O99.0 + (D64.9)
DESCRIPTION
Anaemia in pregnancy is a Hb < 11 g/dL, most commonly due to iron deficiency. Hb levels in pregnancy should be checked at the booking visit and repeated again between 28 and 32 weeks, and at ± 36 weeks.
Treatment of anaemia is recommended when the Hb falls below 10g/dL.
Women with iron deficiency often have ‘pica’, e.g. eating substances such as soil, charcoal, ice, etc.
GENERAL MEASURES
- A balanced diet to prevent nutritional deficiency.
- Reduce intake of tea.
- Do not drink tea within 2 hours of taking iron tablets.
MEDICINE TREATMENT
Established anaemia with Hb < 10 g/dL:
- Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) 12 hourly.
- Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk).
OR
- Ferrous fumarate, oral, 200 mg 12 hourly (± 65 mg elemental iron) with meals.
- Continue for 3 months after the Hb normalises in order to replenish body iron stores. Hb is expected to rise by at least 1.5 g/dL in two weeks.
- Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk).
REFERRAL
Urgent (same day)
- Hb < 6 g/dL.
- Hb = 6-7.9 g/dL with symptoms (dizziness, tachycardia, shortness of breath at rest).
Non urgent (within 1 week)
- Hb = 6-7.9 g/dL without symptoms (high-risk clinic if available).
- Hb = 8-9.9 g/dL and no improvement after one month of treatment (high-risk clinic, if available).
- Hb < 10 g/dL at 36 'weeks’ gestation or more: transfer to hospital for further antenatal care and delivery.