Mrs Lucy Hammed was diagnosed as anaemic when she went to register for antenatal care. She was told that having a low blood volume was dangerous for her and her unborn baby. The nurse said she needs to ensure that she eats well and takes her folic and iron tablets daily.
“During my booking session, I was diagnosed with anaemia. I didn’t understand how much better I felt until I had been taking iron supplements for a few weeks. I hadn’t recognised how exhausted I was and how short my breath was,” Mrs Hammed retorted.
Anaemia is a blood disorder that occurs when the body doesn’t have enough red blood cells or haemoglobin, the protein that carries oxygen. Women in Nigeria experience anaemia at high rates, and it can have serious health consequences.
Worst still, pregnant women with anaemia are substantially more likely to suffer life-threatening bleeding after childbirth.
In a new study, researchers in the journal The Lancet Global Health said that severe anaemia is linked to a seven-fold increased risk of death or life-threatening bleeding after childbirth.
Professor Dapo Olayemi, a consultant Obstetrician and gynaecologist at the University College Hospital (UCH), Ibadan declared that iron tablets were usually given so that pregnant women would not have anaemia.
“The pregnant woman will feel better; they will lose blood during childbirth but, it will not affect them too much,” he added.
According to him, the intake of iron tablets is not only to prevent the loss of blood during childbirth affecting them too much but also to reduce the chances of the woman dying from blood loss during labour and ensure she is better able to fight infections.
However, he stated aside from the intake of iron tablets to treat anaemia, sometimes the woman may be given a blood transfusion, depending on the cause of the anaemia.
“But in the majority of women that have anaemia, it will be because of a deficiency in micronutrients that is iron and folic acid. So, if we prevent anaemia in pregnancy before they come into labour we are likely to reduce severe bleeding after childbirth and maternal deaths. And Iron supplementation could either be orally or in other forms.”
In a clinical study of over 10,500 women giving birth in four low-and middle-income countries, a reduction in haemoglobin, the protein in red blood cells that carries oxygen, of 10 grammes per litre of blood just before birth increased the risk of life-threatening bleeding after childbirth by 23 per cent.
Women with severe anaemia (70 grams or less of haemoglobin per litre of their blood) are seven times more likely to die or to become dangerously ill than those with moderate anaemia (between 70 and 99 grams of haemoglobin per litre of blood).
Despite the strong association, anaemia was not recorded as the cause of severe bleeding in any of the women studied, with the authors stressing that efforts to prevent and treat anaemia in women of child-bearing age must be strengthened.
Iron deficiency is the most common cause of anaemia. Poor access to a healthy diet, infectious diseases (such as malaria or HIV) and untreated heavy menstrual bleeding are the main causes of iron deficiency in young women.
Severe bleeding after birth, known medically as postpartum haemorrhage (PPH), is the leading cause of maternal death, killing one woman every six minutes. Anaemia greatly multiplies the risk of bleeding and death. Worldwide, half a billion young women are anaemic and 20 million are severely anaemic.
In this study, a research team that included those from the London School of Hygiene & Tropical Medicine (LSHTM) analysed data from the ongoing WOMAN-2 clinical trial. These were 10,561 pregnant women with an average age of 27 years old who were due to give birth vaginally in hospitals in Pakistan, Nigeria, Tanzania and Zambia between 2019 and 2022 were recruited.
Haemoglobin measurements were taken after the women arrived at the hospital and just before they gave birth. Doctors assessed whether the new mothers experienced PPH within 24 hours following birth.
Overall, 742 (7 percent) of women in the study developed clinical PPH. Those with moderate anaemia had a 6.2 percent chance of experiencing PPH after childbirth, with the risk increasing to 11.2 percent if their anaemia was more severe.
According to the study, a 10 grammes per litre decrease in the amount of haemoglobin in the blood resulted in a 16 percent to 23 percent increase in the likelihood of developing PPH, depending on the definition used. Women with severe anaemia were seven times more likely to die or nearly die from severe bleeding than those with moderate anaemia.
Although such questions will need to be addressed, the authors conclude that the current findings signal the pressing need to not only treat anaemia in women of childbearing age but also prevent it if fewer mothers are to lose their lives.
READ ALSO: Why you may have vaginal bleeding after sex
