Anemia and Maternal Mortality

The relationship between iron deficiency, anemia, and maternal mortality is complex and controversial. Anemia that results from iron deficiency is a physiological condition

Table 22.3

Iron Requirements during Pregnancy: Compartments.

Gross iron loss during pregnancy is 1.2 g for a healthy woman

Fetus, umbilical cord and placenta Maternal blood loss Basal losses

Red cell mass expansion Total

360 mg 150 mg 230 mg 450 mg 1,190 mg

Net iron losses are 580 mg due to recovery of increased red cell mass (450 mg) at delivery and lack of menstruation (160 mg).

Hemoglobin

Weeks of pregnancy

Fig. 22.3. Hemoglobin levels in pregnancy

Fig. 22.3. Hemoglobin levels in pregnancy

Maternal Consequences Anemia

folate & other micronutrients CDietary intakes)

ematurity and TUGR ^-

Fig. 22.4. Functional consequences of anemia during pregnancy and early childhood. (From [18])

folate & other micronutrients CDietary intakes)

ematurity and TUGR ^-

Fig. 22.4. Functional consequences of anemia during pregnancy and early childhood. (From [18])

that is associated with limited function in that aerobic output may be impaired. The result is that women feel more tired and, therefore, quality of life is affected [1]. It is also well recognized that severe anemia (hemoglobin < 7 g/dl) is associated with an increased risk of dying, especially in settings where access to safe delivery practices is limited, as in many developing countries. Severely anemic women tend to be at increased risk of blood loss and cardiac failure, which can result in death. The relationship between iron deficiency per se, as well as mild-moderate anemia, is, however, less clear.

In a meta-analysis of several observational and intervention trials, Ross and Thomas [21] concluded that approximately 20% of the maternal mortality seen in sub-Saharan Africa and South Asia is attributable to anemia that is primarily the result of iron deficiency. However, the causal association between iron deficiency and maternal mortality has been questioned and is limited by the dearth of data from controlled trials [19, 20, 22]. Another concern is evidence suggesting that iron supplementation may increase the risk of infections [23]. A recent study showed an increased risk of dying among young children who received iron supplements in Zanzibar, a region where malaria is endemic [24]. These findings have renewed concerns about the safety of routine iron supplementation during pregnancy in these settings. This complicates current efforts to address iron deficiency and protect women and young children from the potential adverse effects. Screening for anemia and iron deficiency combined with targeted interventions may be required.

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Responses

  • Jude
    What is maternal anemia?
    2 years ago

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