Anaemia, commonly caused by a deficiency of iron, is the most widespread nutritional deficiency worldwide and affects up to 1 in 2 pregnancies – a time when the demand for iron is increased. Anaemia in pregnancy can lead to low birth weight, early delivery and even death in severe cases. The treatment appears simple: replace the lost iron. But why does anaemia remain a problem?
Most women require some form of additional iron therapy in pregnancy and this can be given through iron-fortified food and water, tablets or injections, and there are a vast number of iron preparations available in the market.
But our recent work shows that not all iron preparations are equal. Most healthcare professionals offer the most widely available iron or the cheapest. This may not be the best option, especially for women with more severe anaemia, women in the latter stages of pregnancy, or for those with dietary issues. And very little follow-up occurs.
Some women, including those with longstanding iron deficiencies or heavy periods, are sometimes given higher dose treatments which are then poorly tolerated. These women could benefit from counselling on alternative dosing strategies such as alternate day iron, using preparations with fewer side effects and offering alternatives to oral medication.
A bewildering number of decisions
Being both a pregnant woman and a healthcare professional, I have found the number of decisions required by pregnant people to make is bewildering. Even as someone who knows how to sift through the deluge and find fact from hearsay, it’s still an overwhelming task.
Having open and transparent discussions with healthcare professionals about the availability of evidence, possible side effects and offers of alternative options have been the most useful consultations. This is especially true for treatments such as iron tablets which can be unpleasant to take even for people who are not pregnant.
Being nauseous and bloated, the last thing I wanted to take was something that would make me feel worse, even if it would be beneficial for me and my baby. Pregnant women are not just vessels for unborn children. Understanding how to optimise health for both mother and child without resorting to placations is vital.
Open conversations about evidence
I have been lucky, the healthcare professionals managing my pregnancy treat me as a colleague and we make joint decisions about care with open conversations about evidence, or lack of. I am not sure the same can be said for all pregnant women, especially for those who cannot advocate for themselves.
Ensuring healthcare professionals and pregnant women are aware of the availability of evidence and the gaps in the literature will be beneficial in guaranteeing that existing policy or guidelines are tailored to their needs. This does require clinicians to be more nuanced with their counselling, especially on areas such as managing anaemia in pregnancy, which while simple in theory to manage, can be challenging to put into practice.
For busy clinicians, this is yet another thing to add to the never ending to do list. But it doesn’t need to be. A simple question about how the pregnant woman is finding the treatments offered can be the gateway to a more meaningful conversation. I am always surprised by the answers I hear from pregnant women and the potential solutions they come up with themselves.
- Read Dr Jahnavi Daru’s research paper: ‘Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis’. Rogozińska et al. The Lancet Haematology.