ANAEMIA AND IMPACTS ON PREGNANCY

DR SUHAIZA ABDULLAH Department of Obstetrics and Gynaecology, International Islamic University Malaysia MD(UKM) MMED (USM) FELLOWSHIP MFM (SINGAPORE)

MUM DIES IN EVERY MINUTE DUE TO PREGNANCY AND CHILDBIRTH! =500,000 /YEAR =10 MILLION IN EVERY GENERATION 15% (20 MIL/YEAR ) FATAL COMPLICATIONS DURING BIRTH >80% - HAEMORRHAGE, SEPSIS,UNSAFE ABORTION,OBSTRUCTED LABOUR, HYPERTENSIVE DISEASE 21% - SEVERE BLEEDING!!!

UNICEF,UNFPA,WHO

MATERNAL ADAPTATION

Maternal anemia
Fetal anemia

Iron Deficiency Anemia Folate deficiency Haemoglobinopathies Infection Others

Hb Barts Parvovirus B19 Rh isoimmunization

WHO CRITERIA ANAEMIA

ANEMIA IN PREGNANCY IN MALAYSIA: A CROSS-SECTIONAL SURVEY

WORLDWIDE PREVALENCE ANEMIA 1993-2005

PREVALENCE

Industrializef country

Malyaysia

50% 23%

35%
(11gm%)

Malaysia

world

11%
(10 gm%)

Jamaiyah H et, al Asia Pac J Clin Nutr 2007

H Jamaiyah Asia Pac J Clin Nutr 2007;16(3):527-536

MATERNAL

PERINATAL

NEONATAL

PREGNANCY IMPACT
MISCARRIAGE FETAL GROWTH RESTRICTION

PRETERM DELIVERY

PERINATAL DEATH

MATERNAL DEATH

ANEMIA AND IRON DEFICIENCY

SP Loh, Malaysian Journal of Medicine and Health Sciences;2010 Vol 6(1)

IRON DEFICIENCY ANEMIA

The ferritin serum iron Hb

MCV (indication iron def affecting Hb synthesis)

profound effect on body functions :

Effects on cellular function :

Impaired muscle fx, neurotransmitter activity, exercise tolerance, epithelial changes & alteration of GIT fx

Assoc between anaemia & preterm birth

Can be corrected by oral iron supplements

Overt sx of iron def generally not prominent

Blood vol following acute loss at delivery but remains relatively stable as long as the blood loss does not exceed 25% of the predelivery volume

No compensatory in blood vol & gradual in plasma vol

Overall result : Hct & blood vol non-preg stat

Amount of blood loss tolerated = 1000 ml

w/out causing significant fall in Hb concentration

Babies delivered by iron def mothers have ferritin level compared to others May cause anaemia during the 1st year of life in baby delivered with depleted iron stores & poor oral iron intake

Change of concentration of chemical mediators in the brain

Cognitive skills

Origin in fetal life due to LBW

Behavioral abnormalities

prevention of adult hypertension

MATERNAL ANEMIA AND PERINATAL OUTCOME EMRE K ET AL, PERINATAL JOURNAL, VOL 15, ISSUE 3, 2007

MATERNAL ANEMIA AND ITS IMPACT ON PERINATAL OUTCOME TROPICAL MEDICINE AND INTERNATIONAL HEALTH VOLUME 9 NO 4 PG 486-490 APRIL 2004

MATERNAL ANAEMIA AND ITS IMPACT ON PERINATAL OUTCOME.

The risk of preterm delivery and LBW among exposed group was 4 and 1.9 times higher among anaemic women, respectively. Newborns of anaemic mothers had 1.8 times increased risk of having an APGAR score of <5 at 1 min and the risk of IUD was 3.7 times higher for anaemic women.

Lone FW et al, Trop Med Int Health. 2004 Apr;9(4):486-90.

SEVERE ANEMIA AND ADVERSE PREGNANCY OUTCOME RIFFAT JALEEL, JOURNAL OF SURGERY PAKISTAN(INTERNATIONAL),13(4) OCT-DEC 2008

Brabin BJ, The Journal Nutr 2001

NICE GUIDELINES

NICE GUIDELINES

FOLATE DEFICIENCY

Baby born to folate def mother :

Risk of megaloblastic anaemia esp if delivery is preterm Assoc cleft palate & neural tube defect (NTD) Periconceptional folate the recurrence of NTD

RCT in Hungary shown : 800 g/ day + MVT prevented occurance of NTD Pre pregancy 400mcg/day

##Previous affected pregnancy / Epilepsy : 4mg/day

HAEMOGLOBINOPATHY
ALPHA

THALASSEMIA BETA THALASEMIA SICKLE CELL ANEMIA

ALPHA THALASSEMIA
Deletion of alpha gene on Chromosome 16

HB BARTS AND HBH

Hb Barts non compatible with life Hydrop Foetalis Polyhydramnios Hyperplacentosis Mirror Syndrome Malpresentation Preterm labour Antepartum haemorrhage PP /AP Caesarean section Post partum haemorrhage

PRENATAL
CVS Amniocentesis Cordocentesis

Non invasive 1st trimester CTR >50% Free Fetal DNA in maternal plasma Preimplantation Genetic Diagnosis

FETAL ANAEMIA

BETA

THALASSEMIA
Mutation of beta gene chromosome 11

-THAL MAJOR
Pregnancy possible - Effective chelating agent - Spontaneous conception - Assissted reproductive technique

MATERNAL HEALTH AND OBSTETRICS OUTCOME OF MOTHERS WITH THALASEMIA

Cardiac problem Endocrine Alloimmunization Viral Infection Hypercoagulable state and thrombosis Osteopenia, osteoporosis and bone deformity

OBSTETRICS RISK -THAL MAJOR AND

INTERMEDIA Spontaneous miscarriage & fetal loss Multiple pregnancy Preterm birth Intrauterine growth restriction Pre eclampsia Caesarean section Maternal cardiac failure Associated medical risk endocrine d/o

 Prepregnancy

counseling Optimise maternal condition Multidisciplinary care Prenatal counseling Diagnostic test Role of Termination of pregnancy Counseling genetic and future health care

SICKLE CELL ANEMIA

Inherited defect Structural alteration of globin chain

Aggravating Factor: Dehydration Stress Extreme Hypoxia

Complications CCF due to severe anemia Aplastic crisis Leg ulcer Vaso-ooclusive Complication Stroke

3rd trimester Intrapartum

CONCLUSION
Anemia

is still prevalent Associated maternal complication Potential fetal and neonatal complication Prepregnancy counselling Prenatal diagnosis Prenatal counseling

RAMADHAN AL MUBARAK THANK YOU