anemia and impacts 060713

7/27/2019 Anemia and Impacts 060713

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A NAEMIA A ND I MPACTS ON P REGNANCY

DR SUHAIZA ABDULLAHDepartment of Obstetrics and Gynaecology,International Islamic University MalaysiaMD(UKM) MMED (USM)

FELLOWSHIP MFM (SINGAPORE)


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MUM DIES IN EVERY MINUTE DUE TOPREGNANCY AND CHILDBIRTH!=500,000 /YEAR=10 MILLION IN EVERY GENERATION15% (20 MIL/YEAR ) FATALCOMPLICATIONS DURING BIRTH>80% - HAEMORRHAGE, SEPSIS,UNSAFE

ABORTION,OBSTRUCTED LABOUR,

HYPERTENSIVE DISEASE21% - SEVERE BLEEDING!!!

UNICEF,UNFPA,WHO


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MATERNAL ADAPTATION


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Iron Deficiency Anemia Folate deficiency Haemoglobinopathies Infection Others

Maternal

anemia

Hb Barts Parvovirus B19 Rh isoimmunizationFetal

anemia


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WHO CRITERIA ANAEMIA


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WORLDWIDE PREVALENCE ANEMIA 1993-2005


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P REVALENCE

w o r l

d

50% I n d u s t r i a l

i z e f c o u n

t r y

23% M a l y a y s i a

35%

(11gm%)

M a l a y s i a

11%

(10 gm%)

Jamaiyah H et, al Asia Pac J Clin Nutr 2007


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H Jamaiyah Asia Pac J Clin Nutr 2007;16(3):527-536


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MATERNAL

PERINATAL

NEONATAL


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PREGNANCY IMPACT

MISCARRIAGEFETAL

GROWTHRESTRICTION

PRETERMDELIVERY

PERINATALDEATH

MATERNALDEATH


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ANEMIA AND IRON

DEFICIENCY


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SP Loh, Malaysian Journal of Medicine and Health Sciences;2010 Vol 6(1)


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The ferritin serum iron

Hb

MCV (indicationiron def affecting

Hb synthesis)

profound effect onbody functions :

Impaired muscle fx,neurotransmitteractivity, exercise

tolerance, epithelialchanges & alteration of

GIT fx

Can be corrected by oraliron supplements

Effects on cellularfunction :

Assoc between anaemia& preterm birth

Overt sx of iron def generally not prominent

IRON DEFICIENCY ANEMIA


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Amount of blood loss tolerated = 1000 ml

w/out causing significant fall in Hb concentration

No compensatory in blood vol & gradual in plasma vol

Overall result : Hct & blood vol non -preg stat

Blood vol following acute loss at delivery but remainsrelatively stable as long as the blood loss does not exceed

25% of the predelivery volume


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Babies delivered by iron def mothers have ferritin levelcompared to others

May cause anaemia during the 1 st year of life in babydelivered with depleted iron stores & poor oral iron intake


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Change of concentration of chemical mediatorsin the brain

Behavioralabnormalities

Cognitive skills Origin in fetal lifedue to LBW

prevention of adulthypertension


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M ATERNAL ANEMIA AND ITS IMPACT ON PERINATAL OUTCOME TROPICAL M EDICINE AND INTERNATIONAL H EALTH VOLUME 9 N O 4

P G 486-490 A PRIL 2004


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M ATERNAL ANAEMIA AND ITS IMPACT ON PERINATAL OUTCOME .

The risk of preterm delivery and LBW amongexposed group was 4 and 1.9 times higher amonganaemic women, respectively. Newborns of anaemic mothers had 1.8 times increased risk of having an APGAR score of


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S EVERE A NEMIA AND A DVERSE P REGNANCY OUTCOME R IFFAT J ALEEL , J OURNAL OF S URGERY P AKISTAN (I NTERNATIONAL ),13(4) O CT -D EC 2008


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Brabin BJ, The Journal Nutr 2001


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NICE GUIDELINES


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NICE GUIDELINES


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F OLATE DEFICIENCY

Baby born to folate def mother :Risk of megaloblastic anaemia esp if delivery ispreterm

Assoc cleft palate & neural tube defect (NTD)

Periconceptional folate the recurrence of NTD RCT in Hungary shown : 800 g/ day + MVT preventedoccurance of NTDPre pregancy 400mcg/day

##Previous affected pregnancy / Epilepsy : 4mg/day


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HAEMOGLOBINOPATHY

ALPHA THALASSEMIA BETA THALASEMIA SICKLE CELL ANEMIA


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A LPHA THALASSEMIA

Deletion of alpha gene onChromosome 16


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H B BART S AND HBH

Hb Barts non compatible with lifeHydrop FoetalisPolyhydramnios

HyperplacentosisMirror Syndrome MalpresentationPreterm labour

Antepartum haemorrhage PP /APCaesarean sectionPost partum haemorrhage


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P RENATAL

CVS AmniocentesisCordocentesis

Non invasive1 st trimester CTR >50%Free Fetal DNA in maternal plasma

Preimplantation Genetic Diagnosis


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FETAL ANAEMIA


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BETA THALASSEMIA

Mutation of beta genechromosome 11


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-THAL MAJOR

Pregnancy possible- Effective chelating agent- Spontaneous conception

- Assissted reproductive technique


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M ATERNAL HEALTH AND OBSTETRICS OUTCOME OF MOTHERS WITH THALASEMIA

Cardiac problemEndocrine

Alloimmunization

Viral InfectionHypercoagulable state and thrombosisOsteopenia, osteoporosis and bone deformity


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OBSTETRICS RISK -THAL MAJOR AND INTERMEDIA

Spontaneous miscarriage & fetal lossMultiple pregnancyPreterm birth

Intrauterine growth restrictionPre eclampsiaCaesarean sectionMaternal cardiac failure

Associated medical risk endocrine d/o


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Prepregnancy counselingOptimise maternal conditionMultidisciplinary carePrenatal counselingDiagnostic test

Role of Termination of pregnancyCounseling genetic and futurehealth care


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S ICKLE CELL ANEMIA

Inherited defectStructural alteration of globin chain


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Aggravating Factor:

Dehydration

StressExtreme Hypoxia

3 rd trimester

Intrapartum

Complications

CCF due to severe

anemia Aplastic crisisLeg ulcer

Vaso-ooclusive

ComplicationStroke


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CONCLUSION

Anemia is still prevalent Associated maternal complicationPotential fetal and neonatalcomplicationPrepregnancy counsellingPrenatal diagnosisPrenatal counseling


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RAMADHAN AL MUBARAK

THANK YOU

anemia and impacts 060713

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