Postpartum anemia II: prevention and treatment

Abstract

This review focuses on the prevention and treatment of anemia in women who have just given childbirth (postpartum anemia). The problem of anemia both prepartum and postpartum is far more prevalent in developing countries than in the Western societies. The conditions for mother and child in the postpartum, nursing, and lactation period should be as favorable as possible. Many young mothers have a troublesome life due to iron deficiency and iron deficiency anemia (IDA) causing a plethora of symptoms including fatigue, physical disability, cognitive problems, and psychiatric disorders. Routine screening for postpartum anemia should be considered as part of the national maternal health programs. Major causes of postpartum anemia are prepartum iron deficiency and IDA in combination with excessive blood losses at delivery. Postpartum anemia should be defined as a hemoglobin level of <110 g/l at 1 week postpartum and <120 g/l at 8 weeks postpartum. Bleeding exceeding normal blood losses of approximately 300 ml may lead to rapid depletion of body iron reserves and may, unless treated, elicit long-standing iron deficiency and IDA in the postpartum period. The prophylaxis of postpartum anemia should begin already in early pregnancy in order to ensure a good iron status prior to delivery. The most reliable way to obtain this goal is to give prophylactic oral ferrous iron supplements 30-50 mg daily from early pregnancy and take obstetric precautions in pregnancies at risk for complications. In the treatment of slight-to-moderate postpartum IDA, the first choice should be oral ferrous iron 100 to 200 mg daily; it is essential to analyze hemoglobin after approximately 2 weeks in order to check whether treatment works. In severe IDA, intravenous ferric iron in doses ranging from 800 to 1,500 mg should be considered as first choice. In a few women with severe anemia and blunted erythropoiesis due to infection and/or inflammation, additional recombinant human erythropoietin may be considered. Blood transfusion should be restricted to women who develop circulatory instability due to postpartum hemorrhage. National health authorities should establish guidelines to combat iron deficiency in pregnancy and postpartum in order to facilitate a prosperous future for both mothers and children in a continuing globalized world.

Safety and efficacy of high-dose intravenous iron carboxymaltose vs. iron sucrose for treatment of postpartum anemia

“…Other publications give an overview over the changes of Hb levels during the fi rst few days after treatment with comparable results for IS [10,26,27] .…”

Anemia e gravidez

“…14,15 O ferro é um elemento importante para o desenvolvimento do cérebro fetal e de habilidades cognitivas do recém-nascido. 16 O crescimento do cérebro demanda uma suplementação de ferro balanceada através da barreira hematoencefálica. 17 No feto e no recém-nascido, a deficiência de ferro pode causar dano permanente ao cérebro e afetar de forma negativa a inteligência, as habilidades cognitivas e o comportamento durante a infância e a idade adulta.…”

“…Por outro lado, na maioria dos países em desenvolvimento, é indicada a profilaxia universal de ferro, e altas doses de ferro por via oral podem ser recomendadas de acordo com o status de ferro em populações específicas de mulheres em idade fértil e gestantes. 16 Não existe um consenso nos países ocidentais acerca do uso profilático de ferro na gestação. Alguns países como a Dinamarca preconizam a administração de ferro profilático enquanto outros como a Noruega não recomendam tal prática.…”

Essential trace element analysis of human breast milk

“…A review has identified that anaemia in both antenatal and postpartum women is more prevalent in developing countries than in Western societies (106).…”

“…The prophylaxis of postpartum anaemia should begin in early pregnancy with prophylactic oral ferrous iron supplements 30-50 mg daily (106). In the treatment of slight-to-moderate postpartum iron deficiency anaemia, the first choice is oral ferrous sulfate 100 to 200 mg daily.…”