Anemia In Pregnancy: Women with less than 11 g/dl Hb are considered to be anemic. Pregnant women are more likely to develop Anemia as mineral and vitamin requirement is increased during pregnancy. In some women amount of blood increases thereby increasing the nutrients required in the body like iron. Even the Hb in pregnant women must be in the range of 11 g/dl-13g/dl.
But in many, the availability of iron and vitamins does not meet the demand, especially in the second and third trimesters. In cases of mild anemia, the mother and baby are at low risk but in case of severe anemia, an infant is at higher risk. If a mother is pregnant in the first two trimesters, she is likely to have a preterm birth, blood loss during labor, and develop infections.
Who all are at risk of becoming anemic during their pregnancy?
- Women with heavy menstrual flow pre-pregnancy
- Women having low iron or who takes less iron in the diet
- When two pregnancies have less time in between
- When a woman is pregnant with more than one child
- Teenage Pregnancy
- Increased frequency of vomiting
Type of Anemia in Pregnancy:
a.) Iron deficiency Anemia
b.) Vitamin B12 Deficiency
c.) Folate deficiency Anemia
Use of Oral Iron Salts:
From what we have read before, one point seems to be clear- an adequate supply of iron in pregnancy. As we know iron deficiency during pregnancy risk the life of a fetus, increasing the chances of pre-term birth or low weight. Or it might hamper the quality of life even before the baby is born as it is important for the development of the fetal brain and their cognitive abilities. A child born to iron-deficient mothers suffers from iron deficiency themselves. So women who suffer from Iron Deficiency Anemia during pregnancy must be prescribed Oral Iron prophylaxis to improve the condition.
Oral Iron salts are preferred as they are cheap, safe, and effective. These include ferrous fumarate, ferrous glycine sulfate, ferrous bis-glycinate.
Traditional iron salts like ferrous fumarate can increase the bioavailability of iron preparation but due to a high dose of ferrous fumarate, there is an increase in gastrointestinal side effects like nausea, vomiting, diarrhea, flatulence, stained stools, etc. Its bioavailability can be easily decreased by the presence of some food items or other drugs, thereby, hampering the hemoglobin amount required by the body.
Ferrous Glycine Sulphate
- Ferrous glycine sulfate is immune-enhancing, an anti-carcinogenic supplement of iron that promotes the production of hemoglobin and is not harmful to the baby during pregnancy.
- But ferrous glycine sulfate has a limitation of frequent Gastrointestinal effects like constipation, abdominal distention, nausea, vomiting, and sometimes also piles. This, in turn, reduces the adherence of the patient to the treatment, thereby lowering the efficacy of the drug.
- According to Randomised Clinical Trials, patients on ferrous glycine sulfate were found to have more GI adverse effects and less production of hemoglobin. Also, a baby born to these mothers had low birth.
- Chelation salts are formed by a process in which metal from soluble salt bonds with molecules of amino acid. Ferrous bis-glycinate is an iron amino acid chelate that is formed by the reaction of iron with two molecules of the amino acid glycine and is connected by a covalent bond.
- It is known to improve the absorption of iron, increasing its storage and hemoglobin level better than other iron salts.
- Bioavailability is higher than other salts due to their pharmacological properties. It is absorbed in intestinal mucosa intact and from here iron is dissociated into the tissues.
- Tolerance: Due to its high bioavailability, it is less likely to have gastrointestinal adverse effects. Thus, it is well tolerated.
- As per the studies and randomized clinical trials performed by various institutes and groups, it has been observed that levels of hemoglobin have been increased after 8 weeks of taking Ferrous bis-glycinate in their pregnancy. Other indices including serum ferritin were also increased in women on ferrous bis-glycinate.
- It was also seen that healthy babies with normal weight were born to women who were on ferrous bis-glycinate.
Ferrous Bisglycinate was observed to have better tolerance and efficacy, good compliance, increased the production of serum ferritin, and low adverse effects as compared to Ferrous Glycine Sulphate based on Randomized Clinical Trials run by various institutes. For better understanding read the table below that reflects the comparison observed between the two drugs during the study:
|Ferrous Bisglycinate||Ferrous Glycine Sulphate|
|Production of Hb||Higher||Less|
|Mean birth weight of babies born to mothers on the drug||high||less|
|Production of ferritin||Increase||less|
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