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Anaemia in Pregnancy

Anaemia during pregnancy, defined as Haemoglobin (Hb) <11 g/dL (or <10.5 g/dL in 2nd trimester). A major complication increasing risk for mother and baby.

Also known as: Pregnancy Anaemia

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Referral and warning signs

When to refer

Severe anaemia (Hb <=7) or heart failure signs. Unresponsive to oral iron. Anaemia late in pregnancy/labour. Sickle cell disease.

Red flags

  • Hb <= 7 g/dL
  • Signs of heart failure
  • Severe pallor
  • Associated heavy bleeding

Signs and symptoms

  • General symptoms of anaemia (fatigue, weakness, pallor, dyspnoea, dizziness, palpitations).
  • Glossitis, stomatitis (nutritional deficiency).
  • Leg oedema.
  • Signs of heart failure in severe cases (engorged neck veins, dyspnoea at rest, hepatomegaly, ascites, gallop rhythm).

Risk factors

  • Iron deficiency (poor diet, increased demand, blood loss).
  • Folate deficiency.
  • Infections/Infestations (Malaria, Hookworm, HIV/AIDS, UTI).
  • Haemoglobinopathies (Sickle Cell Disease).
  • Chronic bleeding.
  • Multiple pregnancy.
  • Short interpregnancy interval.

Diagnosis

Clinical assessment

Suspected based on symptoms and signs (especially pallor). Assess severity based on clinical signs and Hb level.

Investigations

  • Haemoglobin (Hb) estimation: Confirms diagnosis and severity (Mild 10-10.9, Moderate 7-9.9, Severe <7 g/dL).
  • Peripheral Blood Smear: Assess RBC morphology (microcytic, macrocytic, normocytic), check for malaria parasites.
  • Stool analysis: Ova & Cysts (hookworm).
  • Consider Hb Electrophoresis if Sickle Cell suspected.
  • HIV test.
  • Urinalysis (check for UTI).

Diagnostic criteria

Hb <11 g/dL (or <10.5 g/dL in 2nd trimester).

Management

Non-pharmacological management

  • Dietary Counseling: Emphasize balanced diet rich in iron, folate, protein, vitamins.
  • Treat underlying causes (Malaria, Hookworm, UTI, HIV).
  • Advise on child spacing (>2 years interval).

Pharmacological treatment

  • Prophylaxis (All pregnant women): Ferrous Sulphate (~60mg elemental Fe) + Folic Acid (400mcg) combination tablet, 1 tablet daily from 12 weeks until 6 months postpartum. (LOC: HC2)
  • Treatment (Hb >7 g/dL): DOUBLE DOSE Iron + Folic Acid (1 tablet PO BID/TID). Treat underlying cause (Malaria, Deworming - Mebendazole 500mg in 2nd/3rd tri). Review Hb q2wks. Refer if no improvement. (LOC: HC2)
  • Severe Anaemia (Hb <=7 g/dL) or Signs of Heart Failure: Refer URGENTLY to Hospital for likely transfusion. (LOC: HC4)
  • Anaemia at Term (>36 weeks) or During Labour: Refer to well-equipped facility. (LOC: HC4)
  • Sickle Cell Disease with Anaemia: Refer for specialist ANC/delivery. Folic Acid 5mg daily. (LOC: HC4)

Monitoring

Monitor Hb levels during treatment. Monitor clinical symptoms. Assess adherence. Monitor fetal well-being.

Complications

  • Maternal: Preterm labour, PPH, Cardiac failure, Infection risk, Poor lactation.
  • Fetal/Neonatal: IUGR, LBW, Prematurity, Fetal hypoxia, Stillbirth/Neonatal death.

Prevention

  • Routine iron and folic acid supplementation.
  • Malaria prevention (IPTp-SP, ITNs).
  • Deworming.
  • Good nutrition.
  • Child spacing.

Patient education

  • Explanation of anaemia and risks.
  • Importance of taking supplements and managing side effects.
  • Dietary advice.
  • Need to treat underlying causes.
  • Follow-up importance.
  • Danger signs.

Uganda-specific notes

Extremely common, major morbidity/mortality contributor. Multifactorial. Routine supplementation, IPTp-SP, deworming key. Empirical treatment common due to limited diagnostics.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 16, Section 16.2.1

For learning and professional reference. Use current local guidance and clinical judgement.

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