Anemia in Pregnancy: A Pragmatic Approach

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ImportanceAnemia is common in pregnancy, ranging from 5.4% in developed countries to more than 80% in developing countries. Anemia in pregnancy has been associated with prematurity, low birth weight, and adverse pregnancy outcomes.ObjectiveThis review uses clinical vignettes to illustrate the clinical presentations, approach to diagnosis, maternal and fetal implications, and treatment for the common etiologies of anemia in pregnancy.Evidence AcquisitionLiterature review.ResultsNormal physiological changes in pregnancy result in alterations of hematological parameters particularly in a reduction of hemoglobin (Hb) concentration. Consequently, the Hb used to define anemia in pregnancy is lower than in nonpregnant patients. As there is an increased requirement of iron in pregnancy, it is not unexpected that iron deficiency remains the most common cause of anemia and warrants a preemptive approach to prevent a further reduction in Hb. The syndromes associated with microangiopathic hemolytic anemia may pose a diagnostic challenge, as there are several potential etiologies that may be difficult to differentiate, and microangiopathic hemolytic anemia can be associated with significant maternal and fetal morbidity and mortality. Anemia secondary to sickle cell disease and autoimmune hemolytic anemia merit special attention because there are risks secondary to red blood cell transfusion and risks to withholding transfusion.Conclusions and RelevanceAnemia in pregnancy is potentially associated with maternal and fetal adverse outcomes. Providing evidence-based care is essential to achieving the best pregnancy outcomes.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to describe the normal physiological changes in hematological parameters in pregnancy, recognize common and potentially life-threatening diseases manifested as anemia, and develop an approach to anemia in pregnancy.

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