Severe anaemia in pregnancy (as seen in Kuala Lumpur, Malaysia).
Nutritional anemia is common and is found particularly among pregnant women in Malaysia as in other developing countries. Over the 1953-1962 period, 73,048 women were treated in the Maternity Hospital at Kuala Lumpur, Malaysia; 2250 or 3.1% of this group had severe anemia. One half, 1066, were investigated fully. In the remainder an accurate diagnosis was not made before treatment was instituted, and the type of anemia was classified as "unknown." Of those investigated fully, normoblastic iron deficiency anemia was found in 676 (64%) and megaloblastic anemia was found in 373 (35%). The megaloblastic anemia was invariably associated with an iron deficiency anemia, and the more severe the anemia the higher was the proportion with a megaloblastic crythropoiesis. The mortality of anemic mothers was significantly higher (15.5/1000) than those with no anemia (3.5/1000). The effects of maternal anemia on the fetus were considerable and include the following: the prematurity rate among infants of anemic mothers was 18.1%, 3 times that of infants born to nonanemic mothers; the perinatal loss in the anemic mother was 13.1%, twice that of the nonanemic mother (6.8%); and the stillbirth rate among infants born to anemic mothers was 91.0/1000 compared with a rate of 15.7/1000 among infants born to nonanemic mothers. The findings indicate the seriousness of severe anemia in pregnancy. Etiological factors are considered since this will be the basis of rational therapy. Iron deficiency anemia may develop for several reasons. There is usually a dietary deficiency of iron, and there may also be a lowered absorption from the gut. Also, there may be excessive blood loss due to hookworm and menorrhagia, and there are the demands of repeated childbearing. Apart from hookworm infestation, insufficient dietary intake of iron was the principal cause of anemia among the women in the study with iron deficiency anemia. Among the women with megatoblastic anemia folic acid was the prime deficiency leading to this type of anemia. The anemia was aggravated by increasing malnutrition as demonstrated by diminished serum albumin and globulin concentration. The diagnosis of severe iron deficiency anemia was made by estimation of the hemoglobin concentration, supplemented in some cases by serum iron studies. Megaloblastic anemia in pregnancy can only be diagnosed with accuracy by a bone marrow smear. Consideration of the etiology of anemia in Malaysia led to a standard treatment among the pregnant women studies. The treatment approach is reviewed in detail.