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A common condition among the female population, anaemia (or anemia, from the Greek word anaimia, meaning “lack of blood”) is characterised by a reduced amount of haemoglobin due to insufficient iron for erythropoiesis—simply put, there’s not enough iron for red blood cell production. 

Anaemia can lead to fatigue, weakness, and increased susceptibility to infections. In pregnant women, the condition demands urgent attention as it can potentially cause complications such as preterm delivery, low birth weight, and impaired cognitive development in infants.

This comprehensive article sheds light on anaemia, particularly in the context of women’s health. The blog includes key insights and statistics, as well as discussions on the causes, implications, and management for anaemia in pregnancy — underscoring the critical need for early detection and intervention to safeguard maternal and neonatal health.

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Key Insights on Anaemia

In 2011, nearly 33% of the population was affected by anaemia, contributing to 8.8% of all disabilities, according to an article published in The Obstetrician and Gynaecologist, 2017. This condition disproportionately impacts women, with 29% of non-pregnant and 38% of pregnant women experiencing it (Percy L, Mansour D). Findings of the report include: 

    • PREVALENCE OF IRON DEFICIENCY. Iron deficiency is the leading micronutrient deficiency globally, affecting over 20% of women in their reproductive years.
    • IRON SUPPLEMENTATION VARIABILITY. A wide range of oral iron supplements is available, with varying iron content. However, they often lead to gastrointestinal side effects.
    • CHALLENGES IN CLINICAL PRACTICE. Gynaecologists focus on reducing menstrual blood loss in women experiencing heavy menstrual bleeding.
    • ETHICAL CONSIDERATIONS IN ANAEMIA TREATMENT
      • Risk of Blood Transfusion. Women with severe preoperative iron-deficiency anaemia are more likely to need blood transfusions during surgery, increasing the possibility of adverse postoperative outcomes.
      • Need for Early Intervention. Identifying and addressing iron-deficiency anaemia early with intravenous iron treatments can significantly reduce the need for transfusions.
    • TREATMENT OPTIONS & SAFETY MEASURES
      • Intravenous Iron Therapy. Early management of severe anaemia with intravenous iron is crucial to prevent the complications associated with blood transfusions.
      • Infrastructure Requirements. Administering intravenous iron demands a medical environment equipped to handle potential severe adverse reactions, such as anaphylaxis. This underscores the importance of treatment in facilities that are not only well-equipped but also have a qualified medical staff.

    Iron Deficiency Symptoms

    Iron is crucial for various bodily functions, including making DNA, growing cells, and generating energy. It is mainly found in haemoglobin (the part of red blood cells that carries oxygen) and in some proteins and enzymes that help with energy production and protecting cells. Most of our iron is in our blood, with some stored in the liver and other parts for later use.

    The body keeps iron levels balanced through a hormone called hepcidin, produced in the liver. Hepcidin levels increase when there’s a lot of iron in the body and decrease when there’s not enough iron or when the body needs to make more red blood cells.

    SOURCE: Iron deficiency and iron-deficiency anaemia in women’s health (Percy L., Mansour D.)

    Iron-Deficiency Anaemia Causes

    The issue of iron deficiency and iron-deficiency anaemia arises from various causes other than the lack of iron. Causes include deficiencies in folate, vitamin B12, and vitamin A, along with disorders affecting haemoglobin synthesis, red blood cell production or survival, and conditions leading to acute and chronic inflammation or parasitic infections. 

    SOURCE: Iron deficiency and iron-deficiency anaemia in women’s health (Percy L., Mansour D.)

    Uterine fibroids are the 13th leading cause of anaemia globally. Among women suffering from heavy menstrual bleeding (HMB), 27% are diagnosed with iron-deficiency anaemia, and 60% face severe iron deficiency.  The World Health Organization diagnoses anaemia based on haemoglobin levels, defining it as below 120 grams per litre in nonpregnant women and below 110 grams per litre during pregnancy.

    Read: 10 Tips In Choosing The Right OB-GYN For You In Singapore

     

    Managing Anaemia in Pregnancy

    Women of childbearing age should aim for 18 mg of iron daily, though the average intake is around 12 mg to account for menstrual losses. This is higher than the 8 mg recommended for adult men. Key sources of iron in the diet include red meat, poultry, fish, and whole grains, with iron from animal sources (haem iron) being more easily absorbed by the body than plant-based iron (non-haem iron).

    Teenage mothers are at a higher risk for anaemia due to the increased iron demands of pregnancy coupled with their own ongoing growth. High-risk individuals also include those who have previously experienced anaemia, have multiple children, recently had a pregnancy, or have a history of bleeding. 

    • ORAL IRON SUPPLEMENTS

    Oral iron supplements are the primary treatment for iron deficiency and iron-deficiency anaemia. Pregnant women are typically recommended to take 100–200 mg of elemental iron daily in divided doses, with a maintenance dose of 100 mg. To enhance absorption, it’s advised to take iron supplements at night or at least one hour before meals. 

    Certain foods and drinks, like those containing tannins or milk, can hinder iron absorption, while fruit juice rich in ascorbic acid can improve it. However, the treatment can cause side effects like nausea, vomiting, constipation, dark stools, and stomach pain. These issues stem from damage to the stomach lining by free radicals.

    Ferric compounds have been studied as an alternative. In the UK, the iron polymaltose complex combines ferric iron with maltol, making it soluble at neutral pH levels. This tends to cause fewer gastrointestinal side effects compared to traditional ferrous supplements.

    • PARENTERAL IRON

    Parenteral (injected) iron therapy can increase red blood cell production in the bone marrow significantly. This method can quickly boost iron levels, making it a good option before undergoing major surgery. However, it is not recommended during the first trimester of pregnancy. 

    Parenteral iron is generally safe and causes fewer side effects than oral supplements. Still, there’s a rare risk of severe allergic reactions (anaphylaxis), so patients need to be watched closely during and for half an hour after the infusion.

    Several types of parenteral iron are available, including iron dextran, iron sucrose, iron carboxymaltose, and iron isomaltoside.Side effects like low blood pressure, discomfort, nausea, vomiting, joint pain, and abdominal pain can occur, especially with iron dextran.

    During pregnancy, the need for iron jumps significantly, with an overall increase of 1200 mg required throughout the pregnancy to support both the mother and the developing foetus. Iron deficiency during pregnancy can lead to maternal depression and hinder the brain development of the child. 

    • IRON-RICH FOODS & SUPPLEMENTS

    Pregnant women are advised to consume vitamin C-rich foods like oranges, strawberries, bell peppers, and broccoli, which enhance the absorption of non-heme iron. They are also advised to avoid inhibitors, like caffeine and some components in dairy, which impede iron absorption. Incorporating a variety of iron-rich foods into the daily diet can help mothers meet their increased iron needs, combat anaemia, and support the health and development of their baby. 

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    Singapore Obstetrics & Gynaecology 

    Our clinic is here to assist you throughout your pregnancy, starting with information that promotes the well-being of expectant mothers during pregnancy, childbirth, and the postpartum period. Additionally, we provide insights into potential issues that may arise for either the mother or the child.

    To ensure a safe pregnancy, trust only qualified obstetricians in Singapore. Practising at the Thomson Medical Center (TLC Gynaecology Practice) in Singapore, Dr. Pamela Tan is an obstetrics and gynaecology specialist certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy (womb, fibroid, and cyst removal). 

    An in depth consultation is required to tailor advice and treatment to the individual circumstances. To schedule an appointment, please call +65 6254 2878 or send a message here.

    SOURCES:

    1. Percy L, Mansour D. Iron deficiency and iron-deficiency anaemia in women’s health. The Obstetrician and Gynaecologist 2017
    2. Iron-deficiency anemia (Camaschella C.)

     

    Dr Pamela Tan
    About Dr Pamela Tan

    Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.