Anemia in pregnancy is one of the most important factors related to maternal morbidity and mortality. Oral iron provides an inexpensive and effective means of restoring iron balance in a patient with iron deficiency without complicating comorbid conditions. IV iron is appropriate for patients who are unable to tolerate gastrointestinal side effects of oral iron.

1. ANEMIA IN WOMEN OF
REPRODUCTIVE AGE GROUP
DR NIRANJAN CHAVAN
16/07/2022

2. DR. NIRANJAN CHAVAN MD, FCPS, DGO, MICOG, DICOG, FICOG,
DFP,DIPLOMA IN ENDOSCOPY (USA)
Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital
Joint Treasurer, FOGSI (2021-2024)
President, MOGS (2022-2023)
Member Oncology Committee, SAFOG (2021-2023)
Joint Secretary, AFG(2022-2023)
Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses
Editor-in-Chief, FEMAS, JGOG & TOA Journal
57 publications in International and National Journals with 107 Citations National Coordinator, FOGSI
Medical Disorders in Pregnancy Committee (2019-2022)
Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16)
Member, Oncology Committee AOFOG (2013-2015)
Coordinator of 11 batches of MUHS recognized Certificate Course of B.L.M.LE at L.T.M.G.H (2010-16)
Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023)
Editorial Board, European Journal of Gynaec. Oncology (Italy)
Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH
(2018-19)

3. “Iron Deficiency Anemia is a Global
Pandemic!” – Steven Magee

4. Definition
• Anemia is a condition in which the number of
red blood cells and/OR their oxygen-carrying
capacity is insufficient to meet the body’s
physiological needs.

6. Classification of anemia - Based on clinical picture-
• Iron deficiency anemia.
• Megaloblastic anemia.
• Pernicious anemia.
• Hemorrhagic anemia.
• Hemolytic anemia.
• Thalassemia anemia
• Sickle cell anemia
• Aplastic anemia

7. • Iron deficiency anemia
• excessive loss of iron
• Women are at risk - for menstrual blood and
growing fetus
• Megaloblastic anemia
• Less intake of vitamin B12 and folic acid.
• Red bone marrow produces abnormal RBC e.g.
cancer drugs
• Pernicious anemia
• Inability of stomach to absorb vitamin B12 in
small intestine
• Hemorrhagic anemia
• Excessive loss of RBC through bleeding,
stomach ulcers, menstruation

8. • Hemolytic anemia
• RBC plasma membrane rupture, may be due to
parasites, toxins, antibodies
• Thalassemia
• Less synthesis of hemoglobin. Found in population
of Mediterranean sea
• Sickle cell anemia
• Hereditary blood disorder, characterized by red
blood cells that assume an abnormal, rigid, sickle
shape
• Aplastic anemia
• destruction of red bone marrow
• caused by toxins,gamma radiation

9. Classification of Anemia as per Severity
According to ICMR (Indian Council of Medical Research)
Mild – 8-11 g/dl
Moderate- 5-8 g/dl
Severe- less than 5 g/dl

10. Classification of Anemia - Morphological

11. Classification - Women in Reproductive Age Group

12. GLOBAL PREVALENCE
• In 2019, global anaemia prevalence was 29.9% in women of reproductive
age(WRA), equivalent to over half a billion women aged 15-49 years.
• Prevalence was 29.6% in non-pregnant women of reproductive age, and 36.5% in
pregnant women.
• WRA are one of the groups most at risk of anemia, due to their physiological
processes.
• There has been little progress in reducing the anemia burden among WRA over the
past two decades, with prevalence actually increasing in some South Asian and
sub-Saharan African countries.

13. Global Prevalence of anemia in Women of Reproductive Age Group

14. Age-wise Prevalence in India

15. Anemia – a Public health challenge
• The 2019 adoption of anemia reduction among
WRA, as an official target indicator for the second
sustainable development goal (SDG2.2 -
Malnutrition), now provides an opportunity for
renewed commitment and attention to addressing
this global public health challenge.
• Identifying effective drivers of anemia reduction,
including programs and policies, and
understanding how they contribute to
improvements in anemia among WRA, is pivotal
for creating a framework that countries can follow
to improve the health and well-being of their
populations.

16. Anemia in Pregnancy
• Anemia in pregnancy is one of the most important
factors related to maternal morbidity and mortality.
• It reduces a woman’s ability to tolerate intra- or post-
partum blood loss.
• New World Health Organization suggest that
worldwide, 36.5% of pregnant women were anemic in
2019.
• In India, the prevalence of anemia in pregnancy has
decreased from 58% in the National Family Health
Survey-2005–2006 (NFHS-3) to 50% in the NFHS-survey
(2015–2016).
• The most common cause of anemia in pregnancy is
nutritional.

17. Mechanism of development of anaemia

18. SIGNS OF ANAEMIA
• Brittle nails
• Koilonychia (spoon shaped nails)
• Atrophy of the papillae of the tongue
• Angular stomatitis
• Brittle hair
• Dysphagia and Glossitis
• Plummer Vinson/Kelly Patterson

20. Determinants of Anemia in WRA
• Adequate dietary diversity, especially consumption of
iron-rich foods is a vital determinant of the micronutrient
status of individuals
• Diversity in diet during the reproductive years are highly
correlated with improved health and nutrition outcomes
for both women and their children
• National and/or regional-level fortification policies and
programs determine households’ and individuals’ access
to fortified foods

21. • The use of contraceptives reduces the risk of anemia, likely
through a decrease in menstrual bleeding and adverse birth
outcomes, via increased inter-pregnancy intervals and/or
decreased parity
• The proximal maternal characteristics of BMI and age at
pregnancy were also associated with observed changes in
anemia prevalence
• Women who were underweight (BMI < 18.5 kg/m2) had
consistently higher odds of anemia compared to women who
had a BMI higher than 18.5 kg/m2
• Increased maternal age at pregnancy was associated with a
significant decline in anemia

22. • Increase in household wealth and maternal educational
attainment were most strongly associated with a decrease
in WRA anemia prevalence
• Higher educational attainment was also protective against
anemia
• Increased access to improved sanitation, and a reduction
in the proportion of the population practicing open
defecation, were also identified as strong drivers of
improvement.
• Residence in urban areas was also found to be protective
against the risk of anemia.

23. Anemia – Clinical Approach

24. INVESTIGATIONS
• Complete Hemogram
• All blood routine examination
• Peripheral smear
• Reticulocyte count
• MCV, MCH, MCHC
• Sr. Iron, TIBC, Sr. ferritin
• Urine routine examination
• Stool routine examination
• Blood grouping

26. TO CALCULATE IRON DEFICIT

27. Treatment of Anaemia
• Oral iron provides an inexpensive and effective means of
restoring iron balance in a patient with iron deficiency
without complicating comorbid conditions
• Numerous oral iron formulations are available as
discussed in the next slide

29. Oral Iron Preparations

31. Intravenous Preparations
• IV iron is appropriate for patients who are unable to tolerate
gastrointestinal side effects of oral iron
• Older individuals, pregnant women (who already have
gastrointestinal symptoms related to the pregnancy), and
individuals with existing gastrointestinal disorders that may
exacerbate oral iron side effects
• Those with severe/ongoing blood loss (eg, telangiectasias,
varices)
• Gastric surgery (bypass, resection) that reduces gastric acid may
severely impair intestinal absorption of oral iron
• Malabsorption syndromes (celiac disease, Whipple's disease,
bacterial overgrowth) may limit absorption of oral iron

32. Parenteral Iron Preparation

34. • A total of 100 women received a FCM infusion for IDA, with pre-infusion Hb
and serum ferritin levels and post-FCM infusion Hb and serum ferritin levels
available for 100 women
• The findings of this prospective study support previous prospective evidence
that FCM treatment in pregnancy and postpartum is likely to be safe and
effective.

35. • The need to increase
• Awareness,
• Reach and
• Discussion led to
• Times of Anemia
• A medico magazine that highlighted
• A framework for managing care
customization
• An analysis of mass customization in
service sectors
• Care customization compared to
personalized medicine and patient-
centered care
• The available options for treatment of
various types of anemia

37. • The theme for 1st World Congress of Anemia (WCA)
Iron Deficiency Anemia and strategies for its prevention
• WCA 2021 witnessed an august audience of 9450+ doctors globally.
• Associations across segments and boundaries joined hands to create
awareness on various facets of anemia.

38. The theme for 2nd World Congress of Anemia (WCA)
Iron Deficiency Anemia and tools for effective prevention & control

39. WCA will be held in April 2023 and we urge all to join hands for this noble cause to fight Anemia.

40. Take Home Messages:
• From 2019, there has been adoption of anemia reduction among
WRA, as an official target indicator for the second sustainable
development goal (SDG2.2 - Malnutrition)
• Anemia in pregnancy is one of the most important factors related to
maternal morbidity and mortality
• Oral iron provides an inexpensive and effective means of restoring
iron balance in a patient with iron deficiency without complicating
comorbid conditions
• IV iron is appropriate for patients who are unable to tolerate
gastrointestinal side effects of oral iron
• FCM treatment in pregnancy and postpartum is likely to be safe and
effective.

42. References
• Global burden of disease study 2017.Lancet.2018 nov.10;392(10159)
• WHO Global Database on Anemia.Geneva, World Health Organization 2008.
• https://anemiamuktbharat.info
• niti.gov.in/content/anemia-alert-government
• Pavlov AD, Morshchakova EF, Rumyantsev AG. Erythropoiesis, Erythropoietin, Iron. Moscow: GEOTAR-Media;
2011. 304 p
• Radzinsky VE, editor. Guide to Outpatient Care in Obstetrics and Gynecology. 2nd ed., Revised, and
additional. Moscow: GEOTAR-Media; 2014. 944 p
• A teenage girl as a patient. Endocrine gynecology of physiological pubertal: Optimal correction minimum. In:
Kuznetsova IV, editor. Information Bulletin. Moscow: Editorial staff of the magazine Status Praesens; 2014. 20
p
• Kagamimori S, Fujita T, Naruse Y, Kurosawa Y, Watanabe M. A longitudinal study of serum ferritin
concentration during the female adolescent growth spurt. Annals of Human Biology. 1998;15:413-419