Here’s a **detailed, modern-styled, easy-to-read note** on **Anemia in Pregnancy** — designed like what you’d see in a medical app or digital study card.
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## 🌺 **Anemia in Pregnancy – Complete Notes**
### 🩸 **Definition**
Anemia in pregnancy is defined as a **reduction in the oxygen-carrying capacity of the blood** due to decreased hemoglobin concentration, hematocrit, or red cell count.
* **WHO definition:**
* **Hb < 11 g/dL** (in pregnancy)
* **Mild:** 10–10.9 g/dL
* **Moderate:** 7–9.9 g/dL
* **Severe:** < 7 g/dL
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### 🌿 **Normal Hematological Changes in Pregnancy**
* **Plasma volume ↑ by 50%**
* **Red cell mass ↑ by 25–30%**
* **Physiological (dilutional) anemia** – due to greater plasma expansion than RBC mass.
* **Hb normally decreases** by ~1 g/dL.
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### 💠 **Causes of Anemia in Pregnancy**
#### 1. **Nutritional Deficiency (Most Common)**
* **Iron deficiency anemia (IDA)** → 80–90% of cases
* **Folic acid deficiency**
* **Vitamin B12 deficiency**
#### 2. **Hemoglobinopathies**
* Thalassemia (α or β)
* Sickle cell anemia
#### 3. **Chronic Diseases**
* Kidney disease, infections (malaria, HIV, tuberculosis)
#### 4. **Acute Blood Loss**
* Antepartum or postpartum hemorrhage
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### 🧬 **Iron Deficiency Anemia (IDA)**
#### ⚙️ **Pathophysiology**
* Increased iron demand during pregnancy (~1000 mg extra required)
* Inadequate intake or absorption
* Repeated pregnancies with short intervals
#### 📊 **Stages**
1. **Iron depletion** (↓ Ferritin)
2. **Iron-deficient erythropoiesis** (↓ Serum iron, ↑ TIBC)
3. **Iron deficiency anemia** (↓ Hb)
#### 🔬 **Investigations**
| Test | Findings in IDA |
| -------------- | --------------------------- |
| Hb | ↓ |
| MCV, MCH | ↓ (microcytic, hypochromic) |
| Serum Iron | ↓ |
| Serum Ferritin | ↓ |
| TIBC | ↑ |
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### 🧫 **Folic Acid & B12 Deficiency**
* **Folic acid deficiency:** Common in late pregnancy.
* Causes: Poor diet, cooking losses, multiple pregnancies.
* **Megaloblastic anemia** (macrocytic RBCs).
* **Vitamin B12 deficiency:** Rare but occurs in strict vegetarians or malabsorption.
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### ⚠️ **Clinical Features**
| Maternal | Fetal |
| -------------------------------------- | --------------------------- |
| Fatigue, weakness | Low birth weight |
| Pallor (conjunctiva, tongue, nail bed) | Preterm birth |
| Breathlessness, palpitations | IUGR |
| Edema (severe cases) | Stillbirth, neonatal anemia |
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### 🩺 **Diagnosis**
* Routine antenatal Hb screening at first visit and 28 weeks.
* Peripheral smear → type of anemia.
* Iron studies, folate/B12 levels as needed.
* Rule out **malaria, helminths, or chronic disease** if unexplained.
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### 💊 **Treatment**
#### 1. **Prophylaxis (All Pregnant Women)**
* **Iron + Folic Acid tablets (IFA):**
* **100 mg elemental iron + 0.5 mg folic acid daily** for **100 days** (India: as per National Guidelines).
#### 2. **Therapeutic**
| Severity | Treatment |
| ----------------------------------------- | -------------------------------------------------------- |
| Mild–Moderate | Oral iron (100–200 mg elemental iron daily) + Folic acid |
| Severe / intolerance | Parenteral iron (Iron sucrose or ferric carboxymaltose) |
| Very severe (Hb < 6 g/dL or nearing term) | Blood transfusion |
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### 🧘♀️ **Dietary Advice**
* Eat **iron-rich foods:** green leafy vegetables, jaggery, dates, liver, meat.
* **Enhance absorption:** Take with vitamin C (lemon, amla).
* **Avoid inhibitors:** Tea, coffee, calcium with meals.
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### 🤰 **Complications**
#### **Maternal**
* Preterm labor
* Postpartum hemorrhage
* Puerperal sepsis
* Cardiac failure (in severe cases)
* Poor lactation
#### **Fetal**
* Low birth weight
* IUGR
* Intrauterine death
* Neonatal anemia
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### 🌼 **Prevention**
* Early registration & regular ANC checkups
* Routine Hb estimation
* Universal IFA supplementation
* Deworming (after 16 weeks)
* Iron-rich diet education
* Spacing pregnancies
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### 💬 **Key Takeaways**
* Most common cause of anemia in pregnancy = **Iron Deficiency**
* Treat early → prevent maternal & fetal complications
* **Hb < 7 g/dL = Severe Anemia → needs urgent care**
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### 🎯 **Mnemonic for Causes of Anemia in Pregnancy – “NIB-BAD”**
**N**utritional
**I**nfections (Malaria, HIV)
**B**leeding
**B**one marrow suppression
**A**nemia of chronic disease
**D**isorders of Hb (Thalassemia, Sickle cell)
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