Rethinking postpartum anemia
Anemia is still a leading cause of morbidity in every part of the globe and is still a source of serious public health concern as it can be devastating to the family when it affects the parents. It is an easily preventable illness when we undertake simple measures that are obtainable locally in all of our communities to ameliorate it.
It is defined as a medical condition resulting from the deficiency of hemoglobin or red blood cells in the body.
Postpartum anemia is anemia that develops in a woman who has just recently delivered. It can be mild, moderate or severe and this classification is based on the level of hemoglobin in the blood. Being mild when the hemoglobin is between 8 to 10 g/dl. moderate between 6 to 8 g/dl and severe when it is less than 6g/dl with its accompanying symptoms of tiredness, weakness, easy fatiguability, paleness, cardiovascular strain, cognitive problems which can ultimately culminate and lead to psychiatric disorders.
It is a common but often neglected problem with a prevalence rate of around 30% in the community. It is more prevalent in the developing countries where prevalence can reach 80% in some communities.
Routine screening for postpartum anemia should be included as part of a regular postpartum routine check before discharge from hospital following delivery and at the 6 weeks postnatal visit to pay more attention to this often neglected source of maternal morbidity and occasionally mortality.
Causes of postpartum anaemia
Dietary
The main cause of postpartum anemia is deficiency of iron prepregnanacy. When the amount of iron you consume in pregnancy is less than your daily requirement, most of that iron are used by the developing fetus to build up its body systems and meet its own high iron demand as the baby needs vast amount of hemoglobin to extract oxygen from your blood.
This deficit leaves you depleted of iron leading to iron deficiency anemia (IDA). The daily requirement for iron in pregnancy is about 40 – 50 mg per day and when this is not being met in pregnancy be sure you will develop postpartum IDA.
Aside iron there are other nutrients required for the proper functioning of the bone marrow for the production of hemoglobin and when the diet is not rich in protein and other vitamins and minerals there is going to be an increased risk of you developing anemia postpartum.
Peripartum blood loss
The loss of blood prior to delivery like in cases of placenta praevia and abruptio placenta, intrapartum blood loss during the labor process and postpartum hemorrhage all make up peripartum blood loss and is a very important risk factor for your development of postpartum anemia.
These peripartum bleeding which are usually normally greater than the normal average loss of 300ml following delivery leads to a rapid depletion of the body iron stores leading in the process to postpartum IDA.
Diseases of the intestine
Intestinal diseases like Celiac disease, Crohn’s disease and Inflammatory bowel disease cause mal-absorption of nutrients in the intestine including iron and some essential vitamins like B12 leading to the development of anemia both antepartum and postpartum
Other uncommon etiologies
Individuals with medical conditions like folate deficiency, parasitic infestations (severe malaria, hookworm), vitamin B12 deficiency, bacterial infection, autoimmune haemolytic anemia, malignancies, toxic/aplastic anemia will certainly all lead to postpartum anemia in the post delivery period if no measures are taken in the prepregnancy and antenatal period to alleviate it hence these should be screened for when the cause of anemia could not easily be ascertained postpartum.
Prevention of postpartum anemia
Prepartum iron supplements
The administration of iron to correct iron deficiency in the form of 50 to 100mg of ferrous sulphate on a daily basis in pregnancy is the mainstay of the prevention of iron deficiency anemia both antenatally and postnatally.
This dosage is subject to country specific recommendations.
Well balanced diet
There is no substitute for a well-balanced diet in improving your health and state of well-being of both the mother and the unborn baby. Consumption of iron rich foods, for example vegetables like spinach, cereals and legumes like beans and peas, fruits like strawberries apricots pumpkins, plantains and beef and chicken all aid in maintaining the positive iron balance in pregnancy and postpartum.
Vitamin C containing foodstuff also help in the absorption of iron and fruits are among the highest vitamin C containing foodstuff.
Tea consumption
Consumption of certain tea varieties that containing tannin is not advisable in pregnancy as this tannin hampers the absorption of iron from the stomach .
High consumption of calcium also hinders the absorption of iron and of particular importance in some developing countries is some calcium containing local chalks that women consume in early pregnancy to manage hyperemesis gravidarium or vomiting of pregnancy that has been noted to seriously chelate iron leading to its non absorption. This becomes critical when combined with the baseline preexisting iron insufficiency in developing countries.
Properly conducted labor and delivery
The proper management of causes of antepartum hemorrhage like placenta previa with prompt and early use of cesarean section, the proper use of episiotomies and an active management of the third stage of labor are all measures used by the clinician to reduce blood loss and prevent the development of postpartum anemia.
Early diagnosis and treatment
The early diagnosis and control of bacterial infections, the early diagnosis and treatment of ailments like parasitic infestations and malaria and these are measures that when implemented early will prevent the development of postpartum anemia in the long run.
Best treatment strategies
When your hemoglobin result shows that you have anemia the next step is to characterize the severity of the anemia to determine the steps to follow in your management. There is an absolute need to ensure you rest well as the anemia causes weakness and tiredness hence adequate rest is essential during the recovery phase.
For mild postpartum anemia
The best strategy for mild anemia is counseling on the best dietary measures to follow to address the anemia, the implementation of a high dose of iron therapy will help replenish the depleting iron stores and be able to supply the iron necessary for the proper functioning of breastfeeding and lactation.
The hemoglobin level will need to be checked every 2 weeks to ensure that the iron stores are rising as reflected by a rising hemoglobin level.
For moderate postpartum anemia
The best strategy to deal with moderate anemia is the use of high dose oral iron or when this is not feasible, a resort to parentheral iron in the form of total dose iron infusion in addition to dietary measures becomes necessary as the anemia is becoming symptomatic. When you appreciate the fact that your lactation and breast feeding is an added strain on your iron stores, it becomes extremely important to replenish the stores fast.
For severe postpartum anemia
Severe anemia presents with circulatory and cardiovascular complaints and the patient is usually in markedly severe distress whether it is a chronic anemia or acute loss. The best treatment here is to correct the circulatory problems with the use of blood transfusion. You may need total dose iron infusion as the total iron you need to bring your hemoglobin to normal values is calculated and this is then delivered via infusion.
If there are associated infection or inflammation with the hampered erythropoiesis, recombinant human erythropoetin will become necessary.
Your nutritionist will be of immense help in guiding your through the recovery process by counseling on proper iron therapy and the protein and vitamins and minerals rich foods and fruits that will help maintain your iron reserve in the positive balance after ruling out other causes of postpartum anemia.
Still a global problem
Anemia is still a handicapping global ailment in the postpartum period as it makes it extremely tiring to do the necessary routine activities expected of a new mom like breastfeeding as lactation is poor and the patient is always extremely fatigued and weak on any small exertion.
It needs to be characterized and can easily be managed by implementing readily available measures that are cost effective.
Without correction of postpartum anemia you will not be able to enjoy motherhood so it should be tackled fast and at the earliest time with every available measure even blood transfusion if that remains the last resort.
Dr mawa
To your postpartum health and freedom
mypostnatalmanagement.com
