₂ deficiency anemia is often a violation of the normal structure of the gastrointestinal tract with the development of atrophic gastritis.

The mechanism of disorders in this pathology is that special cells of the stomach produce a special coenzyme - the internal factor of Kastla. This factor contributes to the normal absorption of vitamin B ₁₂, which is an external factor of Kastla. When these components are combined, enzymes are activated, which take part in many catalytic processes of the body. Therefore, with atrophic gastritis, Castle's internal factor is not produced and there is no normal metabolism of vitamin B ₁₂, which is necessary, including for the formation of red blood cells, so when it is deficient, the content of hemoglobin and erythrocytes in the liquid part of the blood decreases.

Iron deficiency anemia is the most common etiologic factor of the symptomatology of lowering hemoglobin in carrying a child. This is due to the fact that iron - the main constituent of hemoglobin, so when it is deficient develops a deficiency of hemoglobin and erythrocytes. The reasons for the decrease in hemoglobin in pregnant women, due to iron deficiency can be nonspecific.

First of all, there may be an insufficient exogenous supply of this trace element with food. This can be due to eating disorders or diseases of the digestive tract, which are accompanied by a decrease in iron absorption. During pregnancy, elevated iron stores are needed to form hemoglobin not only of the maternal blood cells, but also of the fetal erythrocytes. This should be taken into account by the woman in choosing food, because the amount of iron should be twice as much, and often this is not taken into account and iron deficiency anemia develops with its increased needs. Another reason for the development of this type of anemia may be a deficiency of transferrin, an enzyme that transfers iron to the red bone marrow for myelopoiesis. This can also be accompanied by the development of anemia.

[14], [15], [16],

Risk factors

It is necessary to identify risk factors for the development of low hemoglobin during pregnancy. This group includes women with the following pathologies:

• chronic diseases of the digestive system that are accompanied by blood loss or chronic diarrhea - a peptic ulcer, ulcerative colitis, Crohn's disease, hemorrhoids, portal hypertension;
• diseases of the digestive system, which are accompanied by a violation of absorption - atrophic gastritis, malabsorption syndrome, maldigestia syndrome;
• women with insufficient nutritional status for the content of vitamins and trace elements;
• pregnancy in the autumn-winter period;
• hereditary pathologies of metabolism and enzymes.

Given these risk factors, women in this group should be carefully and regularly screened when carrying a child for the development of anemia. Also, such women need to give advice on nutrition and include in the diet of vitamin products.

Thus, there may be many reasons for developing low hemoglobin during pregnancy, but there are basic ones - this is a deficiency of vitamin B 12 and iron, which is a priority during pregnancy. These reasons must be taken into account in the appointment of etiological treatment.

[17], [18]

Symptoms of the low hemoglobin in pregnancy

The development of anemia in pregnant women often has a mildly asymptomatic course and the woman simply does not pay much attention to these symptoms, explaining them specifically as pregnancy. But there are those symptoms that somehow accurately indicate a low hemoglobin, that is, the development of anemia.

Hemolytic anemia develops during pregnancy rarely and the only, but very clear and constant diagnostic symptom of this disease is the appearance of yellow skin color and sclera that develops against the background of the breakdown of red blood cells and the formation of bilirubin. But the given process develops not often during pregnancy, as the acquired hemolytic anemia develops against a background of toxic substances that at pregnancy it is avoided as much as possible.

Posthemoragic anemia develops slowly, as the body tries to cope with blood loss and resumes erythrocyte formation. Therefore, the symptomatology develops slowly. In this case, subjective signs come to the fore. The first signs of any anemia - this is the visible pallor of the skin of a pregnant woman, general weakness, malaise. But often these symptoms are not paid special attention, although it is very important for the diagnosis of anemia at the initial stages of the development of the process and its timely correction.

There may be other subjective symptoms that accompany the anemic syndrome. Often, against the background of a reduced level of hemoglobin, hypoxia of the brain develops so much that fainting may occur. For an organism of a pregnant woman this is a dangerous symptom, because at this time, not only the brain of a woman, but also the child's brain, suffers from hypoxia.

Other symptoms that accompany a decrease in hemoglobin, if it is caused by a deficiency of vitamin B ₁₂ - is the pathology of the digestive tract. This can be manifested by abdominal pain, a digestive disorder with the development of diarrhea, which is difficult to correct, as well as vomiting, weight loss. In this case there will be a specific symptom - a language of bright red color, which is caused by the detachment of the papillae of the tongue due to a violation of cell division. There may also be clinical manifestations from the nervous system - sensitivity is impaired due to the development of funicular myelosis. This is also due to a violation of the mitotic activity of cells with a lack of vitamin B ₁₂, which contributes to the violation of myelination of nerve fibers and disruption of nerve conduction. These changes occur against a background of a significant decrease in hemoglobin and in the case of prolonged anemia, this is a dangerous condition for the child, so it is necessary to identify the symptoms before the appearance of such a clinic.

The most typical clinical signs of low hemoglobin against iron deficiency anemia are the appearance of nonspecific preferences in food - often this need of a pregnant woman is chalk or clay. These symptoms are not taken seriously and are explained by pregnancy, but this is a very clear sign of the development of iron deficiency anemia, so if you have such a symptom you need to pay attention to it. Also the diagnostic sign of a lack of iron can be the appearance of white stripes on the nails - this is also a symptom of low hemoglobin.

Dizziness, drowsiness, lethargy are also clinical symptoms of this process.

These are the main symptoms that can develop against a background of low hemoglobin in pregnancy, so early detection of these symptoms helps in the timely and adequate treatment of anemia.

Complications and consequences

What is the danger of low hemoglobin in pregnancy? First of all, in the case of anemia in the first trimester of pregnancy, there is a risk of disrupting the development and differentiation of the child's tissues. This is due to oxygen deficiency, which is necessary for normal cell division and fetal formation. Therefore, for the child there is a danger of breaking the cellular differentiation with the development of congenital malformations. The consequence of low hemoglobin can be the development of chronic fetal hypoxia and placental abnormalities, which can cause hypoxic changes and damage to the central nervous system of the child, which further threatens the development of organic pathologies of the nervous system.

[19], [20], [21]

Diagnostics of the low hemoglobin in pregnancy

It is very important not only to correctly diagnose low hemoglobin in pregnant women, as a symptom of anemia, but also to conduct differential diagnosis of the type of anemia and its etiology. Therefore, it is necessary to conduct a comprehensive examination of a woman aimed not only at confirming the diagnosis, but also on establishing the cause of this level of hemoglobin.

First of all, it is necessary to find out the history and detail the complaints of a woman. Certain signs of pathology may seem at first sight normal for the patient herself, so she will not focus on them. Because it is important to accurately collect anamnesis, ask questions about eating habits, dizziness. Such symptoms are nonspecific and often can be simply not seen, so you need to ask about it. It is also important to clarify the data of the family history and the presence of concomitant pathologies of the gastrointestinal tract. This will help in diagnosing a possible cause of low hemoglobin. It is necessary to clarify the presence of hemorrhoids or foci of chronic hemorrhage.

After collecting the anamnesis and detailing the complaints it is necessary to examine the woman. On examination, the first thing that catches your eye is the pronounced pallor of the skin and mucous membranes. Next, you can set the blueness of the sclera as a specific symptom of iron deficiency anemia. It is also necessary to perform auscultation of the heart - changes are not necessary, but systolic murmurs at the apex of the heart are possible because of accelerated blood flow with a small volume of red blood cells. Also noise of a yula - noise in the field of the jugular veins is possible.

Analyzes that are carried out with this pathology are for the purpose to establish the type and nature of anemia. A compulsory method is a detailed blood test, which gives the widest information about the type of anemia, possible etiology, type of regeneration, and other changes.

Normal blood hemoglobin for women is 120-140 g / l, and for men - 130-160 g / l. If the decrease in hemoglobin in pregnant women is less than 110 g / l, it is an anemia. Also anemia in terms of severity is divided into 4 types:

• 1 degree - the level of hemoglobin 90 - 110 g / l;
• 2 degree - hemoglobin level 70 - 89 g / l;
• 3 degree - the level of hemoglobin 50 - 69 g / l.

In hemolytic anemia, a biochemical blood test should also be performed, which will have a characteristic system - an increase in total hemoglobin due to its indirect fraction and a positive Coombs test.

In chronic posthemorrhagic anemia, especially when there is a history of peptic ulcer, it is necessary to carry out Gregersen's reaction - for the presence of latent blood in the stool. This will help to identify a possible source of bleeding.

A blood test for B 12 deficiency anemia has a very specific picture - a decrease in hemoglobin, an increase in the color index of blood above 1.05 (more often it is 1.2 or more), and the presence of a megaloblastic type of hematopoiesis or megaloblasts in the blood. These changes can form the basis for the diagnosis of B 12-deficiency anemia, even with only one symptom. Also, if changes in this anemia are more pronounced, additional methods of investigation may be needed - instrumental ones - for the detection of etiology.

When iron deficiency anemia is also observed a pattern of blood in the form of a decrease in hemoglobin, a decrease in the color index of blood less than 0.85 (usually 0.7 and lower), as well as the presence of poikilocytosis, anisocytosis of erythrocytes.

For this type of anemia, additional tests are needed - the determination of the level of iron in the blood. If there is iron deficiency anemia, then the iron level will be less than 12.5 micromolar.

It is necessary to conduct a general analysis of urine to exclude renal pathology, because they can also cause the development of low hemoglobin during the period of bearing of the child in case of a decrease in the level of erythropoietin.

Instrumental diagnosis is aimed mainly at identifying the pathology of the gastrointestinal tract. If there is a need or if there is a suspicion of posthemorrhagic anemia, fibroadastroduodenoscopy is performed. This allows you to identify a possible bleeding ulcer. It is also possible atrophic gastritis, which contributes to the development of B12 deficiency anemia.

It is also necessary to carry out electrocardiography to exclude organic disorders from the heart.

If there are serious disorders of nervous activity, then a consultation of a neurologist is needed.

[22], [23], [24], [25],

Differential diagnosis

Differential diagnosis of symptoms that is caused by low hemoglobin in pregnancy should be carried out, first of all, with organic pathologies of the heart, especially with severe cardial symptoms. It is also necessary to differentiate different types of anemia, which can be done even by the type of blood test changes. Distinguish B12 - deficiency anemia and iron deficiency anemia is not difficult, because the main diagnostic feature is the presence of an increased color index in the first case. It is very important for adequate treatment to conduct differential diagnosis of iron deficiency and iron-refractory anemia. This will help determine the level of iron, which is reduced in the first case and increased in the second. Disturbance of sensitivity and hyperesthesia with B 12 deficiency anemia must be distinguished from the state that can be in pregnant women with a lack of magnesium - when neuro-muscular conduction is disrupted. In this case, paresthesias in anemia have a permanent pronounced character that prevents walking normally, and magnesium deficiency manifests itself only by cramps in the gastrocnemius muscles, mainly at night. In this case, for the purpose of differential diagnosis, it is necessary to determine the level of electrolytes in the blood.

This is the main diagnostic program necessary to establish the cause of low hemoglobin in pregnancy and treatment. But one should not fully investigate if it is a simple iron deficiency anemia in pregnancy, in which case it is a simple iron deficiency, which is easily explained by an increased need.

Therefore, the diagnosis should be differentiated.

Treatment of the low hemoglobin in pregnancy

The peculiarity of this pathology is the fact that the etiological orientation is very important in the treatment, and not only the substitution of a deficiency of this or that factor. Therefore, the treatment of low hemoglobin always provides for a wide range of therapeutic measures, using non-drug methods and medicines.

How to raise low hemoglobin during pregnancy? This question is asked by many pregnant women, because it is important not only to cure this pathology, but also not to harm the child.

At the first degree of anemia, when the hemoglobin level is not significantly reduced and the numbers do not reach critical values, the main treatment is exogenous sources of missing trace elements - iron or vitamin B12.

A diet with low hemoglobin in pregnancy should replace a lack of iron. At the same time, the main products that should be in the diet are red meat. It contains a lot of iron, which is well absorbed. But do not overeat, and you need to properly cook meat - you can not fry it or cook for a long time, because all the useful substances disappear. Better bake it in the oven in foil, which is tasty and useful. In addition, you need to enrich your diet with vitamins, especially vitamin C. It promotes a better absorption of the trace element, so you need to eat oranges, lemons, apples of acidic varieties, pomegranate every day. Also, if you want to replenish the deficiency of B vitamins - you need to eat greens - spinach, sorrel, dill, parsley, green salad. A special role is assigned to a grenade, as a product that stimulates blood formation. Indeed, garnet alkaloids affect not the hemoglobin itself, but the formation of erythrocytes in the bone marrow, accelerating the proliferation rate of megaloblastic cells. Therefore, natural pomegranate juice is very useful for restoring the formation of red cells and must be included in the metabolism.

Do not forget about the general principles of nutrition - you need a regular regime with fractional portions, useful products. It is very important that the correct cooking technique is used to preserve as many vitamins and trace elements as possible in food. Fruits are better to eat raw, and as for vegetables, the best way of cooking is cooking in water, but vegetables need to be lowered into hot water, then more useful substances are stored there.

The products that need to be included in the diet with low hemoglobin are not only vitamins, but also nutritional supplements, to which one can include hematogen. This substance, which contains molecules of albumin, necessary for the formation of globin in the structure of red blood cells. Therefore, the use of this product will be uniquely useful for any type of anemia, but one should not get carried away with this product, because it has an alogenic protein, which in a pregnant woman can cause a strong allergic reaction. Therefore, it is not recommended to use more than two tiles per day.

Medical treatment of anemia during pregnancy is the second most important after correction of diet and is a mandatory method. The main principle of treating low hemoglobin is the replenishment of missing elements, that is, vitamin B12 or iron. Speaking of the most common reason during pregnancy is iron deficiency anemia, it is necessary to consider the principles of treatment for this particular disease.

First, the main goal of treatment is replacement therapy with iron preparations. But you need to consider the cause of the development of pathology and according to this, carry out treatment. There are two main types of therapy - oral and parenteral. Oral therapy is performed when the cause of low hemoglobin is its exogenous deficiency. Parenteral therapy is carried out in the event that the process of assimilation of iron is disrupted for various pathologies of digestion. Also, in case of pregnancy, injection drugs are administered at the third and fourth degree of anemia, when a high risk of complications for the child and it is necessary to quickly resume the normal respiratory function of the cells due to the resumption of hematopoiesis.

Drugs of substitution therapy can have in their composition additional salts or molecules that help to absorb iron more intensively. Therefore, you can divide all medicines into two groups. The first group includes medicines for the use of the common use and the main representatives are Ferroplex, Tardiferon, Fenotek, Aktiferrin, Ginotardiferon, Sorbifer, Ferronal, Hemoferon, Maltofer, Totema. These are not all representatives, but the most common ones. Preparations for parenteral use are Ferum Lek and Venofer. Parenteral drugs can be taken for several days, and then go to the reception of tablets, this inclines the patient to such treatment, and especially during pregnancy.

There are basic principles of treatment:

1. First, for successful therapy, it is necessary to prepare the gastric mucosa for maximum assimilation of iron ions. For this, two to three times, it is necessary to carry out purification by the appointment of scavengers.
2. It is necessary concomitant reception of ascorbic acid, which can be taken in the form of a vitamin preparation or simply pomegranate juice.
3. You can not drink tea while treating, because it binds ions and does not interfere with normal digestion. It is also necessary to limit the bakery products.
4. It is obligatory to carry out the control of treatment, by appointment of the control analysis of a blood, but not less than in two weeks from the beginning of treatment. The course of treatment is long - from six to eight weeks.

• Sorbifer - a preparation for oral intake, which contains ferrous sulfate and vitamin C, so its assimilation is very high. This drug is produced in pharmacological form of tablets, which contain one hundred milligrams of elemental iron. The dosage of the drug is one tablet of 380 milligrams twice a day. There are side effects in the form of diarrhea, nausea, an unpleasant aftertaste in the mouth, then you need to reduce the multiplicity and take it only in the morning. Side effects are accompanied only by dyspepsia. Precautions - the drug can not be taken with antacids, it may be a violation of the assimilation of the components of the drug, it is also possible to change the color of the stool, which should be remembered and warned of the patient.
• Totem is a preparation for oral administration in liquid form, which is widely used for the treatment of this pathology and contains iron gluconate. This drug is issued in the form of pharmacological ampoules for oral administration of ten milliliters. Method of application - the solution in the ampoule must be dissolved in water and take one ampoule three times a day. Precautions - should be used neatly in the first trimester of pregnancy. Side effects are possible on the part of the digestive system, as well as allergic reactions.
• Gino Tardiferone is a drug for oral use that contains ferrous sulfate, vitamin C and vitamin B12, which increases its benefit, especially in the case of pregnancy. Dosage of the drug - tablets, which must be taken one at a time at the same time. Precautions - when combined with certain antibiotics, their effect is disturbed, which should be taken into account in this case. Side effects are possible on the part of the digestive system in the form of dyspepsia, as well as dizziness, weakness, fatigue.
• Ferrum - Lek is a parenteral form that is released in ampoules of 2 milliliters, which contains one hundred milligrams of elemental iron. Method of application - one ampoule must be administered intramuscularly every other day. Precautions - you need to do deep intramuscular injections, because there may be local infiltrates. Side effects are possible with the first introduction in the form of allergic manifestations.

Duration of treatment with these drugs should not be less than a month, because there may be insufficient effect even if you feel well.

Alternative treatment of low hemoglobin in pregnancy

Alternative therapies should be combined with diet and substitution therapy. Use individual treatment with alternative means is not recommended, since there is not enough iron ions to replenish its deficiency. In the future, alternative methods for the prevention of anemia can be used. The main alternative therapies:

• A good effect gives vitamin mousse. For its preparation you need to take a glass of natural pomegranate juice, carrot juice and a glass of orange juice or a stack of lemon juice. All this must be mixed and add two tablespoons of honey, then take three times a day for two weeks on a tablespoon.
• Plant hellebore need to insist on honey, then take this infusion over a teaspoon three times a day. This is the first plant that has a direct effect on hemopoiesis, so it is very effective in this case.
• Garlic is an effective bactericidal product, and it also has an effect on the absorption of vitamins due to the content of ascorbic acid. To make the medicine, garlic must be cleaned, cut into slices and insist on honey for a day, after which take such honey half a teaspoon once a day. Course not less than ten days.

Basic recipes using herbs:

• A lot of vitamin C contains rose hips. It is necessary to take tea from the dogrose after it was infused into the water for several minutes. You need to drink this tea three times a day. It has an additional positive effect on the liver, stimulating the synthesis of proteins necessary for globin formation and acceleration of hemopoiesis.
• Two tablespoons of grass hellebore, two tablespoons of fruits of the viburnum and the same number of leaves of blackberries need to insist in boiling water for ten minutes and drink a glass once a day.
• Wormwood should be insisted in honey and water in a one to one ratio throughout the week, then drink a teaspoon once a day. Such a solution also has a beneficial effect on digestion.

Homeopathy is widely used in gynecology, especially when treating pregnant women to replenish vitamins.

1. Eco - berin is a vitamin homeopathic remedy, which is recommended during pregnancy. Vitamins and microelements of the drug restore the balance of not only microelements, but also vitamin C, B, E. The drug is used for one homoeopathic granule three times a day. Precautions - you need to take the scheme for the most pronounced effect and at the same time. Side effects are rare.
2. Ubiquinone compositum is a homeopathic remedy of plant composition, which is used to treat many pathologies, including to increase the hemoglobin content. It contains a huge amount of vitamins, coenzymes and biologically active substances. The drug is available in ampoules, which can be taken orally or parenterally. Dosage one ampoule once a week. Precautions - you need to use it carefully during pregnancy. Side effects are possible with local administration.
3. Kuprum - Plus is a homeopathic remedy that is used in the complex therapy of anemia. The drug is available in the form of drops and dosage of ten drops twice a day. Precautions - the drug contains alcohol, so it must be taken with caution in pregnancy, it is better to plant in water. There were no side effects.
4. Pulsatilla Compositum is a drug that is used in pregnancy and improves not only blood circulation, but also has a beneficial effect on the formation of milk. The drug is released in pharmacological form of a solution in ampoules. You can apply the solution intravenously, intramuscularly, and also orally. Dosage of the drug - one ampoule should be divided into three weeks and taken once a week. Side effects are possible on the part of the digestive system. Precautions - use with caution in case of allergy to sulfur.

[26], [27], [28], [29], [30], [31]

Prevention

Therefore, it is important not only to detect this pathology in time, but also to prevent it. It is necessary to organize proper nutrition, especially during pregnancy, when there is a shortage of many useful substances. It is necessary to organize a diet, the correct preparation of foods, as well as the maximum consumption of fresh vegetables and fruits. It is also important not to wash down food, vegetables and fruits, tea or coffee, because it reduces the absorption of iron ions.

It is recommended to start a preventive intake of vitamins before pregnancy, and also take vitamin complexes throughout pregnancy. You can conduct specific prevention for women at risk, for this you need to take preventive doses of iron substitutes. As for the prognosis, it is favorable at the first degree, as well as with the timely treatment of pathology.

Low hemoglobin during pregnancy is a problem that develops very often and requires timely treatment to a doctor to avoid complications. It is very important before pregnancy to undergo treatment of chronic diseases, including diseases of the digestive system. It is better to prevent the development of this pathology by proper nutrition and preventive intake of vitamins, which is important for the health of the mother and the health of the unborn child.

[32], [33], [34], [35], [36],