Pregnancy is a crucial period in the life of women with an increase in the physiological need of iron and folic acid. The role of iron and folic acid in the life of the growing fetus and the mother makes them essential supplements that must be provided to every pregnant woman throughout their period of pregnancy. Iron and folic acid may not be obtained in sufficient amount from diet alone hence the need for early and adequate supplementation.
The importance of iron during pregnancy cannot be emphasized and it is a routine supplement that is taken by all pregnant women during pregnancy and it’s continued for few months after delivery. Iron is an important component of haemoglobin which is responsible for the transfer of oxygen from the lungs to the fetus via the placenta. Maternal deficiency of iron leads to iron deficiency anaemia which is attributed to low birth weight, intrauterine growth restriction, preterm labour, neonatal anaemia and poor maternal well being.
In a non pregnant woman, 2/3rd of the body iron is found in haemoglobin. During pregnancy, iron demand by the body is increased because iron is passed to the fetus via the placenta and it is incorporated into the fetal blood. The increase in iron requirement is not uniformly spread over the period of pregnancy but rises as pregnancy advances. From 28 weeks of pregnancy, the increase demand of iron is noted with a reduction in packed cell volume if no iron supplements had been given to the pregnant woman. Iron from diet is obtained mainly from meat and liver. A healthy diet provides 15mg of iron per day but only 10% is absorbed by the intestines and this cannot meet with the increase demand of iron during pregnancy.
In the early 60s, it was discovered that the incidence of neural tube defects, anterior abdominal wall defect was on the increase. This led to the incorporation of folic acid as a routine antenatal drug for all pregnant women. Folic acid is needed for the synthesis of DNA and it prevents the occurrence of congenital defects. The best period to commence folic acid intake is during the preconception visit (weeks to months before pregnancy takes place). This is beneficial because it allows time for the replenishment of the store of folic acid in the body.
It is important to note that most neural tube and anterior abdominal wall defects usually occur with the first few months of pregnant and most may have occurred before the woman is even aware that she is pregnant. This is of a problem in underdeveloped countries with poor access to medical facilities and poor health care seeking behaviour. Sources of folic acid includes: yeast extracts, vegetables, crude liver extracts. The demand of folic acid during pregnancy is very high.
Symptoms of anaemia in pregnancy
Common symptoms of anaemia in pregnancy include:
- Generalized body weakness, excessive fatigue, exercise intolerance
- Dizziness, difficulty in breathing, conjuctival pallor
- Swelling of the legs
- Enlarged liver and spleen
- Pale conjunctiva of the eyes, pale hands and nail bed
- In severe cases, patients may suffer from heart failure
Who is at risk of iron and folic acid deficiency?
- Multiple pregnancies increases the risk of developing anaemia because of the increase in demand by the multiple fetus
- Excessive bleeding during pregnancy leading to blood loss
- Women suffering from poor food intake
- Low socioeconomic status and illiteracy have a directly correlation with nutritional status of the mother
- Women suffering from heavy menses
- Multiple pregnancies within a short interval
How to prevent iron and folic acid deficiency
- Ensuring adequate intake of meals rich in iron and folic acid e.g. meat, poultry, liver, fruits and vegetables, nuts, seeds and cereals an grains fortified with iron
- Food rich in vitamin C enhances the absorption of iron. During pregnancy, vitamin C supplement is also prescribed to all pregnant women.
- Ensure that your haemoglobin concentration is optimal before you conceive.
- Report all cases of bleeding during pregnancy to your physician for prompt treatment
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