Abstract
Anemia is a common problem in obstetrics and perinatal care. Any hemoglobin (Hb) below 10.5 g/dl can be regarded as true anemia regardless of gestational age. Main cause of anemia in obstetrics is iron deficiency, which has a worldwide prevalence between estimated 20 and 80% of especially female population. Stages of iron deficiency are depletion of iron stores, iron-deficient erythropoiesis without anemia and iron-deficiency anemia, the most pronounced form of iron deficiency. Pregnancy anemia can be aggravated by various conditions such as uterine or placental bleedings, gastrointestinal bleedings and peripartum blood loss. Beside the general consequences of anemia, there are specific risks during pregnancy for the mother and the fetus such as intrauterine growth retardation, prematurity, feto-placental miss-ratio and higher risk for peripartum blood transfusion. Beside the importance of prophylaxis of iron deficiency, main therapy options for the treatment of pregnancy anemia are oral iron and intravenous iron preparations.
Financial & competing interests disclosure
C Breymann is a medical consultant for Vifor International Co. in the field of iron therapy in OBGYN. No funding or financial support or scientific support was received for this review. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Key issues
• Anemia is a common problem in obstetrics and perinatal care.
• Hemoglobin (Hb) level below 10.5 g/dl can be regarded as true anemia regardless of gestational age.
• Main cause of anemia in obstetrics is iron deficiency, which has a worldwide prevalence between estimated 20 and 80% of especially female population.
• Stages of iron deficiency are depletion of iron stores, iron deficient erythropoiesis without anemia and iron-deficiency anemia, the most pronounced form of iron deficiency.
• It is estimated that in developing countries, up to 20% of pregnant women have hemoglobin less than 8 g/dl and up to 7% less than 7 g/dl, namely severe anemia. For industrialized countries, the WHO indicates a mean prevalence of anemia around 18%.
• Pregnancy anemia can be aggravated by various conditions such as uterine or placental bleedings, gastrointestinal bleedings and peripartum blood loss. Beside the general consequences of anemia, there are specific risks during pregnancy for the mother and the fetus such as intrauterine growth retardation (IUGR), prematurity, feto-placental miss-ratio and higher risk for peripartum blood transfusion.
• Gold standard for the diagnosis of iron-deficiency anemia is evaluation of hemoglobin levels in combination with serum ferritin for the assessment of iron stores. Red cell indices can be useful in selected cases such as thalassemia patients. Advanced diagnostics for differential diagnosis include serum transferrin receptor levels, percentage of hypochromic red cells and probably in the future hepcidin levels.
• Treatment of iron deficiency and iron-deficiency anemia is based on the use of oral and intravenous iron preparations. Oral iron preparations such as iron II salts and iron III complexes can be effective in cases of mild or moderate iron deficiency but are limited by their side effects and limited resorption. Intravenous iron preparations show high effectiveness even in chronic or severe stages of iron deficiency and anemia, a high compliance and are safe in the recommended dosages and administration rules.