ANAEMIA AND MATERNAL HEALTH

1. Context

Recently, there has been news coverage in India regarding folate anaemia and its impact on the National Family Health Survey (NFHS). The government proposed to remove a question specifically addressing anaemia from the survey and replace it with a more comprehensive test to determine haemoglobin levels in the blood. This change is part of the Diet and Biomarker (DAB) survey.

Additionally, a research paper suggesting that normative values for haemoglobin should be lowered in India has faced criticism. The paper is based on a small study, which has raised concerns about its applicability to the entire population.

2. About Anaemia

Anaemia is a common blood disorder characterized by a decrease in the number of red blood cells or a deficiency in the amount of haemoglobin a protein responsible for carrying oxygen to body tissues. It can lead to fatigue, weakness, shortness of breath, and other symptoms. While anaemia can result from various causes, it is often preventable through proper nutrition and a healthy lifestyle.

Image Source: The Hindu

3. Anaemia can occur due to various reasons, including

Iron Deficiency: Iron deficiency anaemia is the most common type of anaemia. It happens when the body doesn't have enough iron to produce sufficient amounts of haemoglobin, the protein in red blood cells responsible for carrying oxygen. Inadequate iron intake, poor absorption of iron, increased iron requirements (such as during pregnancy), and blood loss (through menstruation or gastrointestinal bleeding) can lead to iron deficiency anaemia.
Vitamin Deficiencies: Deficiencies in vitamin B12 and folate (vitamin B9) can result in anaemia. These vitamins are crucial for red blood cell production. A lack of dietary intake, impaired absorption (as seen in certain gastrointestinal conditions), or inadequate utilization of these vitamins can contribute to anaemia.
Chronic Diseases and Conditions: Certain chronic diseases can interfere with red blood cell production or lead to increased destruction of red blood cells. Examples include kidney disease, liver disease, cancer, autoimmune disorders, and chronic inflammation. These conditions can disrupt the normal functioning of the bone marrow, affecting the production of red blood cells, or causing their destruction.
Inherited Disorders: Some types of anaemia are inherited. Examples include sickle cell anaemia, thalassemia, and hereditary spherocytosis. These genetic disorders affect the structure or production of red blood cells, leading to chronic anaemia.
Other Factors: Certain medications, such as chemotherapy drugs, can suppress the production of red blood cells. Infections, such as malaria, can also cause the destruction of red blood cells. Additionally, rare conditions like aplastic anaemia, where the bone marrow fails to produce enough blood cells, can result in anaemia.

4. Anaemia and Postpartum Haemorrhage

The WOMAN trial collaborators conducted a study to examine the association between anaemia and the risk of postpartum haemorrhage (excessive vaginal bleeding after delivery).
Worldwide, more than half a billion women of reproductive age are anaemic, and postpartum haemorrhage is a major cause of maternal deaths, especially in low- and middle-income countries.
The trial included over 10,000 women with moderate or severe anaemia giving birth vaginally in Pakistan, Nigeria, Tanzania, and Zambia.
The study analyzed the continuous relationship between pre-birth haemoglobin levels and the risk of postpartum haemorrhage.
By defining the outcome in three ways (clinical postpartum haemorrhage, WHO-defined postpartum haemorrhage, and calculated postpartum haemorrhage), the researchers assessed different thresholds of blood loss.
The advantage of examining anaemia as a continuous variable is that it helps identify a potential causal relationship by demonstrating a monotonic biological gradient.
The findings provide valuable insights into the strong association between anaemia and the risk of postpartum haemorrhage, emphasizing the need for effective strategies to address and manage anaemia in pregnancy.

5. Prevention Strategies

Balanced Diet: Consuming a well-balanced diet rich in iron, vitamin B12, and folate is essential for preventing anaemia. Iron-rich foods include lean meats, seafood, leafy green vegetables, beans, and fortified cereals. Foods high in vitamin B12 are animal-based products like meat, fish, eggs, and dairy. Folate can be obtained from green leafy vegetables, citrus fruits, beans, and fortified grains.
Iron Absorption: Enhancing iron absorption can contribute to preventing anaemia. Pairing iron-rich foods with vitamin C sources, such as citrus fruits, tomatoes, and bell peppers, can aid in the absorption of dietary iron. On the other hand, certain substances like tannins found in tea and coffee can inhibit iron absorption, so it's advisable to consume them in moderation.
Avoiding Nutrient Deficiencies: Deficiencies in vitamin B12, folate, and other essential nutrients can lead to anaemia. Therefore, it is crucial to maintain a varied diet that includes all necessary vitamins and minerals. If a balanced diet is not sufficient, dietary supplements can be considered under the guidance of a healthcare professional.
Managing Chronic Conditions: Some chronic diseases, such as inflammatory bowel disease, kidney disease, and certain cancers, can contribute to anaemia. Proper management of these conditions, including regular check-ups, medication adherence, and lifestyle modifications, can help prevent anaemia or reduce its severity.
Prenatal Care: Pregnant women are more susceptible to anaemia due to increased blood volume requirements. Regular prenatal care, including iron and folate supplementation, is essential to prevent anaemia during pregnancy and ensure the healthy development of the fetus.
Blood Loss Prevention: Certain individuals, such as women with heavy menstrual bleeding or individuals with gastrointestinal bleeding, are prone to anaemia due to blood loss. Effective management of these conditions, including medical interventions, can help prevent anaemia associated with excessive blood loss.

For Prelims: Anaemia, Maternal Health, National Family Health Survey (NFHS), Diet and Biomarker (DAB) survey, Iron deficiency, Vitamin deficiency, vitamin B12, folate (vitamin B9), and Postpartum Haemorrhage.

For Mains: 1. Analyze the factors contributing to anaemia in pregnant women and evaluate the effectiveness of existing interventions in preventing and managing anaemia during pregnancy. (250 words).

Previous year Question

1. Anaemia is caused by the deficiency of which of the following element? (SSC CGL 2017)

A. Cobalt

B. Iron

C. Sodium

D. Calcium

Answer: B

Source: The Hindu

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