Introduction
Iron deficiency Anaemia (IDA) is the most common micro- nutrient deficiency disease in Nigeria and worldwide. Pregnant women are mostly affected.
The Nigeria Food Consumption and Nutrition Survey (NFCNS, 2003), indicate very high levels of iron deficiency anaemia among the vulnerable group, the accepted definition of anaemia in pregnancy by the World Health organization (WHO, 2003), is haemoglobin less than 110 g/dl or a packed cell volume (PCV)of less than 30 percent. If neither the diet nor body stores can supply the iron needed for haemoglobin synthesis, red blood cell synthesis is reduced. Eventually, the number of red blood cells falls so low that the amount of oxygen carried in the blood is decreased then a person exhibit anaemia, which is characterized by a decreased oxygen-carrying capacity of the blood. The causes of iron deficiency in Nigeria are inadequate dietary intake, parasite infestation disease and menstrual loss especially chronic one. Iron deficiency usually occurs as a result of poor dietary intake and inadequate absorption from the intestine. In the past, Government has been advising the pregnant women to eat food that contain iron, but presently iron supplementation is been given to the pregnant women in the health facilities in order to control anaemia, despite this, the problem of anaemia among pregnant women still exist.
Conceptual framework
Iron is essential for the production of haemoglobin in order to make healthy red blood cells. In chronic deficiency of iron, too few red blood cells are produced thereby leading to a condition known as iron deficiency anaemia. This is the major reason why iron in the red cells is retained immediately after their complete life span of 120 days to form or make new red blood cells (Wali, 2002).
Iron deficiency is the most common in pregnancy due to the fact that there is mother to foetus transfer of it (iron). When deficient, red cells appear microcyctic (small) hypo-chromic (pale) and red cell indices are reduced such as mean cell volume (MCV), means cell haemoglobin (MCH), and the mean cell haemoglobin concentration (MCHC). Also, being deficient of iron could be as a result of poor eating habit such as foods that lacks balance diet (Ochei, 2000).
According to Chesbrough (2002), iron is needed in the production of the heam group of haemoglobin and also a small amount is needed in the production of muscle myeglobin and enzymes such as cyto-chrone (respiratory enzyme) etc in the light of this, the chapter will be subdivided into the following heading. Such as nutritional and metabolic aspect of iron, causes of iron deficiency anaemia in pregnancy, types/ classification of iron deficiency anaemia in pregnancy, prevention of iron deficiency anaemia in pregnancy, treatment of iron deficiency anaemia in pregnancy.
Nutrition and metabolic aspect of iron
Iron is one of the most common elements of the earth crust, yet iron deficiency anaemia is the most common of all. About 500 million people get deficient of iron irrespective of their age gender but seen mostly in pregnant women. This is because the body has limited ability to absorbed iron and excess loss of iron because of haemorrhage is frequent (Hoffbrand, 2004)
Causes of iron deficiency in pregnancy
Ochei (2000), the amount of iron required by the body each day to compensate for loss from the body and growth varies with age and sex, with its peak in pregnancy. This group (pregnant women) therefore is likely to develop iron deficiency if there is additional iron loss in prolonged reduced intake. Due to these facts iron deficiency can occur due to the following reasons such as:
- Poor diet: This occurs due to poor intake of food that are not iron for tidied or lacks iron.
- Blood loss due to injury, disease or bleeding from the gastrointestinal tract due to ulcer, malignancy or hook worm infection.
- Malabsorption: Inability of the body to absorb iron example (gastrectomy celiac disease).
- Iron deficiency can also occur when there is increase demand for iron by the body.
Iron deficiency in women is usually due to reduced intake or absorption of iron (Fraser et al, 2009).
Types/classification of iron deficiency anaemia
Classification of iron deficiency anaemia is done, based on iron pigment in the red blood cells. The amount of iron released from the macrophages, inadequate erythropoietin response to anaemia, ring shaped sideroblas may be seen in the bone marrow (Ochei, 2000).
Iron deficiency anaemia is classified into three, namely
- Sideroblatic iron deficiency anaemia
- Lead poisoning iron deficiency anaemia
- Iron deficiency due to chronic disorder
Sideroblastic iron deficiency anaemia
This is a type of iron deficiency anaemia in which abnormal erythroblast containing more than the normal randomly placed iron pigment (2-4) are seen in a numerous mode arranged in a range round the nucleus. This is caused probably by a defect in the synthesis of haem because the iron cannot be incorporated in the haemoglobin molecule thereby leading to iron deficiency anaemia. This process can be carried out when sideroblast are stained for iron using Prussia blue. After staining the red cells when viewed shows microcytic hypo chromic with the absolute value reduced (Ochei, 2000).
Iron deficiency due to lead poisoning
Lead poisoning causes iron deficiency anaemia because lead inhabits the synthesis of both haem and globins’. In this case, the red cells showshypochronic cells with some having puntate basophilia (Basophilic stippling).
Iron deficiency anaemia due to chronic disease
Low iron level in the body could be because of chronic inflammatory disease, with mildly hypo chronic red cells morphology and low cells indices. The causes of this type of iron deficiency anaemia are:
- Reduced red cells life span
- Inadequate erythropoietin response.
- Decreased release of iron from the reticuloendothelia system (RE) macrophage to plasma
Signs of iron deficiency anaemia in pregnancy/ clinical features
When iron deficiency is developing, the reticuloendothelial store (haemoiderin and ferritin) becomes completely depleted before it occurs. As the symptoms and signs develops, the patient shows the general symptoms and also show a painless glossitis, angular stomatitis, brittle, ridged in spoon nail (koilonychin), dysphagia as a result of pharyngeal webs and usual dietary craving (pica). The sign also includes tiredness that is (fatigue), weakness and development of restless legs syndrome (RLS) (it is a disorder that causes uncomfortable feeling in the legs that can only be relieved by movement.
Effect of iron deficiency anaemia in pregnancy
According to Reveiz, Gyte and Cuervo (2001), pregnant women need twice as much iron for herself and the growing foetus. About 1 in 5 women of childbearing age suffers from iron deficiency anaemia and this can lead to the following problem:
- Cardiac arrest
- The risk of preterm delivery
- Low birth weight child
- Chest pain
- An enlarged heart
- Fast or irregular heart beat etc.
Prevention of iron deficiency anaemia in pregnancy
Iron deficiency anaemia can be prevented in variety of ways. Pregnant women should eat food that are rich in iron such as shellfish, lever, beans, nut such as peanut, butter, peas, dried fruit raisin, apricots, peaches prune juice etc. all these are foods and fruits that should be taken by pregnant women in order to boost the iron content of an individual when pregnant to avoid being deficient of iron (Hoffbrand, 2004).
Treatment of iron deficiency anaemia in pregnancy
Iron deficiency is a curable disease that can be treated in various ways such as the administration of oral iron therapy to correct these anaemia and to replenish stores. Example of oral iron is ferrous sulphate. In addition, the goals of treating iron deficiency anaemia. The treatment is base on the cause and severity of the condition. It includes treatment to stop any bleeding, as well as changes in the diet and supplements are needed. Severe deficiency of iron need to be treated with hospitalization, blood transfusion and iron injections. Supplements can correct low levels with month if taken as ordered. They include iron supplement in pill form and vitamin C to help the body absorbs the iron. But iron supplement are very dangerous if taken in over dose so pregnant women should be health educated on the effect of excess iron supplement. It could cause side effect including dark stools and stomach irritation or burn. Iron also can cause constipation, and a stool softener may be needed (Singh, et al, 2008).
Benefits of iron supplement during pregnancy
There is no doubt that supplementation improve iron status during pregnancy. Even in industrialized countries, iron supplement have been reported to increase haemoglobin serum ferritin, mean cell volume, serum iron and transferring saturation (Zuthi, et al, 2004).
These improvements are seen in late pregnancy, even in women who enter pregnancy with adequate iron status. Supplementation can reduced the extent of depletion in the third trimester. Thus, iron supplementation reduces the risk of abnormalities in Infants or neonates when giving birth to and also prevent neonates from having more prenatal implications. The benefits of iron supplement becomes even more important and numerous as these may reduce the effect of iron deficiency in pregnancy.
Nigeria Food Constipation and Nutrition Survey (NFCNS, 2003) Stated that 48.0% among pregnant women are affected with iron deficiency anaemia.
References
Cheabrough, M. (2002). Measurement of haemoglobin. In: district laboratory practice in tropical countries part 2. Cambridge: Cambridge University Press.
Hoffbrand, A. V, Pettit, J.E, & Moss, P.A. A. (2004). Hypo chronic anaemia and iron over in: essential haemoglobin (4th ed). Orlando: Carale Press.
Ochei, J. & Kolhator, A. (2000). Physiological type of anaemia in: medical laboratory science theory & practical (8th ed) Noida: Sheel Print-N-Park.
Reveiz, L., Gyte, G.M.& Cuerovo, L.G. (2001). The treatment for iron deficiency in pregnant. Cochrane Data, base of systematic reviews. Evr J. Haematol 2, 1002-1009.
The Nigeria Food Consumption and Nutrition Survey (NFCNS) (2001-2003). Indicates very high levels of iron deficiency anaemia among the vulnerable group: Journal of Human Medicine, 5(4), 9-12.
Wali, A.& Mushtaq, A. (2002). Nilofer comparative study efficacy, safety and compliance of intravenous iron sucrose and intramuscular iron sorbital iron deficiency anaemia of pregnancy. J. Pakistan Medical Association 52 (39), 2-5.
Zuthi,V., Batra, S., ahmad, S.S, Khera, N.& Chauchan, G. (2004). Injectable iron supplementation instead of oral therapy for antenatal care. Occupational Medicine, 3(4), 4-9.
