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TEMA
ANEMIA EN GESTANTES
PRESENTADO POR:
• Sandoval Mediana Frank Roger
Huancayo - 2023
ANEMIA EN GESTANTES
La anemia es considerada, según las estadísticas oficiales de la OMS, uno de los problemas
públicos de mayor severidad en el mundo entero. Se estima que 1 620 millones de personas la
padecen, de las cuales las poblaciones más vulnerables son las gestantes y los niños entre 6 y 59
meses de edad. De acuerdo con la OMS, la deficiencia de hierro sería la principal causa de la
anemia, particularmente en países de desarrollo económico mediano y bajo. La gestación es un
estado de mayor requerimiento de hierro por la necesidad de este para la placenta y el feto. Se
estima que por esta mayor necesidad se debe cubrir un gramo adicional de hierro. Sin embargo,
fisiológicamente durante el embarazo ocurre más bien una disminución en la concentración de la
hemoglobina , que se hace evidente a partir del segundo trimestre de gestación.
Esto ocurre como resultado de una mayor expansión vascular respecto al aumento de la
eritropoyesis necesaria para aumentar la disponibilidad de hierro. Sobre esta base, la OMS
recomienda reducir el punto de corte de corte para definir anemia en la gestación a una Hb de 11
g/dL cuando en la no gestante es de 12 g/dL. Estos cambios en las concentraciones de
hemoglobina en el segundo y tercer trimestre determinan que la prevalencia de anemia sea más
alta en el segundo trimestre y disminuya al final del tercer trimestre. Esto podría indicar que la
reducción a 11 g/dL como punto de corte de la Hb podría no ser suficiente. LA CDC de Atlanta
utiliza como punto de corte en el segundo trimestre un nivel de Hb de 10,5 g/ dL. En algunos
estudios de investigación en países desarrollados se define anemia como < 10,5 g/dL en el
segundo trimestre. A la eritrocitosis o hemoconcentración la definen como Hb > 13,0 g/L en el
segundo y tercer trimestres de gestación. Esto podría indicar que la reducción a 11 g/dL como
punto de corte de la Hb podría no ser suficiente. LA CDC de Atlanta utiliza como punto de corte
en el segundo trimestre un nivel de Hb de 10,5 g/dL. En algunos estudios de investigación en
países desarrollados se define anemia como < 10,5 g/dL en el segundo trimestre. A la eritrocitosis
o hemoconcentración la definen como Hb > 13,0 g/L en el segundo y tercer trimestres de
gestación. Sin embargo, la concentración de Hb se mantiene normal con ingestas de hierro de
80% de la dosis recomendada en la primera mitad de la gestación y de 41% en la segunda mitad.
Esto se debe a que, a partir del segundo trimestre, los niveles de hepcidina, la hormona encargada
de regular la homeostasis de hierro, disminuyen significativamente y con ello aumenta de manera
importante la absorción de hierro en el duodeno. Esto quiere decir que no regula el ingreso de
hierro al organismo la mayor ingesta, sino la necesidad de hierro y su regulación a través de la
hepcidina circulante. Las evidencias demuestran que la disminución de la concentración de
hemoglobina en un embarazo normal no necesariamente significa una deficiencia de hierro en la
dieta, sino que ocurre como fenómeno universal de un proceso de hemodilución sanguínea por
expansión vascular, que favorece el flujo arterial uteroplacentario y con ello el adecuado
crecimiento del feto. Si bien la necesidad de hierro en la gestación aumenta debido a las
necesidades del feto (300 mg durante el embarazo), el incremento de la hemoglobina materna
(500 mg durante el embarazo) y para reponer la pérdida de sangre durante el parto, debemos tener
en cuenta que la disminución de la concentración de la Hb en la gestación normal es un proceso
fisiológico. Entonces, de no detectarse una anemia verdadera, no sería necesario suplir con hierro
para incrementar los niveles de Hb en sangre.
Síntomas de la anemia durante el embarazo
Cuando aparece una anemia, la sangre no puede transportar tanto oxígeno como en condiciones
normales. Al principio, la anemia no causa síntomas o solo síntomas vagos, como fatiga, debilidad
y mareos. Las mujeres afectadas presentan palidez. Si la anemia es grave, el pulso puede ser
rápido y débil, pueden sufrirse desmayos y la presión arterial puede ser baja.
• Las mujeres embarazadas pueden llegar a estar muy cansadas y tener dificultad para
respirar.
El sangrado que normalmente acompaña al parto puede agravar de forma peligrosa la anemia en
estas mujeres
• Análisis de sangre
La anemia suele detectarse cuando los médicos realizan un hemograma completo de rutina en la
primera exploración después de la confirmación del embarazo.
• Las mujeres suelen perder hierro cada mes durante la menstruación en una cantidad
equiparable a la cantidad de hierro que consumen al mes, por lo que no pueden
almacenar mucho hierro.
• Para la fabricación de glóbulos rojos del feto, las mujeres embarazadas necesitan el
doble de hierro de lo habitual. Como resultado, suele aparecer una carencia de hierro y
la consiguiente anemia.
• Infecciones: las más frecuentes son neumonía, infecciones del sistema urinario e
infecciones del útero
• Obstrucción de las arterias en los pulmones por coágulos de sangre (embolia pulmonar):
este problema puede ser potencialmente mortal.
CONCLUSIONES:
Anemia is considered, according to official WHO statistics, one of the most serious public
problems in the world. It is estimated that 1.620 million people suffer from it, of which the most
vulnerable populations are pregnant women and children between 6 and 59 months of age.
According to the WHO, iron deficiency would be the main cause of anemia, particularly in
countries with medium and low economic development. Pregnancy is a state of greater iron
requirement due to its need for the placenta and the fetus. It is estimated that due to this greater
need, an additional gram of iron must be covered. However, physiologically during pregnancy
there is rather a decrease in hemoglobin concentration, which becomes evident from the second
trimester of pregnancy.
This occurs as a result of greater vascular expansion relative to the increase in erythropoiesis
necessary to increase iron availability. On this basis, the WHO recommends reducing the cut-off
point to define anemia in pregnancy to an Hb of 11 g/dL when it is 12 g/dL in non-pregnant
women. These changes in hemoglobin concentrations in the second and third trimesters
determine that the prevalence of anemia is highest in the second trimester and decreases at the
end of the third trimester. This could indicate that the reduction to 11 g/dL as the Hb cutoff
point may not be sufficient. The Atlanta CDC uses an Hb level of 10.5 g/dL as the second-
trimester cut-off point. In some research studies in developed countries, anemia is defined as <
10.5 g/dL in the second trimester. Erythrocytosis or hemoconcentration is defined as Hb > 13.0
g/L in the second and third trimesters of pregnancy. This could indicate that the reduction to 11
g/dL as the Hb cutoff point may not be sufficient. The Atlanta CDC uses an Hb level of 10.5
g/dL as the second trimester cutoff point. In some research studies in developed countries,
anemia is defined as < 10.5 g/dL in the second trimester. Erythrocytosis or hemoconcentration
is defined as Hb > 13.0 g/L in the second and third trimesters of pregnancy. However, the Hb
concentration remains normal with iron intakes of 80% of the recommended dose in the first
half of pregnancy and 41% in the second half. This is because, starting in the second trimester,
hepcidin levels, the hormone responsible for regulating iron homeostasis, decrease significantly
and with this, iron absorption in the duodenum increases significantly. This means that the
higher intake of iron does not regulate the entry of iron into the body, but rather the need for
iron and its regulation through circulating hepcidin. Evidence shows that the decrease in
hemoglobin concentration in a normal pregnancy does not necessarily mean a deficiency of iron
in the diet, but rather occurs as a universal phenomenon of a blood hemodilution process due to
vascular expansion, which favors uteroplacental arterial flow and with This is the proper growth
of the fetus. Although the need for iron in pregnancy increases due to the needs of the fetus (300
mg during pregnancy), the increase in maternal hemoglobin (500 mg during pregnancy) and to
replace blood loss during childbirth, we must take Keep in mind that the decrease in Hb
concentration in normal pregnancy is a physiological process. So, if true anemia is not detected,
it would not be necessary to supplement with iron to increase Hb levels in the blood,
When anemia develops, the blood cannot carry as much oxygen as in normal conditions. At
first, anemia causes no symptoms or only vague symptoms, such as fatigue, weakness, and
dizziness. Affected women are pale. If the anemia is severe, the pulse may be rapid and weak,
fainting may occur, and blood pressure may be low.
• The fetus may not receive enough oxygen, necessary for normal growth and development,
especially of the brain.
• Pregnant women can become very tired and have trouble breathing.
The bleeding that normally accompanies childbirth can dangerously aggravate anemia in these
women.
• Blood test
Anemia is usually detected when doctors perform a routine complete blood count on the first
scan after confirmation of pregnancy.
Iron deficiency is the cause of anemia during pregnancy in approximately 95% of cases. Iron
deficiency anemia is usually caused by
• Women usually lose iron each month during menstruation in an amount equal to the amount of
iron they consume per month, so they cannot store much iron.
• For the manufacture of fetal red blood cells, pregnant women need twice as much iron as
usual. As a result, iron deficiency and consequent anemia often appear.
• Folate (folic acid) deficiency can also cause anemia during pregnancy. If the level of folic acid
is insufficient, the risk of having a baby with a birth defect of the brain or spinal cord (neural
tube malformation) such as spina bifida is increased.
• Blood tests can confirm the diagnosis of iron deficiency anemia or folate deficiency anemia.
• Anemia can usually be prevented or treated by taking iron and folic acid supplements during
pregnancy. If a pregnant woman is iron deficient, the newborn is usually given an iron
supplement. Taking folic acid supplements before becoming pregnant or during pregnancy
reduces the risk of the baby having a neural tube defect.
• Infections: the most frequent are pneumonia, urinary system infections and infections of the
uterus
• Hypertension: About a third of pregnant women with sickle cell disease develop high blood
pressure during pregnancy.
• Heart failure
• Blockage of the arteries in the lungs by blood clots (pulmonary embolism): This problem can
be life-threatening.
• Problems in the fetus: the fetus may grow slowly or not grow as expected (small for
gestational age). You run the risk of being born prematurely.
CONCLUSIONS:
• Anemia is a major global health problem, particularly related to obstetric practice, and is
related to major complications that affect both mothers and the newborn. Effective treatment
improves the health of the mother and prevents complications in the child.
• At the maternal level, there is a greater predisposition to hypertonic disease during pregnancy,
mainly preeclampsia and premature birth; In newborns, prematurity, which is associated with
multiple complications, such as a respiratory disorder due to lack of lung maturation,
intrauterine growth retardation, and low birth weight newborns.
• The rate of anemia in pregnant women was high in the population from 20 to 34 years of the
total number of pregnant women is 29.1% had anemia, the majority were young at 52.7%,
56.3% were married, 96.4% of wives from home and 76.4% with secondary instructions.