Publication: Gebelikte Demir ve Folat Eksikliği Anemisinde Kanıta Dayalı Güncel Yaklaşımlar
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Date
2019-12-15
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Abstract
Anemi, gebelikte en yaygın hemotolojik bir sorundur. Dünyadaki gebe kadınların %38.2'sinin anemik olduğu, tahmin edilmektedir. Türkiye’de üreme çağındaki kadınlarda anemi sıklığının %20 ile %39.9 arasında değiştiği belirtilmektedir. Gebelik dönemindeki anemiler edinsel ve kalıtsal olmak üzere iki grupta değerlendirilir. Gebelikte sıklıkla edinsel yetmezlik anemilerinden olan demir eksikliği ve daha az sıklıkla da folik asit eksikliği anemisi oluşur. Demir eksikliği anemisi (DEA)’nin en temel nedeni; gebelik öncesinde demir düzeyinin düşüklüğü, gebelikte absorbsiyonun artması ile artan gereksinimdir. Demir eksikliği anemisinin tanısı için öncelikle hemoglobin (Hb) ve serum ferritin düzeyi ölçülür. Gebelikte en düşük Hb değeri 1. ve 3. trimesterde <11 gr/dL, 2. trimesterde <10,5 gr/dL’olmalıdır. Gebelikte anemi; annenin hastalanma ve ölüm riskinde artışla (%20-40 oranında), fetüste ise intrauterin büyüme geriliği, düşük doğum ağırlığı, erken doğum ve perinatal mortalite riskinde artışla ilişkilidir. Maternal ve fetal komplikasyonların önlenmesi için gebe kadınlara demir ve folat desteği verilmesi önemlidir. Demir eksikliği anemisinde oral demir tedavisi birinci basamak tedavi olarak verilir. Oral tedavi yanıtsızlığı, tedaviye uyum sorunu, çok düşük hemoglobin değerleri ve hızlı demir replasmanına ihtiyaç duyulması gibi durumlarda intravenoz (İV) demir tedavisi tercih edilmektedir. Bu derlemede gebelikte demir ve folat eksikliği anemisinde kanıta dayalı güncel yaklaşımların incelenmesi amaçlanmıştır.
Anemia is the most common hematologic problem during pregnancy. It is estimated that 38.2% of pregnant women in the world are anemic. The frequency of anemia in women of reproductive age in Turkey is reported to vary between 20% and 39.9%. Anemia during pregnancy is evaluated in two groups as acquired and inherited. During pregnancy, iron deficiency, which is often an acquired deficiency anemia, and less frequently folic acid deficiency anemia occur. The main cause of iron deficiency anemia (IDA) is; The low level of iron before pregnancy, increased absorption during pregnancy is an increasing need. Hemoglobin (Hb) and serum ferritin levels are measured primarily for the diagnosis of iron deficiency anemia. The lowest Hb value during pregnancy should be <11 gr/dL in 1st and 3rd trimester and <10.5 gr/dL in second trimester. Anemia in pregnancy; increased risk of illness and death of the mother (20-40%), and increased risk of intrauterine growth retardation, low birth weight, preterm delivery and perinatal mortality in the fetus._x000D_ In order to prevent maternal and fetal complications, it is important to give iron and folate support to pregnant women. Oral iron therapy in iron deficiency anemia is given as the first-line therapy. Intravenous (IV) iron treatment is preferred in cases such as failure of oral treatment, compliance to treatment, very low hemoglobin values and need for fast iron replacement. In this review, it is aimed to examine the evidence based current approaches in iron and folate deficiency anemia during pregnancy. _x000D_
Anemia is the most common hematologic problem during pregnancy. It is estimated that 38.2% of pregnant women in the world are anemic. The frequency of anemia in women of reproductive age in Turkey is reported to vary between 20% and 39.9%. Anemia during pregnancy is evaluated in two groups as acquired and inherited. During pregnancy, iron deficiency, which is often an acquired deficiency anemia, and less frequently folic acid deficiency anemia occur. The main cause of iron deficiency anemia (IDA) is; The low level of iron before pregnancy, increased absorption during pregnancy is an increasing need. Hemoglobin (Hb) and serum ferritin levels are measured primarily for the diagnosis of iron deficiency anemia. The lowest Hb value during pregnancy should be <11 gr/dL in 1st and 3rd trimester and <10.5 gr/dL in second trimester. Anemia in pregnancy; increased risk of illness and death of the mother (20-40%), and increased risk of intrauterine growth retardation, low birth weight, preterm delivery and perinatal mortality in the fetus._x000D_ In order to prevent maternal and fetal complications, it is important to give iron and folate support to pregnant women. Oral iron therapy in iron deficiency anemia is given as the first-line therapy. Intravenous (IV) iron treatment is preferred in cases such as failure of oral treatment, compliance to treatment, very low hemoglobin values and need for fast iron replacement. In this review, it is aimed to examine the evidence based current approaches in iron and folate deficiency anemia during pregnancy. _x000D_