Chapter 2 - Hematinic deficiencies

Summary

Iron, folate, and vitamin B12 deficiency are the most common hematinic deficiencies. Maternal iron deficiency anemia affects both mother and fetus. Iron-dependent enzymes in every cell are affected and there are neuromuscular, gastrointestinal, and epithelial consequences that can influence fetal mortality, growth, and programing. Anemia screening is primarily done by measuring the hemoglobin. Further investigation is usually a ferritin level or a trial of iron. Periconceptual folic acid is advised to reduce the incidence of neural tube defects. Folate prophylaxis should be considered in at risk groups such as those on anticonvulsants and with chronic hereditary or acquired red cell disorders. Folate stores can be depleted within months and women need education on diet to ensure recommended folate consumption. B12 deficiency is rare in pregnancy and vitamin B12 levels should be interpreted with caution. B12 levels fall in pregnancy by up to 50% in the third trimester.