Anemic Pregnant Women Twice as Likely to Need Blood Transfusion After C-Section
Wed, April 21, 2021

Anemic Pregnant Women Twice as Likely to Need Blood Transfusion After C-Section

Pregnant women with anemia are twice as likely to need a blood transfusion after a C-section delivery if the surgical procedure is needed or advised by the doctor / Photo by: Saksiri Saksrisathaporn via 123RF

 

Pregnant women with anemia are twice as likely to need a blood transfusion after a C-section delivery if the surgical procedure is needed or advised by the doctor. This is based on a study that was presented during the Anesthesiology 2019 forum and published by the medical research platform Medical Xpress. The authors emphasized how most pregnant women nowadays are not screened for iron deficiency during their early pregnancy and it may lead them to anemia.

 

Anemia in Pregnancy

Anemia is a condition where one lacks enough healthy red blood cells or hemoglobin to carry adequate oxygen to the tissues throughout the body. Such a deficiency in red blood cells can cause serious problems in pregnancy. One situation would be postpartum hemorrhage, which is excessive bleeding after the woman delivers the child. In the United States, postpartum hemorrhage (PPH) has been the leading cause of maternal mortality. Compared with other developed countries, the US has the highest maternal mortality rate, which is 56 percent between 1990 and 2015.

 

Postpartum Hemorrhage and Severe Iron Deficiency

Even a small amount of blood loss is already considered life-threatening for women with anemia. The current research indicated that the most common cause of anemia in pregnancy is severe iron deficiency. During the first prenatal visit of pregnant women in the US, they are required by the American College of Obstetricians and Gynecologists and the US Preventive Services Task Force to be screened for anemia. Yet, they are not always checked for a possible iron deficiency, which is a different blood test for anemia.

Anemia is a condition where one lacks enough healthy red blood cells or hemoglobin to carry adequate oxygen to the tissues throughout the body / Photo by: PaylessImages via 123RF

 

Iron Deficiency to Anemia

The research said that many women may just be iron deficient during their early pregnancy, but they become anemic later on because their body has an increasing need for iron. Most often, their anemia is not discovered until late in their pregnancy and that becomes more difficult as it needs efficient and quick treatment at the same time. 

Lead author Ghislaine Echevarria, M.D., M.Sc., who is also an assistant professor of anesthesiology, said that if iron deficiency screening is not performed in all pregnant women during their prenatal visit, women who are not yet anemic may not be determined. This is why they suggested in their study the need for iron deficiency screening. So, if one is found iron deficient in the early stages of pregnancy, the doctor can already prescribe an iron supplement. Such would be a safe treatment that is beneficial not only to the mother but to the baby as well. It will also mean fewer blood transfusions if the mother will have to undergo cesarean delivery.

Prevalence of Anemia in Pregnant Women

Scientific online publication Our World in Data shared the prevalence of anemia in pregnant women in 2016. Their data was measured as the percentage of pregnant women, whose hemoglobin level was less than 110 grams per liter at sea level and was detailed per country:

Russia (24 percent), United States (16.2 percent), Canada (17.4 percent), Brazil (37.3 percent), Australia (20.1 percent), India (50.1 percent), Mexico (19.6 percent), Spain (24.5 percent), Saudi Arabia (45.5 percent), Germany (23.3 percent), Philippines (30.3 percent), Indonesia (42 percent), Cambodia (55.8 percent), South Korea (25.8 percent), Japan (34.1 percent), and China (32.4 percent). 

In the study presented during Anesthesiology 2019, the authors analyzed the electronic health records of 5,527 women who had a planned C-section delivery during a four-and-a-half-year period and also studied the clinical registry of these women. They found out that 23 percent or 1,276 of them tested positive for anemia when they were admitted to the hospital already for their delivery. Of these women, 8.4 percent or 107 of them underwent a blood transfusion. 

Probability of Receiving a Blood Transfusion

Out of the 4,251 women who were not diagnosed with anemia, only 4.4 percent or 187 of them underwent a blood transfusion. The data only goes to show how the odds of receiving a blood transfusion are twice greater for pregnant women with anemia upon their hospital admission.

Dr. Echevarria emphasized how screening for iron deficiency can improve the hospital experience and outcome of the patient. Also, it will help them save the costs associated with blood transfusion. If the pregnant woman has iron deficiency in the early pregnancy, she may be prescribed to take oral iron supplements. If the women cannot tolerate the side effects (nausea, constipation, etc.) of such supplements, then they can be advised for intravenous or IV therapy later on.

Echevarria and the team stated that anemia during pregnancy not only can cause PPH but also increases the mother’s risk of other life-threatening conditions such as cardiac failure, placental abruption, and preeclampsia. Anemic pregnant women are also three times as likely to deliver their babies at low birth weight and have double the risk of going into early labor. Their baby may also be iron deficient and, as a result, will have delayed development and growth. Anemia also causes impaired thinking and fatigue on the part of the mother, which can negatively affect the baby-and-mother bonding after childbirth.

Even a small amount of blood loss is already considered life-threatening for women with anemia. The current research indicated that the most common cause of anemia in pregnancy is severe iron deficiency / Photo by: Elnur Amikishiyev via 123RF