Huch R
Klinik und Poliklinik für Geburtshilfe, Universitäts-Frauenklinik, Zürich.
Praxis (Bern 1994). 1999 Jan 28;88(5):157-63.
Pregnancy and postpartum anaemia occurs worldwide, particularly in developing countries where it accounts for substantial maternal and infant morbidity and mortality. The main cause is iron deficiency, primarily of dietary origin: 20% of the world population are estimated to have some degree of trace element deficiency. Even in industrialized countries iron deficiency anaemia is common in pregnancy due to the negative iron balance created by the high fetal demand for iron. It is compounded by blood loss during and after delivery, particularly in the absence of adequate prevention and treatment. The main effects of pregnancy and postpartum anaemia (defined by the WHO as hemoglobin values < 110 g/l and < 100 g/l, respectively) present for the mother an increased susceptibility to infection and premature delivery and for the baby intrauterine growth retardation and the consequences of prematurity. Diagnosis and differential diagnosis are thus a major obstetric concern. Iron deficiency can be particularly difficult to diagnose in postpartum anaemia because ferrritin is often falsely elevated due to concurrent infection. Prevention with oral iron + folic acid supplementation has proven effective, as has intravenous iron in more severe cases, while the addition of recombinant erythropoietin augments the effect of iron alone.
妊娠和产后贫血在全球范围内都有发生，尤其是在发展中国家，它导致了大量的孕产妇和婴儿发病及死亡。主要原因是缺铁，主要源于饮食：据估计，世界上20%的人口存在某种程度的微量元素缺乏。即使在工业化国家，由于胎儿对铁的高需求导致铁平衡为负，缺铁性贫血在孕期也很常见。分娩期间及产后的失血会使情况更加严重，尤其是在缺乏充分预防和治疗的情况下。妊娠和产后贫血（世界卫生组织分别将其定义为血红蛋白值<110 g/l和<100 g/l）对母亲而言，会增加感染易感性和早产风险，对婴儿而言，则会导致宫内生长受限以及早产后果。因此，诊断和鉴别诊断是产科的一个主要关注点。在产后贫血中，缺铁可能特别难以诊断，因为由于并发感染，铁蛋白常常会出现假性升高。口服铁剂加叶酸补充剂预防已被证明有效，在更严重的病例中静脉注射铁剂也有效，而添加重组促红细胞生成素可增强单独使用铁剂的效果。
