18.2 Anaemia in pregnancy
Women with anaemia have less strength for childbirth and are more likely to bleed heavily afterwards (postpartum haemorrhage), become ill after childbirth, or even die. You have already learned a lot about the diagnosis and prevention of anaemia in earlier study sessions in this Module, so in this session we will focus on its treatment and reinforcing what you have learned already.
What is anaemia and what happens in the body of an anaemic person?
When someone has anaemia, it usually means the person has not been able to eat enough foods containing iron. Red blood cells need iron to make haemoglobin, the substance that helps the red blood cells carry oxygen from the air we breathe to all parts of the body. A person with anaemia can’t make enough red blood cells, so their body is short of oxygen.
Note that some kinds of anaemia are caused by illness, not lack of iron, and some are inherited (genetic). It may also be caused by infestation with certain parasites, including malaria and hookworm. In this session we are concerned with anaemia caused by iron deficiency in the diet. Many pregnant women have anaemia, especially poor women who can’t afford to eat enough iron-rich foods, as you already know from Study Session 14.
18.2.1 Diagnosis of anaemia
Screen all pregnant women for anaemia at every antenatal visit, by asking about their symptoms. Useful questions to ask are:
- ‘Do you feel weak or get tired easily?’
- ‘Are you breathless (short of breath) when you do routine household work?’
- ‘Do you often feel dizzy, and have you ever fainted (become unconscious)?
These symptoms are caused by too little oxygen in the blood to provide energy for normal activities. A person with anaemia tends to feel short of breath because they have to breathe more rapidly to get enough oxygen into their body. If the brain can’t get enough oxygen, the person will feel dizzy and may faint.
The signs of anaemia (things a trained health professional can look out for or measure) are:
- Pallor: paleness inside eyelids, palms of the hands, fingernails and gums.
- Rapid breathing (faster than 40 breaths in a minute; normal breathing rate is 18-30 breaths per minute).
- Fast pulse (over 100 beats in a minute). You learned how to measure the pulse rate in Study Session 9 (Section 9.4).
On the first antenatal care visit
If you suspect that the woman may be anaemic, encourage her to have a blood test for anaemia if it is available at the nearest Health Centre. The blood test measures the concentration of haemoglobin (the iron-containing substance in the blood) to see if there is enough to carry the oxygen that she needs for normal activity and her unborn baby needs for growth. If blood testing is not available, use your judgement of the known signs and symptoms (listed above) to diagnose anaemia and offer treatment as described below.
On subsequent antenatal care visits
If you are concerned that a pregnant woman has anaemia and she is not responding to the treatment you give her, you should refer her to a Health Centre straight away.
- Look for pallor inside her eyelids, hands, fingernails and gums.
- Take her pulse. Is it over 100 beats per minute?
- Count the number of breaths she takes in 1 minute. Is it faster than 40 breaths?
Anaemia poses a serious risk to her health and that of her baby, especially around the time of delivery.