anemia and impacts 060713
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A NAEMIA A ND I MPACTS ON P REGNANCY
DR SUHAIZA ABDULLAHDepartment of Obstetrics and Gynaecology,International Islamic University MalaysiaMD(UKM) MMED (USM)
FELLOWSHIP MFM (SINGAPORE)
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MUM DIES IN EVERY MINUTE DUE TOPREGNANCY AND CHILDBIRTH!=500,000 /YEAR=10 MILLION IN EVERY GENERATION15% (20 MIL/YEAR ) FATALCOMPLICATIONS DURING BIRTH>80% - HAEMORRHAGE, SEPSIS,UNSAFE
ABORTION,OBSTRUCTED LABOUR,
HYPERTENSIVE DISEASE21% - SEVERE BLEEDING!!!
UNICEF,UNFPA,WHO
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MATERNAL ADAPTATION
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Iron Deficiency Anemia Folate deficiency Haemoglobinopathies Infection Others
Maternal
anemia
Hb Barts Parvovirus B19 Rh isoimmunizationFetal
anemia
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WHO CRITERIA ANAEMIA
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WORLDWIDE PREVALENCE ANEMIA 1993-2005
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P REVALENCE
w o r l
d
50% I n d u s t r i a l
i z e f c o u n
t r y
23% M a l y a y s i a
35%
(11gm%)
M a l a y s i a
11%
(10 gm%)
Jamaiyah H et, al Asia Pac J Clin Nutr 2007
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H Jamaiyah Asia Pac J Clin Nutr 2007;16(3):527-536
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MATERNAL
PERINATAL
NEONATAL
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PREGNANCY IMPACT
MISCARRIAGEFETAL
GROWTHRESTRICTION
PRETERMDELIVERY
PERINATALDEATH
MATERNALDEATH
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ANEMIA AND IRON
DEFICIENCY
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SP Loh, Malaysian Journal of Medicine and Health Sciences;2010 Vol 6(1)
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The ferritin serum iron
Hb
MCV (indicationiron def affecting
Hb synthesis)
profound effect onbody functions :
Impaired muscle fx,neurotransmitteractivity, exercise
tolerance, epithelialchanges & alteration of
GIT fx
Can be corrected by oraliron supplements
Effects on cellularfunction :
Assoc between anaemia& preterm birth
Overt sx of iron def generally not prominent
IRON DEFICIENCY ANEMIA
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Amount of blood loss tolerated = 1000 ml
w/out causing significant fall in Hb concentration
No compensatory in blood vol & gradual in plasma vol
Overall result : Hct & blood vol non -preg stat
Blood vol following acute loss at delivery but remainsrelatively stable as long as the blood loss does not exceed
25% of the predelivery volume
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Babies delivered by iron def mothers have ferritin levelcompared to others
May cause anaemia during the 1 st year of life in babydelivered with depleted iron stores & poor oral iron intake
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Change of concentration of chemical mediatorsin the brain
Behavioralabnormalities
Cognitive skills Origin in fetal lifedue to LBW
prevention of adulthypertension
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M ATERNAL ANEMIA AND ITS IMPACT ON PERINATAL OUTCOME TROPICAL M EDICINE AND INTERNATIONAL H EALTH VOLUME 9 N O 4
P G 486-490 A PRIL 2004
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M ATERNAL ANAEMIA AND ITS IMPACT ON PERINATAL OUTCOME .
The risk of preterm delivery and LBW amongexposed group was 4 and 1.9 times higher amonganaemic women, respectively. Newborns of anaemic mothers had 1.8 times increased risk of having an APGAR score of
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S EVERE A NEMIA AND A DVERSE P REGNANCY OUTCOME R IFFAT J ALEEL , J OURNAL OF S URGERY P AKISTAN (I NTERNATIONAL ),13(4) O CT -D EC 2008
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Brabin BJ, The Journal Nutr 2001
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NICE GUIDELINES
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NICE GUIDELINES
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F OLATE DEFICIENCY
Baby born to folate def mother :Risk of megaloblastic anaemia esp if delivery ispreterm
Assoc cleft palate & neural tube defect (NTD)
Periconceptional folate the recurrence of NTD RCT in Hungary shown : 800 g/ day + MVT preventedoccurance of NTDPre pregancy 400mcg/day
##Previous affected pregnancy / Epilepsy : 4mg/day
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HAEMOGLOBINOPATHY
ALPHA THALASSEMIA BETA THALASEMIA SICKLE CELL ANEMIA
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A LPHA THALASSEMIA
Deletion of alpha gene onChromosome 16
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H B BART S AND HBH
Hb Barts non compatible with lifeHydrop FoetalisPolyhydramnios
HyperplacentosisMirror Syndrome MalpresentationPreterm labour
Antepartum haemorrhage PP /APCaesarean sectionPost partum haemorrhage
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P RENATAL
CVS AmniocentesisCordocentesis
Non invasive1 st trimester CTR >50%Free Fetal DNA in maternal plasma
Preimplantation Genetic Diagnosis
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FETAL ANAEMIA
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BETA THALASSEMIA
Mutation of beta genechromosome 11
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-THAL MAJOR
Pregnancy possible- Effective chelating agent- Spontaneous conception
- Assissted reproductive technique
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M ATERNAL HEALTH AND OBSTETRICS OUTCOME OF MOTHERS WITH THALASEMIA
Cardiac problemEndocrine
Alloimmunization
Viral InfectionHypercoagulable state and thrombosisOsteopenia, osteoporosis and bone deformity
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OBSTETRICS RISK -THAL MAJOR AND INTERMEDIA
Spontaneous miscarriage & fetal lossMultiple pregnancyPreterm birth
Intrauterine growth restrictionPre eclampsiaCaesarean sectionMaternal cardiac failure
Associated medical risk endocrine d/o
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Prepregnancy counselingOptimise maternal conditionMultidisciplinary carePrenatal counselingDiagnostic test
Role of Termination of pregnancyCounseling genetic and futurehealth care
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S ICKLE CELL ANEMIA
Inherited defectStructural alteration of globin chain
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Aggravating Factor:
Dehydration
StressExtreme Hypoxia
3 rd trimester
Intrapartum
Complications
CCF due to severe
anemia Aplastic crisisLeg ulcer
Vaso-ooclusive
ComplicationStroke
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CONCLUSION
Anemia is still prevalent Associated maternal complicationPotential fetal and neonatalcomplicationPrepregnancy counsellingPrenatal diagnosisPrenatal counseling
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RAMADHAN AL MUBARAK
THANK YOU