Low hemoglobin during pregnancy

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

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

Epidemiology

The epidemiology of this pathology is very broad. Low hemoglobin occurs in every eighth woman, and as for pregnancy, every third pregnant woman has this pathology. This is explained by the presence of a risk factor, such as pregnancy, since the need for many useful substances and microelements increases. As for the etiology, more than 80% of all cases of low hemoglobin development during pregnancy are iron deficiency anemia.

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

Causes low hemoglobin in pregnancy

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

When speaking about the decrease in hemoglobin content in a unit of blood volume, we are talking about the so-called anemia, which can have many causes. It is necessary to classify such changes and highlight three main types of anemia - hemolytic, posthemorrhagic and deficiency anemia. Hemolytic anemia can be congenital or acquired. In the case of its congenital etiology, the decrease in hemoglobin content manifests itself immediately after birth and is hereditary. Such anemia during pregnancy is not widespread.

Often the cause of low hemoglobin content in a unit of blood volume during pregnancy is a chronic focus of blood loss, which is the basis for the development of posthemorrhagic anemia. In this case, the pathogenesis of the development of this type of anemia is constant long-term blood loss, which cannot be fully replenished due to the low rate of regeneration of the erythrocyte germ of hematopoiesis. The cause of such constant bleeding is most often ulcerative disease of the duodenum or stomach. In this case, the focus is an ulcer that was not treated before the period of pregnancy or it worsened; symptoms can be expressed in the form of constant black stool, which is more acceptable for diagnosis than the manifestation in the form of hidden blood in the stool.

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

B12 _- deficiency anemia develops when there is a deficiency of this vitamin in a woman's diet. Since the diet of a pregnant woman is somewhat limited and many useful substances and vitamins go to the child, the mother's body has a deficiency of these microelements. Therefore, when there is a deficiency of this vitamin in the diet, there is a sharp deficiency with the development of pathology. Also, the cause of the development of B12 _- 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 Castle. This factor promotes the normal absorption of vitamin B ₁₂, which is the external factor of Castle. When these components are combined, enzymes are activated that participate in many catalytic processes of the body. Therefore, with atrophic gastritis, the internal factor of Castle is not produced and normal metabolism of vitamin B ₁₂ does not occur, which is necessary, among other things, for the processes of formation of red blood cells, therefore, with its deficiency, the content of hemoglobin and erythrocytes in the liquid part of the blood decreases.

Iron deficiency anemia is the most common etiological factor of the symptomatology of decreased hemoglobin during pregnancy. This is due to the fact that iron is the main component of hemoglobin, so its deficiency leads to a deficiency of hemoglobin and red blood cells. The causes of decreased hemoglobin in pregnant women, due to iron deficiency, may be nonspecific.

First of all, there may be insufficient exogenous intake of this microelement with food. This may be due to nutritional disorders or gastrointestinal diseases, which are accompanied by decreased iron absorption. During pregnancy, increased iron depots are needed to form hemoglobin not only in maternal blood cells, but also in fetal erythrocytes. This should be taken into account by a woman when choosing a diet, because the amount of iron should be twice as much, but often this is not taken into account and iron deficiency anemia develops with increased needs. Another reason for the development of this type of anemia may be the 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, which are accompanied by blood loss or chronic diarrhea - these are peptic ulcer disease, nonspecific ulcerative colitis, Crohn's disease, hemorrhoids, portal hypertension;
• diseases of the digestive system, which are accompanied by impaired absorption - atrophic gastritis, malabsorption syndrome, maldigestion syndrome;
• women with insufficient nutritional status in terms of vitamin and microelement content;
• 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 examined during pregnancy for the development of anemia. Such women should also be given nutritional recommendations and include vitamin-rich foods in their diet.

Thus, there may be many reasons for the development of low hemoglobin during pregnancy, but there are the main ones - a deficiency of vitamin B 12 and iron, which is of priority importance during pregnancy. These reasons must be taken into account when prescribing etiological treatment.

[ 17 ], [ 18 ]

Symptoms low hemoglobin in pregnancy

The development of anemia in pregnant women often has a low-symptomatic course and the woman simply does not pay much attention to these symptoms, explaining them by pregnancy. But there are symptoms that in one way or another accurately indicate low hemoglobin, that is, the development of anemia.

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

Posthemorrhagic anemia develops slowly, as the body tries to cope with blood loss and red blood cell formation resumes. Therefore, the symptoms develop slowly. In this case, subjective signs come to the fore. The first signs of any anemia are visible pallor of the skin of a pregnant woman, general weakness, and malaise. But often these symptoms are not given special attention, although this is very important for diagnosing anemia at the initial stages 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 hemoglobin level, hypoxia of the brain develops so much that fainting may be observed. For the body of a pregnant woman, this is a dangerous symptom, because at this time, not only the woman's brain suffers from hypoxia, but also the child's brain.

Other symptoms that accompany a decrease in hemoglobin levels, if caused by a deficiency of vitamin B ₁₂, are gastrointestinal pathology. This may manifest itself in abdominal pain, indigestion 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 bright red tongue, 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 also occurs due to a violation of the mitotic activity of cells with a lack of vitamin B ₁₂, which contributes to a violation of the myelination of nerve fibers and a violation of nerve conduction. These changes occur against the background of a significant decrease in hemoglobin and in the case of a long-term course of anemia, this is a dangerous condition for a child, so it is necessary to identify symptoms even before such a clinic appears.

The most typical clinical signs of low hemoglobin against the background of iron deficiency anemia are the appearance of non-specific food preferences - often this is the need of a pregnant woman to eat 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, a diagnostic sign of iron deficiency can be the appearance of white stripes on the nails - this is also a symptom of low hemoglobin.

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

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

Complications and consequences

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

[ 19 ], [ 20 ], [ 21 ]

Diagnostics 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 diagnostics of the type of anemia and its etiology. Therefore, it is necessary to conduct a comprehensive examination of the woman aimed not only at confirming the diagnosis, but also at establishing the cause of such a hemoglobin level.

First of all, it is necessary to find out the anamnesis data and detail the woman's complaints. Certain signs of pathology may seem normal at first glance to the patient herself, so she will not focus on them. Therefore, it is important to accurately collect anamnesis, ask questions about food preferences, dizziness. Such symptoms are non-specific and often can simply not be noticed, so you need to ask about it. It is also important to clarify family history data 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 blood loss.

After collecting the anamnesis and detailing the complaints, it is necessary to examine the woman. During the examination, the first thing that catches the eye is the pronounced pallor of the skin and mucous membranes. Then, the blueness of the sclera can be established as a specific symptom of iron deficiency anemia. It is also necessary to auscultate the heart - changes are not mandatory, but systolic murmur at the apex of the heart is possible due to accelerated blood flow with a small volume of red blood cells. Also possible is the murmur of a spinning top - murmur in the area of the jugular veins.

The tests that are carried out in this pathology are aimed at establishing the type and nature of anemia. In this case, a comprehensive blood test is a mandatory method, which provides the most comprehensive information about the type of anemia, possible etiology, type of regeneration, and other changes.

Normal blood hemoglobin levels for women are 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, then we are talking about anemia. Also, anemia is divided into 4 types according to severity:

• 1st degree – hemoglobin level 90 – 110 g/l;
• 2nd degree – hemoglobin level 70 – 89 g/l;
• 3rd degree – hemoglobin level 50 – 69 g/l.

In case of hemolytic anemia, it is also necessary to conduct a biochemical blood test, 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 if there is a history of peptic ulcer, it is necessary to conduct the Gregersen reaction - for the presence of hidden blood in the feces. This will help identify a possible source of bleeding.

Blood analysis for B12 deficiency anemia has a very specific picture - a decrease in hemoglobin content, an increase in the color index of the blood above 1.05 (usually 1.2 and more), as well as the presence of a megaloblastic type of hematopoiesis or megaloblasts in the blood. These changes can form the basis for diagnosing B12 deficiency anemia, even if there is only one symptom. Also, if the changes in this anemia are more pronounced, additional research methods may be needed - instrumental - to identify the etiology.

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

With this type of anemia, it is necessary to conduct additional tests - determination of the iron level in the blood. If there is iron deficiency anemia, then the iron level will be less than 12.5 micromoles.

A general urine analysis should be performed to rule out kidney pathology, as they can also cause low hemoglobin during pregnancy if the level of erythropoietin decreases.

Instrumental diagnostics is aimed mainly at identifying gastrointestinal tract pathology. If there is a need or if posthemorrhagic anemia is suspected, fibrogastroduodenoscopy is performed. This allows identifying a possible bleeding ulcer. Atrophic gastritis is also possible, which contributes to the development of B12 deficiency anemia.

It is also necessary to conduct an electrocardiogram to rule out organic disorders of the heart.

If there are serious disturbances in nervous activity, then a consultation with a neurologist is necessary.

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

Differential diagnosis

Differential diagnostics of symptoms caused by low hemoglobin during pregnancy should be carried out, first of all, with organic pathologies of the heart, especially with pronounced cardialgic symptoms. It is also necessary to differentiate different types of anemia, which can be done even by the type of changes in the blood test. It is not difficult to distinguish between B12-deficiency anemia and iron deficiency anemia, because the main diagnostic sign is the presence of an increased color index in the first case. It is very important for adequate treatment to carry out differential diagnostics 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. Impaired sensitivity and hyperesthesia in B 12-deficiency anemia must be distinguished from a condition that can occur in pregnant women with a lack of magnesium - when neuromuscular conduction is impaired. In this case, paresthesias in anemia have a constant, pronounced character, which interferes with normal walking, and magnesium deficiency manifests itself only in cramps in the calf 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 during pregnancy and prescribe treatment. But do not fully investigate everything if it is a simple iron deficiency anemia during pregnancy, in this case it is a simple iron deficiency, which is easily explained by increased need.

Therefore, diagnostics must be approached in a differentiated manner.

Treatment low hemoglobin in pregnancy

The peculiarity of this pathology is the fact that the etiological focus is very important in treatment, and not just the replacement of the deficiency of one or another factor. Therefore, the treatment of low hemoglobin always involves a wide range of therapeutic measures, using non-drug methods and drugs.

How to increase low hemoglobin during pregnancy? Many pregnant women ask this question, because it is important not only to cure this pathology, but also not to harm the child.

In the first stage 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 microelements - iron or vitamin B12.

A diet for low hemoglobin during pregnancy should compensate for the lack of iron. The main products that should be in the diet are red meat. It contains a lot of iron, which is well absorbed. But you should not overeat, and you also need to cook the meat correctly - you can't fry it or cook it for a long time, because all the nutrients disappear. It is better to bake it in the oven in foil, which is both tasty and healthy. In addition, you need to enrich your diet with vitamins, especially vitamin C. It promotes better absorption of the microelement, so you need to eat oranges, lemons, sour apples, and 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. Pomegranate plays a special role as a product that stimulates hematopoiesis. Indeed, pomegranate alkaloids do not affect hemoglobin itself, but the formation of red blood cells in the bone marrow, accelerating the rate of proliferation of megaloblastic cells. Therefore, natural pomegranate juice is very useful for restoring the processes of red cell formation and should be included in the metabolism.

Do not forget about the general principles of nutrition - you need a regular regime with fractional portions, healthy products. The correct cooking technique is very important to preserve as many vitamins and microelements in food as possible. Fruits are best eaten raw, and as for vegetables, the best way to cook them is to boil them in water, but vegetables should be dipped in hot water, then more useful substances are preserved there.

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

Drug treatment of anemia during pregnancy is second only to dietary correction and is a mandatory method. The main principle of treating low hemoglobin is replenishment of missing elements, i.e. vitamin B12 or iron. Speaking about the most common cause during pregnancy - iron deficiency anemia, we should consider the principles of treatment of this disease.

Firstly, the main goal of treatment is replacement therapy with iron preparations. But it is necessary to take into account the cause of the development of pathology and conduct treatment accordingly. There are two main types of therapy - oral and parenteral. Oral therapy is carried out when the cause of low hemoglobin is its exogenous deficiency. Parenteral therapy is carried out if the process of iron absorption is disrupted in various digestive pathologies. Also, in case of pregnancy, injections are administered at the third and fourth degree of anemia, when there is a high risk of complications for the child and it is necessary to quickly restore the normal respiratory function of cells by resuming hematopoiesis.

Substitution therapy drugs may contain additional salts or molecules that help absorb iron more intensively. Therefore, all drugs can be divided into two groups. The first group includes drugs for enteral use and the main representatives are Ferroplex, Tardiferon, Fenotek, Aktiferrin, Ginotardiferon, Sorbifer, Ferronal, Hemoferon, Maltofer, Totema. These are not all the representatives, but the most common of them. Drugs for parenteral use are Ferum Lek and Venofer. Parenteral drugs can be taken for several days, and then switch to taking tablet drugs, this inclines the patient to such treatment, especially during pregnancy.

There are basic principles of treatment:

1. First, for successful therapy, it is necessary to prepare the gastric mucosa for maximum absorption of iron ions. To do this, it is necessary to cleanse it two or three times by prescribing laxatives.
2. It is necessary to take ascorbic acid concomitantly, which can be taken in the form of a vitamin supplement or simply pomegranate juice.
3. You cannot drink tea during treatment, because it binds ions and does not prevent normal absorption. You should also limit bakery products.
4. It is necessary to monitor the treatment by prescribing a control blood test, but not less than two weeks after the start of treatment. The course of treatment is long - from six to eight weeks.

• Sorbifer is an oral medication that contains iron sulfate and vitamin C, so its absorption is very high. This medication is available in the pharmacological form of tablets that contain one hundred milligrams of elemental iron. The dosage of the medication is one 380-milligram tablet twice a day. Side effects such as diarrhea, nausea, and an unpleasant taste in the mouth are possible, in which case the frequency should be reduced and taken only in the morning. Side effects are accompanied only by dyspeptic disorders. Precautions - the medication should not be taken with antacid medications, as the absorption of the components of the medication may be impaired, and changes in the color of the stool are also possible, which should be remembered and the patient should be warned about.
• Totema is a liquid oral medication that is widely used to treat this pathology and contains iron gluconate. This medication is available in the pharmacological form of ten-milliliter oral ampoules. Directions for use: the solution in the ampoule should be dissolved in water and taken one ampoule three times a day. Precautions: should be used with caution in the first trimester of pregnancy. Side effects are possible from the digestive system, as well as allergic reactions.
• Gino Tardiferon is an oral medication that contains iron sulfate, vitamin C and vitamin B12, which increases its benefits, especially in case of pregnancy. The dosage of the medication is tablets that should be taken one per day at the same time. Precautions - when used simultaneously with some antibiotics, their effect is impaired, which should be taken into account in this case. Side effects are possible from the digestive system in the form of dyspepsia, and dizziness, weakness, fatigue are also possible.
• Ferrum-Lek is a parenteral form, which is released in 2-milliliter ampoules, which contain one hundred milligrams of elemental iron. Method of administration - one ampoule should be administered intramuscularly every other day. Precautions - deep intramuscular injections should be made, since there may be local infiltrates. Side effects are possible with the first administration in the form of allergic reactions.

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

Folk remedies for low hemoglobin during pregnancy

Traditional methods of treatment should be combined with diet and replacement therapy. It is not recommended to use individual treatment with traditional methods, since there are not enough iron ions to replenish its deficiency. In the future, traditional methods can be used to prevent anemia. The main traditional methods of treatment are:

• Vitamin mousse gives a good effect. To prepare it, take a glass of natural pomegranate juice, carrot juice and a glass of orange or a shot of lemon juice. Mix everything and add two tablespoons of honey, then take three times a day for two weeks, one tablespoon.
• The hellebore plant should be infused in honey, then take this infusion one teaspoon three times a day. This is the first plant that has a direct effect on hematopoiesis, 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 prepare the medicine, garlic must be peeled, cut into slices and infused in honey for a day, then take such honey half a teaspoon once a day. The course is not less than ten days.

Basic recipes using herbs:

• Rose hips contain a lot of vitamin C. You need to drink rose hip tea after it has been steeped in 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 the formation of globin and acceleration of hematopoiesis.
• Two tablespoons of hellebore herb, two tablespoons of viburnum berries and the same amount of blackberry leaves should be infused in boiling water for ten minutes and drunk one glass once a day.
• Wormwood should be infused in honey and water in a one-to-one ratio for a week, then drink a teaspoon once a day. This solution also has a beneficial effect on digestion.

Homeopathy is widely used in gynecology, especially in the treatment of pregnant women to replenish vitamin reserves.

1. Ecoberin is a vitamin homeopathic remedy that is recommended to be taken 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 one homeopathic granule three times a day. Precautions - it is necessary to take according to the scheme for the most pronounced effect and at the same time. Side effects are rare.
2. Ubiquinone compositum is a homeopathic herbal remedy used to treat many pathologies, including increasing hemoglobin levels. It contains a huge amount of vitamins, coenzymes, and biologically active substances. The drug is available in ampoules that can be taken orally or parenterally. The dosage is one ampoule once a week. Precautions - should be used carefully during pregnancy. Side effects are possible with local administration.
3. Cuprum - Plus is a homeopathic remedy used in the complex therapy of anemia. The drug is available in the form of drops and the dosage is ten drops twice a day. Precautions - the drug contains alcohol, so it should be taken with caution during pregnancy, it is better to dilute in water. No side effects have been identified.
4. Pulsatilla Compositum is a drug used during pregnancy and improves not only blood circulation, but also has a beneficial effect on milk production. The drug is available in the pharmacological form of a solution in ampoules. The solution can be used intravenously, intramuscularly, and orally. The dosage of the drug is one ampoule should be divided into three weeks and taken once a week. Side effects are possible from 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, proper preparation of products, as well as maximum consumption of fresh vegetables and fruits. It is also important not to wash down food, vegetables and fruits with tea or coffee, because this reduces the absorption of iron ions.

It is recommended to start taking vitamins prophylactically before pregnancy, and to take vitamin complexes throughout pregnancy. Specific prophylaxis can be carried out for women at risk, for this purpose it is necessary to take prophylactic doses of iron replacement drugs. As for the prognosis, it is favorable at the first stage, as well as with timely treatment of the pathology.

Low hemoglobin during pregnancy is a problem that develops very often and requires timely medical attention to avoid complications. It is very important to undergo treatment for chronic diseases before pregnancy, 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 future child.

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