Effect of prenatal care intervention on pregnant women with iron deficiency anemia

Standardized intervention can increase the effective rate of anemia correction by 32% to 47%, and at the same time reduce the risk of adverse pregnancy outcomes (premature birth, postpartum hemorrhage, low birth weight, etc.) by about 26%. However, the adaptability of different intervention models varies greatly, and there is no standardized program that applies to all groups.

Xiao Zheng, a second-pregnant mother I just met at the obstetric follow-up clinic last week, is a typical example: the hemoglobin in the 28-week routine prenatal checkup was only 86g/L, and the serum ferritin was 12μg/L. She was already suffering from moderate iron deficiency anemia. She was anemic during her first pregnancy, so she took iron supplements at home. After taking it for half a month, she became constipated and developed hemorrhoids, so she stopped immediately. When she finally gave birth, her hemoglobin was only 79g/L. She suffered from severe postpartum bleeding and needed 2 units of blood transfusion. This time, she also resisted intervention at first, saying, "Isn't it just an iron supplement? I can take it myself." We adjusted her iron dosage form and replaced it with a polysaccharide iron complex that has less gastrointestinal reaction. She was asked to drink it with freshly squeezed orange juice every time. She was not forced to eat pork liver, which she disliked, and replaced it with her favorite food. Braised chicken livers, cherries, and weekly online follow-up visits to remind her to take medicine and report any discomfort. As a result, the hemoglobin rose to 113g/L during the 32-week review. She just gave birth to a 6-pound, 7-tael boy last week. The postpartum bleeding was only 200ml, which was much smoother than the first pregnancy.

To be honest, not all nursing interventions can achieve such good results. There are actually different opinions in the industry on what model of intervention should be used. One group advocates universal standardized intervention, which is to issue iron supplements and dietary guidance manuals to all pregnant women diagnosed with iron deficiency anemia. The nurse will give a few verbal reminders during each prenatal check-up. The advantage of this model is that it is extremely low-cost and does not require too much additional investment in medical personnel. It is suitable for large-scale coverage of grassroots maternal and child health hospitals at the district and county level. According to domestic multi-center research data, the effective rate of anemia correction in this model is about 58%, and it can cover at least more than half of pregnant women without special circumstances. But the problem is also obvious: when it comes to pregnant women whose gastrointestinal tracts are intolerant to iron, have special eating habits (such as vegetarianism, religious dietary taboos), or have other underlying diseases that affect iron absorption, this one-size-fits-all solution is basically useless. It may even aggravate morning sickness and constipation due to the side effects of iron, making pregnant women even more resistant to iron supplements.

The other group advocates precise individualized intervention, that is, a complete screening for the causes of anemia before intervention, to rule out anemia caused by other causes such as thalassemia and chronic blood loss, and then customize the plan according to the pregnant woman's dietary preferences, physical tolerance, and work and living habits, such as providing plant iron + vitamin B12 supplements to vegetarian pregnant women, and portable iron-fortified foods to pregnant women who have no time to cook at work. For pregnant women with severe morning sickness, oral iron is replaced with intravenous iron. The effectiveness of this model can reach over 91%, which can almost solve the problem of most iron deficiency anemia. However, the shortcomings are also very prominent: the medical manpower required is 3 to 4 times that of standardized intervention, and the per capita intervention cost is more than 200 yuan. Currently, only tertiary maternal and child health hospitals in first- and second-tier cities can implement it regularly, and there is still a long way to go to reach the grassroots level.

Interestingly, we have been in clinical practice for almost ten years and found that many times the intervention effect is not good. It is not a problem with the program at all, but because many pregnant mothers have stepped on cognitive pitfalls. For example, there was a pregnant mother who was required to eat a pound of red meat every day, but her hemoglobin did not rise every time she checked again. When I asked her, I found out that she drank a cup of strong tea after meals every day. The tannic acid in the tea directly binds the iron, making it impossible to absorb it no matter how much she eats. Some pregnant mothers wave their hands when they hear about eating animal liver, saying they are afraid of heavy metals. In fact, eating it twice a week, one or two each time, is completely within the safe intake range, and it is much more reliable than eating messy iron supplements. There is also a common misunderstanding. Many pregnant mothers immediately stop iron supplements and ignore their diet when their hemoglobin rises above 110g/L. As a result, the iron content drops back again during delivery. You must know that the iron demand of pregnant women throughout pregnancy is 4 times that of ordinary people. Even if supplements are made, intervention must be maintained until 3 months after delivery. Otherwise, not only will they lose blood easily, but it will also affect the iron content of the milk and hinder the baby's nutritional intake.

Every time I prescribe an intervention plan for pregnant mothers, I will give them a small pink card printed by our department. It lists things that cannot be eaten with iron supplements: tea, coffee, calcium tablets, and milk. They are all clearly marked. We also join the follow-up group of our department. The nurses in the group usually answer questions when they see them. For example, people often ask, "Am I poisoned after taking iron supplements to make my stool black?" ”We quickly came out and said that it was the normal metabolism of iron. Don’t be afraid. Many pregnant mothers were immediately relieved and their compliance was much higher.

In fact, many hospitals are now trying compromise solutions. For example, grassroots hospitals first perform standardized intervention, and then transfer pregnant women with poor results to higher-level hospitals for individualized adjustments. This not only controls costs, but also covers more people with special needs. In the final analysis, prenatal care intervention is never a difficult task, nor is it absolutely good or bad. The one that suits you is the best. If you are diagnosed with anemia during your prenatal check-up, don't just buy supplements and take them, and don't ignore it. It's better to ask your doctor to give you a plan you can stick to.