Gebelik ve Anemi
Özet
Gebelikte anemi küresel bir sağlık sorunudur ve hamileliklerin yüzde 40'ından fazlasını etkilemektedir. Dünya Sağlık Örgütü, anemiyi trimesterlere göre hemoglobin değerleri üzerinden tanımlamaktadır. Hamilelikteki fizyolojik değişiklikler plazma hacmini artırarak dilüsyonel anemiye yol açarken, en yaygın neden demir eksikliği anemisidir. Artan maternal kan hacmi ile fetal ve fetoplasental büyüme gereksinimleri, hamilelik boyunca demir ihtiyacını trimester bazında kademeli olarak artırır. Demir eksikliği dışında talasemi gibi hemoglobinopatiler, folik asit ve B12 eksiklikleri ile kronik hastalıklar da anemiye sebep olabilir. İlk prenatal ziyarette tam kan sayımı ile tarama önerilir; yüksek riskli gebelerde ferritin ve transferrin satürasyonu test edilebilir. Anemi, anne ölümü, eklampsi, yoğun bakıma kabul gibi ciddi maternal morbiditeleri iki kat artırırken, fetüste erken doğum ve düşük doğum ağırlığı riskini yükseltir. Korunma için günlük 27-30 mg, tedavi için ise daha yüksek dozda oral demir önerilir; tolere edilemeyen durumlarda ikinci ve üçüncü trimesterde intravenöz demir tercih edilir. Tedaviye yanıt retikülositoz ve hemoglobin artışı ile izlenir; doğum sonrası da takviyeye devam edilmelidir.
Anemia in pregnancy is a global health problem affecting more than 40 percent of pregnancies, defined by the World Health Organization through hemoglobin thresholds across trimesters. While physiological changes expand plasma volume and result in dilutional anemia, iron deficiency anemia remains the most common cause due to increased maternal blood volume, fetal erythropoiesis, and fetoplasental growth requirements that raise iron demands across trimesters. Other causes include hemoglobinopathies like thalassemia, folic acid or B12 deficiencies, and chronic diseases. Screening via complete blood count is recommended at the initial prenatal visit, and high-risk individuals can be evaluated using ferritin levels. Anemia doubles the risk of severe maternal morbidity, such as maternal death, eclampsia, and intensive care admission, while increasing risks for preterm birth and low birth weight. Prevention involves 27 to 30 mg of daily oral iron, whereas treatment requires higher doses, with intravenous iron preferred in the second and third trimesters if oral iron is not tolerated. Response to treatment is monitored through reticulocytosis and hemoglobin increases, and supplementation should continue for six to eight weeks postpartum.
Referanslar
Obstetricians ACo, Gynecologists. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233. Obstetrics and gynecology. 2021;138(2):e55-e64.
Organization WH. WHO recommendations on antenatal care for a positive pregnancy experience: World Health Organization; 2016.
Ruiz de Viñaspre‐Hernández R, Gea‐Caballero V, Juárez‐Vela R, Iruzubieta‐Barragán FJ. The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines. Birth. 2021;48(1):14-25.
De Benoist B, Cogswell M, Egli I, McLean E. Worldwide prevalence of anaemia 1993-2005; WHO global database of anaemia. 2008.
Reveiz L, Gyte GM, Cuervo LG, Casasbuenas A. Treatments for iron‐deficiency anaemia in pregnancy. Cochrane Database of Systematic Reviews. 2011(10).
Auerbach M, Landy H, Barss VA. Anemia in pregnancy. UpToDate Basow DS (Ed), UpToDate, Waltham MA. 2018.
Bothwell TH. Iron requirements in pregnancy and strategies to meet them. The American journal of clinical nutrition. 2000;72(1):257S-64S.
Society SC. Standards for the clinical care of adults with sickle cell disease in the UK: Sickle Cell Society; 2008.
Cazzola M, Borgna‐Pignatti C, Locatelli F, Ponchio L, Beguin Y, De Stefano P. A moderate transfusion regimen may reduce iron loading in beta‐thalassemia major without producing excessive expansion of erythropoiesis. Transfusion. 1997;37(2):135-40.
Campbell BA. Megaloblastic anemia in pregnancy. Clinical obstetrics and gynecology. 1995;38(3):455-62.
Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, et al. Folic acid supplementation for the prevention of neural tube defects: US preventive services task force recommendation statement. Jama. 2017;317(2):183-9.
Costa MM, Belo S, Souteiro P, Neves JS, Magalhães D, Silva RB, et al. Pregnancy after bariatric surgery: M aternal and fetal outcomes of 39 pregnancies and a literature review. Journal of Obstetrics and Gynaecology Research. 2018;44(4):681-90.
Control CfD, Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR RR. 1998;47(3):1-29.
Pavord S, Daru J, Prasannan N, Robinson S, Stanworth S, Girling J, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020;188(6):819-30.
Tunkyi K, Moodley J. Anemia and pregnancy outcomes: a longitudinal study. The Journal of Maternal-Fetal & Neonatal Medicine. 2018;31(19):2594-8.
Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru‐Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015;55(12):2799-806.
Ren A, Wang J, Ye R, Li S, Liu J, Li Z. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. International Journal of Gynecology & Obstetrics. 2007;98(2):124-8.
Rigas AS, Pedersen OB, Sørensen E, Thørner LW, Larsen MH, Katz LM, et al. Frequent blood donation and offspring birth weight—a next‐generation association? Transfusion. 2019;59(3):995-1001.
Shao J, Lou J, Rao R, Georgieff MK, Kaciroti N, Felt BT, et al. Maternal serum ferritin concentration is positively associated with newborn iron stores in women with low ferritin status in late pregnancy. The Journal of nutrition. 2012;142(11):2004-9.
Juul SE, Derman RJ, Auerbach M. Perinatal iron deficiency: implications for mothers and infants. Neonatology. 2019;115(3):269-74.
Auerbach M, Georgieff MK. Guidelines for iron deficiency in pregnancy: hope abounds: Commentary to accompany: UK guidelines on the management of iron deficiency in pregnancy. Wiley Online Library; 2020. p. 814-6.
Christoph P, Schuller C, Studer H, Irion O, De Tejada BM, Surbek D. Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose vs. iron sucrose. Journal of perinatal medicine. 2012;40(5):469-74.
Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy in obstetrics: 8 years experience with iron–sucrose complex. British journal of nutrition. 2002;88(1):3-10.
Swaim LS, Perriatt S, Andres RL, Paradissis J, Watson MN. Clinical utility of routine postpartum hemoglobin determinations. American journal of perinatology. 1999;16(07):333-7.
Medina Garrido C, León J, Romani Vidal A. Maternal anaemia after delivery: prevalence and risk factors. Journal of Obstetrics and Gynaecology. 2018;38(1):55-9.
