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Does a low haemoglobin during pregnancy affect the mother or the child?

Q: My wife is seven weeks pregnant and was tested with low haemoglobin? The doctor suggested her to go for a thalassaemia test. How would this affect the delivery process? She is undergoing a caesarean delivery. How would this affect the mother and the baby? Please advise.

A:Anaemia is inadequate level of haemoglobin appropriate for age & sex. The most common cause of anaemia in pregnancy is deficiency of iron (~85% cases) and folic acid. Even if a woman is not anaemic at the time of pregnancy, she may still develop anaemia as the pregnancy progresses due to increased demands of the developing baby. There are certain risk factors for women being anaemic and these include: poor nutrition, inadequate gap between pregnancies, persistent nausea or vomiting in early pregnancy and twin pregnancy. The loss of iron (elemental) with each normal menses is around 12-15 mg. A normal diet must include 1.5-2 mg/day of elemental iron to compensate for menstrual losses alone. In pregnancy, 500 mg of additional iron is needed by the mother (to expand her red cell mass) while another 500 mg is needed for the baby and placental tissues. Thus, on an average, an additional 3 mg/day of elemental iron must be absorbed from dietary sources. The amount of iron absorbed by the body is only 10% of the total amount consumed, thus 30 mg/day needs to be consumed to meet the requirement. An iron deficient mother can have premature labour, intrauterine growth retardation (poor development of baby), severe anaemia due to normal blood loss during delivery and increased susceptibility to infection. The likelihood of postpartum transfusion may be reduced if a woman enters the birth with a higher haemoglobin level. The gene frequency of thalassaemia is quite high in North India. Thalassaemia trait (thal minor/carrier state) can mimic iron deficiency and can be excluded by estimating the Hb A2 and Hb F levels in the blood. In case your wife is a carrier, you would need to be tested too, as there would be a 25% chance of the baby being normal, 50% chance of thal trait and 25% chance of thal major (which is a chronic disease requiring lifelong transfusion).

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