Pregnancy with Iron Deficiency Anemia - Medical Nutrition Therapy ...

Hannah Welsh
KNH 406
April 21, 2010

Mrs. Sarah Henley
Age: 31
Wt. 135 pre, 145 currently
Ht. 5’5
Smoker
23 rd week of Gestation
Stay-at-Home mother, two son 12 months and 3
years
Chief Complaint: “ I went out to get the mail
and slipped on the ice. After I got back I noticed
a small amount of bleeding when I went to the
bathroom. Over the next hour, I had some
abdominal pain. I was afraid something might
have happened to the baby”

Mrs. Henely is “gravida 3/para 2
• Gravida-indicates the total number of times a woman
has been pregnant, regardless of whether these
pregnancies were carried to term. A current
pregnancy, if any, is included in this count.
• Para-indicates the number of viable (>20 wks) births.
Pregnancies consisting of multiples, such as twins or
triplets, count as ONE birth for the purpose of this
notation.
• Abortus- is the number of pregnancies that were lost
for any reason, including induced abortions or
miscarriages. The abortus term is sometimes dropped
when no pregnancies have been lost.

PMH: Two previous pregnancies delivered at
38 and 37 weeks respectively.
Fatigue
Short of breath
Pale
Prenatal vitamins
Family history of CAD

Microcytic, Hypochromic Anemia
• Anemia is classified by the size of red blood cells
• The size is reflected in the mean corpuscular
volume (MCV).
• If the cells are smaller than normal (under 80 fl),
the anemia is said to be microcytic
• If they are normal size (80–100 fl), normocytic;
• If they are larger than normal (over 100 fl), the
anemia is classified as macrocytic.

• Megablasic Anemia-is a blood disorder in which there is
aneima with larger-than-normal red blood cells.
• Pernicious Anemia-a decrease in red blood cells that
occurs when the body cannot properly absorb vitamin
B12 from the gastrointestinal tract.
• Normocytic anemia- a blood disorder characterized by
red blood cells which are of a normal size but present in
insufficient quantities. It is often associated with chronic
diseases, blood loss, bone marrow problems and kidney
disease
• Microcytic anemia-a generic term for any type of anemia
characterized by small red blood cells.
• Sickle cell anemia- a disease passed down through
families in which red blood cells form an abnormal
crescent shape
• Hemolytic anemia- a condition in which there are not
enough red blood cells in the blood, due to the
premature destruction of red blood cells.

• Mrs. Henley has gained 10 lbs in
her 23 rd week
• Smoker-doubles the risk of having
a low birth weight baby
• A “safe” weight gain for expecting
mothers is anywhere from 25-35
lbs
• Her previous pregnancies were
about 15-18 lbs which indicates
her baby’s were most likely at a
low birth weight.
• In general, women should gain
about 2 to 4 pounds during their
first three months of pregnancy
and 1 pound a week for the
remainder of the pregnancy.
• This indicates that her current
weight gain is about 5 lbs less than
it should be.

Currently, she is only receiving 1,428 kcal
day and 62.0 grams of protein.
She is only consuming 14.3 grams of iron
opposed to the 18 grams that is
recommended for her age, and 27 grams
recommended for pregnant women

• The total energy cost of pregnancy has been estimated
at 77,000 Calories. averages out to 285 kcal a day
• Based on the estimate of 285 Calories per day overall -
this would equate to:
First Trimester - 85 Extra Calories
Second Trimester - 285 Extra Calories
Third Trimester - 475 Extra Calories
• Using Harris-Benedict Equation,
• BMR= 655 + (587.5) + (297) – (145.7)=1393 X 1.2
=1671.9kcal/day
First Trimester 1768 Calories/day
Second Trimester 1968 Calories/day
Third Trimester 2158 Calories/day
• Protein= (weight in kg) x (1.0-1.2- grams/day)
61 -67 grams of protein a day

Non-heme iron can
be improved when a
source of heme iron
is consumed in the
same meal.
The iron absorptionenhancing
foods can
also increase the
absorption of nonheme
iron.
Any vitamins and
minerals help
absorb iron?
• Iron Rich Foods
containing Heme Iron
include clams, pork
liver, oysters, mussels
and beef liver
• Iron Rich Foods
containing Non-Heme
Iron includes
breakfast cerels,
cooked beans and
lentils, pumpkin seeds
and blackstrap
molasses.

The most advantageous nutrient for helping increase
absorption of plant-food iron is vitamin C.
A meal that contains about 25 milligrams of vitamin C
may as much as double absorption of plant food iron
from that meal.
Copper is another key nutrient for supporting iron
metabolism. In this case, it is transport of iron
around the body that relies in many ways on the
presence of copper.
So important is this relationship that iron-deficiency
anemia may sometimes reflect the more basic
underlying problem of copper deficiency.
Vitamin A may also help improve iron status, and
perhaps because of their relationship to stomach
acidity levels

She was put on bed rest monitoring fetal
heart tones and contractions, routine vital
signs
Fetal heart tones were within normal limits
Patient was discharged the following day on
40 mg ferrous sulfate
Common side effects include constipation, darkened
or green stools, diarrhea, nausea, and stomach upset.

http://www.babyyourbaby.org/duringpregnancy/
weightgain.htm
http://www.babycenter.com/0_iron-deficiencyanemia-in-pregnancy_3073.bc
http://my.clevelandclinic.org/healthy_living/pre
gnancy/hic_increasing_iron_in_your_diet_during
_pregnancy.aspx
http://www.marchofdimes.com/pnhec/188_104
9.asp
http://health.utah.gov/mihp/pregnancy/preged
/duringpreg/Anemia_during_pregnancy.htm
http://www.anemia.org/patients/faq/
http://web2.airmail.net/uthman/lab_test.html