Iron Deficiency Anemia and Pregnancy

Introduction

It is essential to refer to official definitions of anemia and iron deficiency anemia in order to correctly define the scope of knowledge and give an overview of the health problem. IDA can be mild (with a possibility to get worse), moderate or chronic. When it is mild or moderate, it can be difficult for a person to notice that they are anemic because the symptoms do not raise concern at first.

General Overview

Anemia presents a serious global health issue that disproportionally affects young children, pregnant women, and elderly people. The issue is generally sourced in iron deficiency in daily intake. For example, the daily requirement for iron for an adult varies between 8 to 10 mg in men over 18 and nearly 14 in women of childbearing age (Chaparro & Suchdev, 2019).

Associated Epidemiology

Even though iron deficiency anemia is a global health issue, not everyone is aware that they are anemic. It is due to the lack of knowledge as well as the complexity of a disease. Iron deficiency anemia has a wide range of symptoms, affecting different areas and systems of an organism, which is hard to fixate and find the pattern to identify the problem. It is essential to spread information about the disease and its symptoms and encourage people to practice conscious nutrition and take blood tests regularly.

The widespread prevalence of iron deficiency anemia and the fact that it is pregnant women and children at risk of developing the disease suggests that the epidemiological situation is in dire need of resolution. Despite this, studies show that trying to avoid the spread has had little or no effect on the incidence rate (Chaparro & Suchdev, 2019).

Groups at Risk

In the first years of a child’s development, it is imperative to check whether the body receives the components it needs, including the minimum amount of iron. Common symptoms in children include pale skin, frequent respiratory illnesses, and behavioral and appetite disturbances—the greatest likelihood of anemia in premature babies or children with low birth weight. Children who are artificially fed with cow’s milk instead of breast milk also have a high chance of developing anemia.

A pregnant woman’s body is sensitive to the hemoglobin level in the blood since it should be nutritious enough to provide both the mother and the baby with the needed components. A low level of iron in the mother’s blood directly affects the child during pregnancy and leads to some complications after giving birth, including the infant’s underweight. A pregnant woman needs more iron than the usual norm (around 15-18 mg) since, during pregnancy, the body fluid volume increases, respectively there is more circulating blood in the organism. Check and monitor hemoglobin levels are advised not only during pregnancy but also as preconception care. According to Banjari (2018), children reflect the mother’s iron status. Therefore, those born to a mother with IDA are at a greater risk of inheriting the disease and developing ADHD or autism

The low iron status is associated with a functional ability (fatigue, low productivity, overall physical performance), which naturally decreases at 60. Although with IDA, these are more prominent, especially with chronic anemia. Since anemia affects the functioning of the cardiovascular system, older people are at significant risk of developing heart diseases. It also causes mood swings and symptoms of depression.

Symptoms

Often, the symptoms of iron deficiency anemia can appear unnoticed by the patient. However, this disease has several symptoms worth paying attention to, even if their manifestation does not cause concern. Among the conditions that can indicate that a person is anemic are persistent drowsiness, headaches, fatigue, cold hands and feet, irregular heartbeat, and trouble breathing. It is also worth paying attention to the skin and hair condition. With iron deficiency, the skin will be very pale or yellowish in color; it may also be dry and tend to peel off. Hair in this condition can fall out unevenly and be brittle and dry in texture. In such cases, it is necessary to check the blood for iron content.

Stages of IDA

As mentioned before, iron deficiency anemia can be mild, moderate, and chronic. Mild anemia means hemoglobin concentration in the blood corresponds to 10 mg or below. Respectively, moderate anemia corresponds to 7 mg or below, and chronic – 5 mg and below. Most of the time, people with mild anemia do not experience many symptoms, and only two or three are dominant (for instance, pale skin, tiredness, and cold hands).

What Can Cause IDA

There are several factors that can result in iron deficiency anemia (IDA). The most prominent one is the inability to absorb iron. A person can have other disorders or conditions that interfere with the iron absorption process in blood. If the diet is not rich enough with iron, the percent of naturally absorbed iron through food is even less. Blood loss also affects the iron status in the body. Due to menstruation, there is a regular outflow of iron from a woman’s organism. Internal bleeding, for example, from a recent operation or disease, could also be the reason for iron deficiency. Some people are genetically predisposed to develop anemia. It can be due to various conditions that interfere with iron absorption, passed to a person through a family member.

Consequences of IDA

Several significant consequences impair the quality of life and average life expectancy. This information should be available and widely spread, especially among the groups at risk of having iron deficiency anemia. For pregnant women, there is a risk of pre-term delivery, as well as the possibility of an increased mortality rate during the perinatal period. The child could also be highly underweight after the labor. Low iron level in infants also impacts their ability to develop cognitive, social, and motor skills. Cognitive decline is noticeable among older people as well. However, the most frequent symptom among the elderly is the development of heart disease.

Physiology

Physiologically, anemia dramatically affects the human body, as it is directly related to the sets of tissues responsible for muscle tissue, for example, the myocardium (heart muscle). Therefore, IDA has symptoms like fast or irregular heartbeat, breathing shortage, and chest pain.

Anatomy

Iron metabolism occurs when iron in absorbed in the duodenum and proximal jejunum with the use of special transporter proteins. Iron is regulated by hepcidin peptides which prevent it from leaving the cell. Iron is generally stored in liver in the form of ferritin or its derivative, haemosiderin.

Iron Metabolism

The process of iron absorption in an organism is quite complex. There are two forms of iron – heme iron (Fe2+ or ferrous iron) and non-heme iron (Fe3+ or ferric iron). Heme iron usually enters the body through foods of animal origin, whereas non-heme iron comes from plant foods. It is also worth mentioning that heme iron absorbs better than non-heme iron, although it does not mean it accounts for most of its iron intake. Hepcidin is a hormone that functions as an iron-regulator by helping it to transfer directly to the blood cell. According to Zeng et al., the process starts with transforming ferric iron into ferrous iron. Then it needs to be transferred into the cell across the enterocyte. “Afterwards, the iron is stored in these intestinal lining cells as ferritin, which is accomplished by Fe3+ binding to apoferritin, or could be released into the body via the only known iron exporter ferroportin” (Zeng et al., 2018, p. 4).

Iron Storage

Ferroportin sticks to transferrin receptor and together they enter the cells that function as an iron storage. According to Zeng et al. (2018), such cells as “enterocytes, hepatocytes and reticuloendothelial macrophages, are considered to be major iron storage sites” (p. 5). Enterocytes are cells located in the gut intestine. Heparocytes are located in the tissue of the liver, while macrophages are in the bone-morrow. Iron storage helps to keep and redistribute evenly regulated amount of iron in the blood cells regularly. It also prevents iron levels to exceed the norm needed for the organism, which could be toxic to the organs and tissues. Nevertheless, there is a chance that the iron storage is in a bad state, which leads to a poor distribution of iron. It is a problem in contemporary medicine, because it is hard to check whether the iron storage works properly, it is only seen if there is already iron deficiency in the blood.

Iron Regulation

Hepcidin is a hormone that functions as an iron-regulator by helping it to transfer directly to the blood cell. It also helps with reducing serum iron levels. Zeng et al. (2018) claim that “anemia will develop due to lack of inadequate amount of serum iron being available for developing red cells”. Iron regulation prevents not only iron deficiency but also iron excess in the blood cells, which can also be detrimental to the human body. Therefore, the regulatory mechanisms must function correctly to maintain the immune system and meet the body’s needs.

Diagnosis Criteria

The most frequently requested test for iron deficiency anemia is a test that measures the amount of hemoglobin in blood cells. It is a straightforward procedure that will not cost as much. Even though there are standard measurements for different ages and groups of people, it is still not entirely reliable when identifying anemia in relatively tricky cases. The individual approach is the most complex as it relies on different methods and a combination of analyses. The measurement of serum ferritin is also widely used, “but it spuriously elevated in malignancy, inflammatory conditions or liver disease” (Zeng et al., 2018, p. 11). Serum soluble transferrin receptor is a valuable marker to which doctors pay attention when identifying iron deficiency anemia. Although, the receptors will increase if the patient has a different kind of anemia or leukemia. Another critical indicator of IDA is low transferrin saturation. However, this test is influenced by inflammation. Therefore it will be less accurate in some cases (Zeng et al., 2018, p. 12).

Treatment

One of the most frequent methods to treat iron deficiency is to take iron supplements (oral iron pills). Within a couple of months oral therapy will be able to restore patient’s iron levels. There are published guidelines on how to take iron supplements for every age group at World Health Organization. However, it is important to take a blood test and consult medical workers before taking iron supplements. In order to comprehensively approach treatment, it is also worth adjusting the diet. Diverse diet full of products that are high in iron component (red meat, seafood, peas, beans) will positively affect one’s health. However, the diet alone cannot fully treat iron deficiency, so it is better to complement it with supplements. Zeng et al. (2018) claims that “intravenous iron formulation for rapid and high‐dose replenishment of depleted iron stores with very low immunogenic potential is ideal alternative choice for the treatment of iron deficiency anaemia” (p. 18).

Patient Education

The question of how to prevent iron deficiency anemia is one of the most eminent for current society. Globally, IDA negatively affects general quality of life, therefore, certain decisions should be made by healthcare providers to help people take care of themselves and their families. Healthcare providers can spread awareness not only in particular medical institutions but also by visiting schools and giving lectures to children, as well as creating training for adults in the workplace.

Conclusions

Globally, iron deficiency anemia primarily affects children and pregnant women, therefore, it can have an extremely negative impact on the future population. Since the main symptoms of IDA are slow cognitive and social development, problems in the cardiovascular system, and constant fatigue and weakness, it will transform society very quickly. Medical institutions worldwide should start working on the issue of the iron deficiency epidemic, as there are already more than two billion people from the disease. Even though it is a complex condition, there are clear regulations and guidelines on preventing IDA or taking care of oneself. The most important thing is monitoring iron status, so if there are any symptoms of mild anemia, one can regulate the course of the disease.

References

Anaemia. (2019). World Health Organization. Web.

Banjari, I. (2018). Iron deficiency anemia and pregnancy. In Khan J. (Ed.), Current Topics in Anemia (pp. 73 – 90). InTech. Web.

Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences. Web.

Miller, A. Symptoms of anemia.[Photograph]. HealthScope. Web.

Virely, H. (2022). Schematic diagram of iron absorption [Photograph]. TeachMePhysiology. Web.

Zeng, L., Pei, L., Li, C., & Yan, H. (2018). Iron deficiency anemia. In Khan J. (Ed.), Current Topics in Anemia (pp. 3–28). InTech. Web.