Anemia in Pregnancy

                       (Under-nutrition, रक्ताल्पता, पाण्डु)

                                                                  

Anemia is one of the  most commonly encountered medical disorders during pregnancy. In developing countries it is a cause of serious concern as, besides many other adverse effects on the mother and the fetus it contribute significantly high maternal mortality.

Introduction

Pregnancy is a state in which  all the physiological functions are hyper stimulated in order to meet the demands of the growing fetus. Anemia during pregnancy is a very common condition which involves the fall in the hemoglobin concentration and is one of the leading causes for maternal mortality in India. It may antedate conception, often aggravated by pregnancy and delivery.

A pregnant women becomes weak and pale, her fetus gets troubled. In pregnant women blood has to provide nutrition for three causes :

• Nourishment of mother's body
• For lactation
• And for growth of the fetus.

thus a pregnant women is more prone to suffer from anemia.

Absorption of exogenous iron is regulated by the state of the body store. In women entering pregnancy with adequate iron in the first trimester, there is little absorption of iron in the first trimester. The stores are exhausted on the late pregnancy due to increased demand and according the iron absorption is increased from 7.2% in the first trimester to 66.1% in the third trimester. Therefore, women with adequate iron stores and consuming high bio-available iron containing diet may require no exogenous supplementation.

Diagnosis

●   Physical Examination :     Pale skin and fingernails, lips and earlobes

 ●  Complete blood count (CBC)

      Blood test: The average level of hemoglobin in adult females is between 12 to 16g. The WHO defines anemia in pregnant women as haemoglobin level below 11gm/dl. The degree of anemia is graded according to the haemoglobin (Hb) levels as :

• Moderate 7,0 -10.9 g/dl
• Severe 4-6.9 g/dl
• Very Severe <4 g/dl

●     Endoscopy to rule out peptic ulcer

●     Ultrasound for fibroid

“Anemic women are prone to infections and may need blood transfusions during pregnancy”

Complication

●     Repeated infections due to decreased resistance of the body.

●     Heart failure may occur.

●     Preterm labor.

●     Low birth weight baby.

●     Excessive bleeding during labor

●     Postpartum depression

●     Intrauterine death of a baby may occur

●     A child born of Anemic women often remain underdeveloped with poor immunity.

Types of Anemia

The following are different types of anemia associated with pregnancy :

• Iron deficiencies
• Magaloblastic
• Aplastic varieties
• Haemoglobinopathis
• Hemolytic
• Secondary (eg repeated bleeding, chronic infections, Hodgkin's disease)

Causes

• Iron deficiency anemia is the commonest type, and depending upon the socioeconomic status may be found in up to  50 to 90% of all pregnancies. 
• Multiparity (producing many or more than one at a birth), 
• Previous menorragia and malnutrition contribute to this condition.. 
• Dietary insufficiency 
• Inadequate absorption of iron is important cause of anemia.
• Weak digestion.

Effect of Anemia during Pregnancy 

Maternal Effects

• Mild anemia may not have any effect on pregnancy and labour except that mother will have low  iron stores and may become moderately to severely anemic in subsequent pregnancies. 
• Moderate anemia may cause increased weakness, lack of energy fatigue and poor  work performance. 
• Severe anemia however is associated with poor outcome. The women may have palpitations, tachycardia, breathlessness, increased cardiac output leading to the cardiac stress which can cause de-compensation and cardiac failure which may be fatal. Increased incidence of pre-term labour (22.2%), pre-eclampsia (31.2%) and sepsis have been associated with anemia.

Foetal Effects

Irrespective of maternal iron stores, the fetus still obtain iron from  maternal transferrin which is trapped in the placenta and which in turn removes  and actively transports iron to the fetus. Gradually, however such fetuses tend to have decreased iron stores due to depletion of maternal stores. Adverse perinatal outcome in the form of pre-term and small for gestational age babies and increased perinatal mortality rates have been observed in the neonates of anemic mothers. Iron supplementation to the mother during pregnancy improves outcome, means weight, Apgar score and haemoglobin level.

Signs and Symptoms

Pallor : Light coloured skin

Pale Skin

Spoon nails (koilonychia) are soft nails that look scooped out. The depression usually is large enough to hold a drop of liquid. Often, spoon nails are a sign of iron deficiency anemia

 Spoon nails (koilonychia)

●   Pica : That is desire to eat mud..

●   Cold hands and feet

●   Shortness of breath, fainting

●     Hair fall, Premature wrinkles, itchy feeling

                Hair Fall

●     Swelling of face, feet all over the body

Swollen feet

●     Palpitation of heart, irregular heartbeat

●     A headache or migraine and dizziness. Low iron level can cause migraine.

Headache & Dizziness

     

●     Reduced work capacity, irritability, leg cramps.

Leg Cramps

     ●   Chest pain, weakness, and fatigue (tiredness)

Fatigue

●     Tachycardia increase in heart rate

●     Poor memory,

●     Slow healing of wounds, recurrent infections, and delayed mental development

●   Birth of a weak and low birth weight babies.

●   Stomatitis : Sores or ulcers at the corner of the mouth

Stomatitis

Lifestyle

●  Start eating healthy food during your prenatal period itself

●  Make sure you drink enough milk, but avoid milk immediately after taking an iron supplement as calcium may interrupt iron absorption.

●  Cook food in iron utensil and avoid too much cooking

●  Refined food like white bread, polished rice, sugar and desserts. It rob the body of the much-needed iron.

●     Avoid carbonated beverages. They prevent absorption of iron

●     Tea and coffee inhibit the absorption of iron.

●     Avoid taking iron and calcium tab together.

●     Avoid excessive intake of alkaline, sour, salty, too hot, incompatible food.

●     Avoid Palak paneer combination, as iron calcium don't go together.

●     Avoid fried foods and food rich in fat

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Yoga 

Regular practice of different yoga poses increases the RBC production as well as purifies the blood.

●    Seated Forward Bend Pose Pachimotanasana (पश्चिमोतान)

                                             

                     

●   Shoulder Stand pose   Sarvangasana  ( सर्वांगासन  )    
                                         

  ●   Copse Pose Savasana (शवासन)

●    Uttanapada Asana / Raised Leg Pose

                                            

                

                                       

Exercise

 Walking :    Daily walking for half an hour.

Chakra 

Manipur chakra or Navel chakra: 

It corresponds to solar plexus. Concentrate on this chakra. As this chakra is responsible for digestion and assimilation. It helps in transformation of food into energy. It is situated at the level of the umbilicus.

Mudra

●     Prithvi Mudra : 

Formation - Join the tip of the ring finger with the tip of the thumb.

●  Varun Mudra or Jala Vardhak Mudra : 

Formation - This Mudra is formed by joining together the tips of the thumb and the little finger.

●  Prana Mudra or Kapha kaarak Mudra : 

Formation The tip of little fingers and ring fingers are joined with the tips of the thumbs. It increases stamina, vitality, strength and immunity.

Diet

Iron Rich Foods

Iron is very difficult to digest and anemia is often caused by weak digestion, so eating more iron is often not enough. Many people assume that meat is the best way to increase your iron but "the incidence of iron deficiency anemia in a vegetarian is not significantly different from that  in omnivores."

The following foods all help with anemia even though they are not all high in iron. They are strengthening and liver cleansing, aids digestion and assimilation of iron or are greatly laxative.

•  ghee, milk
• Turmeric, saffron, cinnamon
• Licorice tea
• Sunflower seeds, pumpkin seeds
• Cabbage, mung dal 

• Jaggery

●     Iron is plenty in red raisins, broccoli .

●     Non-vegetarian food such as egg yolks. red meat, liver, poultry, fish and seafood.

●  Vegetables Green leafy vegetables choulai, spinach, mustard leaves, turnip green, bathua, celery, lettuce, cauliflower, lady’s finger, radish leaves. dill (soya) leaves greens, Curry leaves, Drumstick leaves,  lotus Stem, beans, beetroot, pumpkin, mushrooms, soybeans

Diet rich in Iron & Folate or Folic acid 

●     Garlic can help can get rid of intestinal parasites.

●    Raw carrot are also effective.

●    Fruits like figs, almonds, cashew, pista , mulberry, watermelon, pomegranates, jamun, apples, strawberries, pineapple, orange, lemon, guava, berries, cherries, peaches, apricots.

●     Dates, almonds Eaten as soaked dried fruit.

 

●      Drink a mixture of tomato and apple juice.

●    Sugarcane juice is good for anemia. Sugarcane It contains 9  milligrams of iron per kg. Its product like jaggery is another alternative.

●     Sprouted pulse like Kala Chana, soybeans, lentils and wheat are rich in iron and vitamin C.

●   Vitamin B12 usually found in animal proteins, i.e. meat, kidney and liver. Dairy products like milk,  and cheese, peanuts. Wheat germ and soybeans etc.

●     Oil - sesame oil

●  Seeds Sunflower seeds, Nuts, ground black sesame, pumpkin seeds. Cashew  because of its richness in dietary iron and vitamin B thiamine
                                         

                                                           Black Sesame  

  

●    Kalonji Onion seeds are rich in iron therefore good for Anemia .
                                                             

                                                      Onion seeds or Kalonji  कलोंजी 

● Honey-  It helps in increasing the hemoglobin in the blood.

● Ragi Battles Anemia: Ragi (नाचनी in Marathi) is an excellent source of natural iron and thus a boon for anemic patients and also for those with low haemoglobin levels.
                                                

●  Diet rich in Folate or Folic acid includes cereals, green leafy vegetables, dried beans, Asparagus, citrus fruits. , berries, mushroom, corn, carrot, cauliflower, brinjal.

●   Diet rich in Vitamin C is lemon, orange ,Amla , grapefruit, strawberries, kiwi, cabbage, baked potato, tomato with skin and bell peppers. These are necessary for absorption of iron.

●     Tamarind (इमली) is good source of iron.

●    Dark chocolate, whole grain bread can be good source of iron from food.

“Meat diet is associated with a high hemoglobin and high red cell count”

“Take sugarcane juice to avoid Anemia”.

Ivy Guard / Bimbi (Coccinia grandis), Kundru

Ivy Guard, Kundru

Coccinia grandis is the botanical name of ivy Gourd. It is also known as Kundru (Hindi) Bimbi. Bimbaka  in Sanskrit, Kovai in Siddha,  The fruits of this plant are eaten as vegetable throughout the country. It is used for the treatment of cough, respiratory illness, fever, burning sensation and swelling. It is good for anemia and worm infestation. Major nutrients : Iron (17.50%), vitamin B2 (6.15%), Vitamin B1 (5.83%), Dietary fiber (4.21%). calcium (4.00%).

         "Lemon juice good for anemia, joint pain, bleeding oral diseases and scurvy."

Lemon Juice

Herbs

●  Fenugreek Methi is effective in Anemia. 4 grams of methi soaked overnight, if taken every day, seems to improve Anemic conditions. Take two tsp of fenugreek seeds and cook them with one cup of rice. Eat it with a little salt, regularly. It helps to augment hemoglobin in Anemia . Or take 4 grams of fenugreek every day.

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●    Cumin seeds are rich in iron.

Punarnava (Hogweed)

Boerrhavia diffusa. Punarnava

'Punar' denotes restoring or regaining and 'nava' means new. Punarnava, as the name suggest, has the tendency to rejuvenate. These tendency converts into many Punarnava benefits. Two varieties of  the Punarnava plant have been mentioned in the scriptures - Sweta Punarnava (white variety) and Rakta Punarnava (red variety).The whole variety of Punarnava plants is commonly used for medicinal purposes and its botanical name is Boerrhavia diffusa. The Punarnava plant belongs to the family Nyetaginacae. It is known as 'hogweed' in English ,and 'Gandhapurna' or 'Sand' in Hindi. Though the whole plant is used, medicinally the most important part is root.

Amalki

Indian Gooseberry, Amla

Amalki refers to the herbal use of the amla fruit also called Indian gooseberry. The word amla literally mean "sour" and its other name, dhatri, means "mother" or nurse. Its association point to and Amalki's reputation as being greatly nourishing and supporting for a great array of body systems and all the body types or doshas. Amalki's is an essential herb in Ayurvedic medicine and posses a variety of healing properties. It is one of the three herbs in the traditional Ayurvedic formula known as Triphala churna.  Amla in form of fresh fruit, churana, chatani, chawanprash ,candies can be eaten. . It's greatly nourishing. Powder of amalaki taken along with honey alleviates Anemia .

Shatavari

Shatavari means "who posses a hundred husbands or acceptable to many" It is both a general tonic and a female reproductive tonic.

Ayurvedic Preparations

• Dhatri loha
• Punarnava mandur
• Navayasa churana
• Pradrantaka loha

Home Remedies

Home Remedies Anemia During Pregnancy

●   Chyawanprash

●  Dissolve ¼ tsp cinnamon powder and two tsp honey in one cup pomegranate juice and drink.

●    Have a bowlful of pomegranate, with a dressing of one tsp of lime juice for breakfast.

●    Soak 10 - 12 raisins in water and leave them overnight, have them in the morning.

●    Have a glassful of carrot juice mixed with 1 tsp of lime juice once a day.

● Have ½ bowlful of a boiled black gram (Kala Chana) with a dressing of chopped onions, tomatoes, cucumber and lime juice. Add roasted cumin powder and rock salt to taste. 

●     A churned drink prepared from the juice of sugarcane and Amla is beneficial.

●     1 cup beetroot juice, 1 cup apple juice, mixed with sugar or honey is useful.

●     Take lots of sea foods, liver, egg yolk, chickpeas, green peas, broccoli, raisins

●   Take a cup of beetroot juice and a cup of apple juice with honey or sugar  This speeds up R.B.C production

●     Tomato juice with till.

●     Eat a ripe banana with two teaspoon honey twice a day

●     Drink a cup of tomato juice mixed with apple juice

●     Take honey. It has easily digestible and absorb able minerals, especially iron.

●     Juice of onion contains iron, therefore it is beneficial in treating Anemia. 

●     Green Coriander Chutney

●   Iron-rich drink - ½ cup raisins, ¼ cup dried apricots or peaches,1 cup water,1-2 pinch of dry ginger. Soak raisins and dried fruits overnight in water. Next morning blend soaked fruit and water in a blender. If needed garnish with a pinch of ginger.

●   Beetroot and carrot juices combined build the red corpuscles, tone up the blood generally and help in treating low vitality and anemia.

●     Spinach or Palak soup

●    Whatgrass juice is good for Anemia

●     Pomegranate lemonade - pomegranate, lemon and sugar.

●     Methi paratha along with green coriander and Amla chutney

●     Grapes Juice or raisins (dried grapes) 10-15 overnight and have them in the morning.
   

"Caution: Take iron preparation under your physician's guidance. Iron supplements can cause irritation and constipation"

“A proper diet is the key factor for the prevention of Anemia”

Treatment

●     Mild to moderate cases of iron deficiency can be treated with iron supplements or dietary changes .

    Iron Deficiency Anaemia Iron tab along with  vitamin C after first trimester

●     Inj Imferon 2 ml/ on alternate days IM for 10 days.

●     Blood transfusion in a severe loss.

●     De -worming for worm infestation.

●     Chyawanprash and Amla churan are a good source of iron.
                                         

                                              
                                                                       

   

●   Packed cell transfusion whenever Hb drops below  6g in severe cases.

●    Platelet transfusion if the platelet count falls below 20,000/c mm or life-threatening bleeding sets in.

●     Blood transfusion in the severe loss.

     Megaloblastic Anemia

●     Vitamin B 12 deficiency Inj Hydroxocobalamin

●     1000 mg

●     Foliage deficiency Tab Folic acid 5 mg daily

     Aplastic Anaemia Inj Deca Durabolin 25 mg IM once a week.

●     Tab prednisolone

●     Wheat grass juice therapy is good for Anemia

●     Taking Coriander juice with equal honey twice daily has been found very promising

                       “Anemia is easily prevented than corrected”!

Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.

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