Treatments for iron-deficiency anaemia in pregnancy

RHL practical aspects by Candio F and Hofmeyr GJ

FIRST CONTACT (PRIMARY CARE) LEVEL

In settings with a high prevalence of iron deficiency anaemia, iron and folic acid should be offered to all pregnant women, without the need to perform haematological studies.

Screening for anaemia may be limited to inspection of the conjunctiva for the presence of pallor, but there are no published reports of the accuracy of screening for anaemia using this method in pregnant women in the rural antenatal clinic setting. Any method of screening for anaemia at primary health care level should be acceptable to both patients and staff, be simple to operate, require a minimum of materials, be inexpensive, and give immediate accurate results. Haemoglobin measurement or estimation with the use of the WHO haemoglobin colour scale to confirm anaemia is recommended. Women with severe anaemia (Hb<7 g/dl) should be referred for investigation of the causes and treatment. The copper sulphate method is inexpensive, but requires staff trained in its use.

In women with mild-to-moderate anaemia, it is very important to perform timely iron and folate supplementation to prevent the development of more severe anaemia especially in settings with out safe blood transfusion facilities to reduce the need for blood transfusion with its associated risks.

The impact of supplementation can be improved by counselling on why, how, and when to take iron tablets and by supplying the tablets.

REFERRAL HOSPITAL (SECONDARY CARE) LEVEL

Pregnant women with severe anaemia should be referred to a hospital for monitoring and further treatment. These hospitals should be able to provide red blood cells transfusion and intramuscular (IM) or intravenous (IV) iron. The use of IV or IM iron should be done only in hospital. The different treatments alternatives should be discussed with the patient taking into account the transport facilities, gestational age, cost and availability of the different preparations.

Blood transfusion may become necessary for severe anaemia especially close to term. Unnecessary blood transfusion can be reduced by introducing guidelines, information materials for women and their families, and the establishment of a hospital blood transfusion committee.

AT HOME OR IN THE COMMUNITY

Iron or folate supplementation of pregnant women should prevent a deterioration of the anaemic condition. Routine preventive iron supplementation has been successfully delivered through traditional birth attendants integrated into a primary health care programme in a trial in rural Gambia.

In developing countries, where perhaps most women are nutritionally deficient, it is very important to give dietary advice during pregnancy with adequate quantities of iron-rich foods and counsel to pregnant women of the risks of anaemia in pregnancy. Generally women with poor nutrition and exposure to chronic illness are those least likely with to antenatal care, so programs directed at antenatal clinic attendees are likely to have limited effectiveness. Research is needed into strategies to reduce iron deficiency at a community level such as fortification of staple foods.

Pregnant women residing in endemic malaria areas should be given anti-malaria prophylaxis according to country policies, because this infection increases anaemia risk, would be recommend iron supplementation in settings with high prevalence of malaria because the benefits are considered to outweigh the risks. In clinically suspected cases of severe anaemia, the health workers at the community level should be advised immediate referral of these pregnant women to a secondary care level.

References

  • Van den Broek N, Ntonya C, Mhango E, White S. Diagnosing anaemia in rural clinics: assessing the potential of the Haemoglobin colour Scale. Bulletin of the World Health Organization 1999:77:15-21
  • Menendez C, Todd J, Alonso PL et al. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Transactions of the royal society of tropical medicine and hygiene 1994;88:590-93

This document should be cited as:Candio F, Hofmeyr GJ. Treatments for iron-deficiency anaemia in pregnancy : RHL practical aspects (last revised: 23 November 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.