IRON

DEFICIENCY
ANEMIA
IN PREGNANCY

Obstetric and Gynecology Department

Medical Faculty Brawijaya University/Saiful
Anwar Hospital
Malang
 • The Centers for Disease Control and Prevention ( 1998) defined anemia in iron-supplemented pregnant
women using a cut of of the 5th percentile-l l g/dL in the first and third trimesters, and 10.5 g/dL in the
second trimester
• Highlights the global trends in hemoglobin concentrations and anemia thresholds in pregnant and
nonpregnant women
Cunningham, F., et al. Williams obstetrics, 25. Mcgraw-hill, 2018.
ETIOLOGY

Cunningham, F., et al. Williams obstetrics, 25. Mcgraw-hill, 2018.

Iron deficiency in pegnancy
• Iron is so fundamental to cellular functions that its uptake
by cells is a highly conserved process
• Essential for oxygen delivery to the maternal-placental-
fetal unit to support the increased oxygen consumption
demand of pregnancy
Pregnancy increase maternal iron demand

• maternal plasma and blood volume are increased during

pregnancy
• The fetus reqires iron for its own metabolic and oxygen delivery
needs
• Placenta is a highly metabolically active organ with large iron
requirements
 Pregnancy requires an additional 1 g of iron
Iron specific biomarkers
• Serum ferritin
• % total iron binding capacity saturation (%TSAT) 
dividing the serum iron level by the total iron-binding
capacity and multiply times 100
• Hepcidin
Effects on mother & fetus
Mother
• More susceptible to infection
• Increased severity of infection
• Peripartum blood loss

Fetus
• Prematurity
• Low birth weight
• Altered neonatal brain structure  alteration in gray matter
• Compromised recognition memory processing
• Long-term neurocognitive dysfunction
• Neurodevelopmental sequelae  slower speed of processing, poorer motor function, increased
social dysfunction, neuro-morbidities (depression, anxiety)
Clinical presentation
• Symptoms : weakness, fatique, irritability, hair loss, poor
concentration, poor work performance
• Cold intolerance, palpitations, dizziness, headache, restless leg
TREATMENT
Iron therapy during pregnancy
• Oral iron supplementation
• Adverse effect : nausea and vomiting, constipation, diarrhea,
epigastric discomfort, severe abdominal pain, indigestion and
tendency to develop hemorroids
TERAPI

Selama periode kehamilan Kebutuhan setiap hari

Minggu Kebutuhan Kebutuhan Kebutuhan Kebutuhan

Maternal Feto-Plasenta (mg) harian total asupan harian
(mg) (mg) (mg)

1–9 100 40 1.4 10 – 12

10 – 19 200 65 2.6 10 – 12

20 – 29 200 120 3.3 14 – 16

30 – 39 200 200 4.0 18 - 22

 TERAPI

30 mg Elemental Fe ~ 150 mg Ferrous sulfate heptahydrate ~ 90 mg Ferrous fumarate ~

250 mg Ferrous gluconate
TERAPI
Strategies to prevent the iron deficiency in human
Goonewardene, Malik, Mishkat Shehata, and Asma Hamad. "Anaemia in pregnancy." Best practice & research Clinical obstetrics &
gynaecology 26.1 (2012): 3-24.
Thankyou