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During pregnancy, the concentration of hemoglobin, red blood cells and hematocrit decreases due to the increase in the physiological plasma volume of the pregnant woman. However, when the hemoglobin of the pregnant woman falls below 11.0 g / dl (according to the criteria of the World Health Organization) the pregnant woman is diagnosed with anemia.
Anemia must be monitored during pregnancy, not only because of the negative effects it has on the mother's health, but also because of the consequences it can have on the baby.
Babies of moms with anemia are usually born with less weight, have a higher risk of being born prematurely (in the case of severe anemia) among other problems. That is why the care and monitoring of anemia during pregnancy is essential. But there is various types of anemia. They are classified according to the mean erythrocyte corpuscular volume, which allows us to determine the cause (levels that are measured by a blood test).
- Microcytic anemias: They occur when the Mean Corpuscural Volume is less than 83 (fl), that is, when the red blood cells are small. In the vast majority of cases it responds to a lack of iron (iron deficiency). It is the most common anemia and in fact, many women have low iron prior to pregnancy. It is treated by supplementing with ferrous sulfate or other similar salts
- Normocytic anemias: When the Mean Corpuscural Volume is between 83 and 98 fl. The size of red blood cells is normal, but there is an abnormal number of them. It is less frequent. It is usually related to previous bleeding - the most frequent cause - or to diseases such as preeclampsia, autoimmune diseases ... Sometimes the woman has this disease before pregnancy, but it has not been diagnosed until it, when it presents its first symptoms.
- Macrocytic anemias: When the Mean Corpuscural Volume is greater than 98 fl. The most frequent cause in this case is a vitamin deficiency, cobalamin (vitamin B12) and folic acid (vitamin B9). Pregnancy consumes a large amount of Ac. Folic, on the part of the fetus, and the reserves of this vitamin are scarce.
- If the problem is eIron deficiency: Pregnant women have iron requirements of 30 mg / day for pregnant women, which can be achieved through a diet rich in food with a large amount of it. However, in most cases, it is chosen to supplement with 150 mg of ferrous sulfate, 300 mg of ferrous gluconate. These supplements are intended to be taken on an empty stomach since the acidic pH of the stomach facilitates its absorption.
In some preparations it is accompanied by vitamin C precisely for this reason. Tea, coffee, milk, and other substances like calcium carbonate and magnesium oxide make it difficult. Sometimes this treatment can cause gastric discomfort or constipation. If the anemia is especially severe, or does not respond to oral treatment, the gynecologist may choose to administer said iron intravenously
- If the problem is vitamin B9 and / or vitamin B12 deficiency: Folic acid supplementation is done primarily before pregnancy as it has been shown to prevent neural tube defects. The recommended dose is at least 0.4 mg per day in low-risk women and 4 mg / day in high-risk women, in addition to a balanced diet.
Vitamin B12 supplementation is carried out mainly in women with twin pregnancies, hyperemesis, strict vegetarian women and other circumstances that may favor their deficiency.
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