Presented by: Nadia Presented by: Nadia Rouchdy BscRouchdy Bsc

Charge NurseCharge Nurse

OutPatient ClinicsOutPatient Clinics

SFHPSFHP

WHO recommendation: Hemoglobin should not fall below 11

gm/dL

CDC – 10.5 gm/dL (North America)

DefinitionDefinition

ObjectivesTo find the associated factors in our

pregnant anaemic patients, in relation to

AGEPARITYDIETCOMPLIANCE with medication (Iron)

in order to provide relevant patient education.

PHYSIOLOGYTHERE IS AN INCREASE IN PLASMA

VOLUME – by 28 weeks it has increased by 50%.

THERE IS AN INCREASE IN BONE MARROW RED CELL PRODUCTION – but not enough to compensate for the huge plasma volume increase.

FACTORS WHICH ARE KNOWN TO LEAD TO IRON DEFICIENCY ANAEMIA IN PREGNANCY

Increasing age

Increasing parity

Pregnancy interval of < 2 years (at least 2

years is needed to rebuild Iron Stores)

A diet low in meat/poultry

Taking Iron absorption - reducers (calcium/ caffeine) within 1 hour of meals or Iron tablets.

Caffeine reduces Iron absorption by 40-60%

Calcium reduces Iron absorption by 30-40%

• Non-compliance with Iron Rx

ANAEMIC MOTHERS HAVE A HIGH RISK OF:

Morbidity from OB hemorrhage

Transfusion risk

Post-partum infection

Thromboembolism

THEIR BABIES HAVE A HIGH RISK OF :

Pre-term birth

Low birth weight

Low intelligence and behavioral problems

MATERIALS/ METHODS

Type Prospective

Population – pregnant patients following in SFHP ante-natal clinics with a HB≤10 gm/dl. (MO1 dependents)

Sickle Cell Anaemia /Thalassaemia patients excluded.

Sample – 180

Randomly selected and interviewed by the attending Physician who completed the questionnaire, between Nov.2009 and March 2010

Statistical analysis – SPSS – version. 17

RESULTS

15 - 19 20 - 24 25 - 29 30 - 3435 - 39 40

Age 1.70% 15% 22% 23% 25% 13.90%

0-1 2 - 4 5 - 8 9 +

Parity 28.30% 31.10% 38.30% 2.20%

0 - 1 2 - 4 5 - 8 9 +

Primagravida 1 - 2 Years 3 - 4 Years 5 + Years

Pregnacy 14% 31.50% 34.30% 20.20%

None Primary Middle SecondaryUniversity or More

Educ Level 3.90% 18.30% 12.80% 30% 35%

# of Weeks 62.78% 37.22%Pregnant on First Visit

Late 2nd Trimester & Above

Weekly 5.56% 94.44%

Daily 68.33% 31.67%

Weekly 21.67% 78.33%

Yes NO65.36% 34.64%

2nd Trimester 90% 10%

Iron Rx 38.20% 39.30% 18% 4.50%Compliance

Always SometimesOccassionall

y

As Rx Miss 1/Day Take Never Take

Nau

sea/V

om

iting

Co

nstip

ation

&

20.4%

2.7%

39.8%

1.8%0.9%4%

0.9%3.5%

25.7%

Conclusions

Factors that DID NOT contribute to developing Anaemia are:

Parity

Education Level

Pregnancy Interval

Consumption of Animal Protein

Gestational stage at first visit

Timing of Starting Iron Therapy

Factors that DID Contribute to Developing Anaemia Are:

Age

Diet (Not Consuming Liver & Green

Vegetables)

Iron Absorption-Reducers

(takingTea/Coffee/Dairy Products and Calcium

Supplement with meals & Iron)

Iron Compliance

WHAT WE FOUND OF STATISTICAL SIGNIFICANCE WAS:

Women with a higher education level had a lower parity (p-value <0.001)

Older women tended to eat more meat/ chicken (p-value = 0.018)

Contrary to our belief the majority of our patients came early for care and were started early on IRON Treatment (p-value=0.027)

Younger women (< 30 yrs) were more likely to forget to take their IRON Tablet (p-value =0.048)

RECOMMENDATIONSEducate pregnant patients regardless of age, parity,

education level or gestational age regarding:

The dangers of anaemia in pregnancy

Diet - Eating a source of animal protein at least every other day

- Eating liver and molokia weekly

Avoidance of IRON Absorption -Reducers

- Not drinking tea/coffee/dairy products within 1 hour of meals

- Not taking the CALCIUM supplement together with IRON Tablet .

Taking Iron as Prescribed:

- Having a routine to help in remembering to take their IRON Tablet

- Avoiding constipation by increasing roughage containing foods & increasing fluid intake

- Avoiding nausea and stomach upset by taking IRON during their meals

Include information regarding Anaemia in Pregnancy in High School.

Physician should show the patient their hemoglobin result in order to increase their compliance with their Iron Rx.