CURRENT APPROACHES BASED ON EVIDENCE IN IRON AND FOLATE DEFICIENCY ANEMIA IN PREGNANCY

Year 2019, Volume: 50 Issue: 3, 167 - 174, 15.09.2019

Zümrüt Bilgin Nurdan Demirci

https://doi.org/10.16948/zktipb.469571

Cited By: 1

Abstract

Abstract: Anemia is the most common hematologic problem during pregnancy. It is estimated
that 38.2% of pregnant women in the world are anemic. The frequency of anemia
in women of reproductive age in Turkey is reported to vary between 20% and
39.9%. Anemia during pregnancy is evaluated in two groups as acquired and
inherited. During pregnancy, iron deficiency, which is often an acquired
deficiency anemia, and less frequently folic acid deficiency anemia occur. The
main cause of iron deficiency anemia (IDA) is; The low level of iron before
pregnancy, increased absorption during pregnancy is an increasing need.
Hemoglobin (Hb) and serum ferritin levels are measured primarily for the
diagnosis of iron deficiency anemia. The lowest Hb value during pregnancy
should be <11 gr/dL in 1st and 3rd trimester and <10.5 gr/dL in second
trimester.  Anemia in pregnancy;
increased risk of illness and death of the mother (20-40%), and increased risk
of intrauterine growth retardation, low birth weight, preterm delivery and
perinatal mortality in the fetus. In order to prevent maternal and fetal
complications, it is important to give iron and folate support to pregnant
women. Oral iron therapy in iron deficiency anemia is given as the first-line
therapy. Intravenous (IV) iron treatment is preferred in cases such as failure
of oral treatment, compliance to treatment, very low hemoglobin values and need
for fast iron replacement. In this review, it is aimed to examine the evidence
based current approaches in iron and folate deficiency anemia during pregnancy.

Keywords

Pregnancy, iron and folate anemia

GEBELİKTE DEMİR VE FOLAT EKSİKLİĞİ ANEMİSİNDE KANITA DAYALI GÜNCEL YAKLAŞIMLAR

Abstract

Özet:Anemi,
gebelikte en yaygın hemotolojik bir sorundur. Dünyadaki gebe kadınların %38.2'sinin
anemik olduğu, tahmin edilmektedir. Türkiye’de üreme çağındaki kadınlarda anemi
sıklığının %20 ile %39.9 arasında değiştiği belirtilmektedir. Gebelik
dönemindeki anemiler edinsel ve kalıtsal olmak üzere iki grupta değerlendirilir.
Gebelikte sıklıkla edinsel yetmezlik anemilerinden olan demir eksikliği ve daha
az sıklıkla da folik asit eksikliği anemisi oluşur. Demir eksikliği anemisi (DEA)’nin en temel nedeni;
gebelik öncesinde demir düzeyinin düşüklüğü, gebelikte absorbsiyonun artması
ile artan gereksinimdir. Demir eksikliği anemisinin tanısı için öncelikle hemoglobin
(Hb) ve serum ferritin düzeyi ölçülür. Gebelikte en düşük Hb değeri 1. ve 3. trimesterde <11 gr/dL,
2. trimesterde <10,5 gr/dL’olmalıdır. Gebelikte anemi; annenin
hastalanma ve ölüm riskinde artışla (%20-40 oranında), fetüste ise intrauterin büyüme
geriliği,  düşük doğum ağırlığı, erken
doğum ve perinatal mortalite riskinde artışla ilişkilidir. Maternal ve fetal
komplikasyonların önlenmesi için gebe kadınlara demir ve folat desteği
verilmesi önemlidir. Demir eksikliği anemisinde oral demir tedavisi birinci basamak tedavi olarak verilir. Oral
tedavi yanıtsızlığı, tedaviye uyum sorunu, çok düşük hemoglobin değerleri ve
hızlı demir replasmanına ihtiyaç duyulması gibi durumlarda intravenoz (İV)
demir tedavisi tercih edilmektedir. Bu derlemede gebelikte demir
ve folat eksikliği anemisinde kanıta dayalı güncel yaklaşımların incelenmesi
amaçlanmıştır.

Keywords

Gebelik, demir ve folat anemisi

References

• Küçükgöz Güleç Ü, Tuncay Özgünen F, Evrüke İC, Demir SC. Gebelikte anemi. Archives Medical Review Journal 2013; 22(3):300-316.
• World Health Organization (WHO). Guideline: Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects. Geneva: World Health Organization. 2015;1-48.
• Prakash S, Yadav K. Maternal Anemia in Pregnancy: An Overview. IJPPR. 2015; 4(3):164-179.
• Goonewardene M, Shehata M, Hamad A. Anaemia in pregnancy. Best Practice & Research Clinical Obstetrics and Gynaecology 2012; 26 3-24.
• Friedrisch JR, Friedrisch BK. Prophylactic ıron supplementation in pregnancy:A controversial Issue. Biochemistry Insights 2017;10:1-8.
• The U.S. Preventive Services Task Force (USPSTF). Screening for ıron deficiency anemia and ıron supplementation in pregnant women to ımprove maternal health and birth outcomes: Recommendation statement. American Family Physician 2016;93(2):133-136.
• Uçar MG, Uçar RM, Çelik Ç. Gebelerde anemiye yaklaşım. Türkiye Klinikleri J Fam Med-Special Topics 2016; 7(3):17-24.
• Api O, Breyman C, Çetiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period:iron deficiency anemia working group consensus report. Turk J Obstet Gynecol 2015;12:173-181.
• Gupta A, Gadipudi A. Iron Deficiency Anaemia in Pregnancy: Developed Versus Developing Countries EMJ Hematol. 2018;6 (19):101-109.
• Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C. UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology, 2012; 156, 588-600.
• Palihawadana TS, Goonewardene IMR, Motha MBC, Williams HSA. Iron deficiency anaemia in pregnancy: diagnosis, prevention and treatment. Sri Lanka Journal of Obstetrics and Gynaecology 2014;61-65.
• Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, Tunçalp Ö, Torloni MR, Mittal S, Jayaratne K, Lumbiganon P, Togoobaatar G, Thangaratinam S, Khan KS. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health 2018;6:e548-554.
• The Society of Obstetricians and Gynaecologists of Canada (SOGC). Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies. J Obstet Gynaecol Can 2015;37(6):534–549.
• Muñoz M, Peña-Rosas JP, Robinson S, Milman N, Holzgre W, Breymann C, Goffinet F, Nizard J, Christory F, Samama CM, Hard JF. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfusion Medicine 2018;28: 22-39.
• World Health Organization (WHO). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience: Summary. Geneva, Switzerland: WHO; 2018. Licence: CC BY-NC-SA 3.0 IGO.
• Achebe MM, Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. BLOOD, 2017 ;129 ( 8):940-949.
• Yıldız Y, Yapar Eyi EG. Gebelikte annenin anemisi. The Journal of Gynecology- Obstetrics and Neonatology 2012; 9(35):1456-1459.
• Brannon PM, Stover PJ, Taylor CL. Iron supplementation during pregnancy and infancy: Uncertainties and implications for research and policy. Am J Clin Nutr. 2017;106(Suppl 6):1703-1712.
• Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004736.
• Namazi A. Anemia and ıron supplement in pregnancy: a mini review. JOJ Nurse Health Care 2018; 7(3):1-3.
• Vural T, Özcan A, Sancı M. Güncel Bilgiler Işığında Gebelikte Demir Eksikliği Anemisi:Demir Desteği Kime? Ne Zaman? Ne Kadar?. Van Tıp Derg. 2016;23(4):369-376. https://www.journalagent.com/vtd/pdfs/VTD-58070-REVIEW-VURAL.pdf
• 22. Rukuni R, Knigh M, Murphy MF, Roberts D, Stanworth SJ. Screening for iron deficiency and iron deficiency anaemia in pregnancy:a structured review and gap analysis against UK national screening criteria. BMC Pregnancy and Childbirth 2015;15:269.
• Timmermans S, Jaddoe VWV, Hofman A, Steegers-Theunissen RPM, Steegers EAP. Periconception folic acid supplementation, fetal growth and the risks of low birth weight and preterm birth:the generation r study. British Journal of Nutrition 2009 102, 777-785.
• 24. Kozuma S. Approaches to anemia in pregnancy. JMAJ 2009;52(4):214-218. https://www.med.or.jp/english/journal/pdf/2009_04/214_218.pdf
• Czeizel AE, Dudás I, Vereczkey A, Bánhidy F. Folate deficiency and folic acid supplementation:The prevention of neural-tube defects and congenital heart defects. Nutrients 2013; 5, 4760-4775.
• Sharma JB, Shankar M. Anemia in regnancy. JIMSA 2010;23 (4):253-260.
• Gatt M, Baron YM, Lautier EC, Calleja N. Folic Acid - Prevention of birth defects. Malta Medical Journal 2016;28 (4):49-54.
• The US Preventive Services Task Force (USPSTF) Folic acid supplementation for the prevention of neural tube defects us preventive services task force recommendation statement. JAMA. 2017;317(2):183-189.
• McStay CL, Prescott SL, Bower C, Palmer DJ. Maternal folic acid supplementation during pregnancy and childhood allergic disease outcomes: a question of timing?. Nutrients 2017;9 (123):2-14.
• Moussa HN, Hosseini Nasab S, Haidar ZA, Blackwell SC, Sibai BM. Folic acid supplementation: what is new? Fetal, obstetric, long-term benefits and risks. Future Sci OA. 2016 2(2): FSO116.
• Catherine DeSoto M, Hitlan RT. Synthetic folic acid supplementation during pregnancy may increase the risk of developing autism. Journal of Pediatric Biochemistry 2012;2 251–261.
• Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron defi ciency anaemia. Lancet 2016; 387: 907-916.
• Chowdhury S, Rahman M, Moniruddin ABM. Anemia in pregnancy. Medicine Today 2014;26(1):49-52.