The effect of prenatal care intervention on pregnant women with iron deficiency anemia

Combining the domestic clinical data from multiple centers in the past three years and the follow-up results of our obstetrics frontline, targeted prenatal care intervention can increase the hemoglobin efficiency of pregnant women with iron deficiency anemia by 32% to 41% compared with routine care, and reduce the risk of premature birth, postpartum hemorrhage, and low birth weight of newborns. The incidence rate of adverse pregnancy outcomes has dropped by about 22% on average, but this effect is not absolute - the suitability of the intervention plan, the pregnant woman's own compliance, and the basic physical condition will directly affect the final result. Not all "process-based prenatal care" can achieve ideal benefits.

To be honest, I just met a 28-year-old pregnant mother of her second child in the clinic last week for a 36-week routine prenatal checkup. I looked through her prenatal checkup book and found that her hemoglobin was only 91g/L at 24 weeks of pregnancy, which was a moderate iron deficiency anemia. We sent her away without giving her the iron supplement directly. First, we calculated the actual iron-replenishing efficiency of her bowl of soup - the tannic acid in the spinach would offset most of the iron absorption in the pig liver, which meant that after half a month of drinking it, the actual iron supplement she received was less than 1/3 of her daily requirement, which was a waste of time. Later, we did not force her to eat pork liver. Knowing that she loved braised duck blood and lean beef, we directly changed the recipe to her favorite foods. We also tied the iron supplement time to the time when she drinks milk powder for pregnant women every day. We set up a WeChat reminder for her, specially for her old age. The bus agent reminded her every day to take half a cup of the bottled fresh orange juice she likes when taking iron supplements (she doesn’t like fresh oranges because they are sour, and we didn’t force her to do so, as long as she has enough vitamin C). We also specially adjusted the dosage of the iron supplements for her and mixed it with a small amount of lactulose to avoid constipation. During the 32-week check-up last month, her hemoglobin had risen to 117g/L, which was completely within the normal range. This check-up was also very stable. She even laughed to herself and said, "If I had known it was so easy, why did I drink so much spinach soup before?"

Of course, not everyone agrees with the idea of ​​"earlier intervention, the better". There are actually two completely different tendencies in the academic community: one group advocates routine ferritin screening from the 12th week of pregnancy. As long as the ferritin is lower than 30 μg/L, even if the hemoglobin is completely normal, preventive iron supplementation should be started to nip the signs of anemia in the cradle. Our department has done this kind of screening for half a year in the first two years, and has indeed reduced the incidence of anemia in the third trimester to less than 10%.； But the view of the other group is also very reasonable. They think that there is no need to screen the entire population. After all, many pregnant mothers have sufficient iron reserves. Blind iron supplementation will aggravate constipation and gastrointestinal flatulence, which are easy to occur during pregnancy. It will affect appetite, and in severe cases, it will lead to iron overload, which is not good for the body. We have also encountered pregnant mothers who vomited as soon as they took iron supplements. The morning sickness was relieved, but they returned to the state of vomiting after taking iron supplements, which was not worth the gain. We have tried both of these views in clinical practice. There is no absolute right or wrong. The key lies in the degree of fit.

In fact, after working on the front line for a long time, you will find that whether the nursing effect is good or not has a lot to do with whether the plan is "down-to-earth". We have also stepped into the trap before and issued a unified dietary guidance manual to all anemic pregnant mothers. The preferred iron-supplementing foods listed in it were all pork liver and pig red. Later, when we met a Hui pregnant mother, she laughed on the spot when she got the manual and said that the manual was of no use to her except to hold a cup. It was only then that we realized that the previous plan was too taken for granted. Later, we changed the rules. When doing intervention, we first asked people about their eating habits, whether they had any taboos, whether they often ordered takeout at work, and whether there would be any adverse reactions to taking supplements. After we found out everything, we gave them a plan, and the effect was immediately noticeable. There are also many people who tend to ignore the role of family members. Many pregnant mothers have to go to work and take care of their elders, and they simply cannot remember to take iron supplements on time. If their family members can help and remind them, the compliance rate will more than double.

Of course, there are also situations that are particularly difficult to intervene. For example, there was a pregnant mother who had Crohn's disease and poor intestinal absorption function. She did not absorb oral iron at all and her hemoglobin dropped all the way to 82g/L. We did not force her to take oral medicine at that time. We directly contacted the nutrition department and gastroenterology department for consultation and gave her intravenous infusion of iron sucrose, which rose to 103g/L in two weeks. The baby who was finally born was also very healthy and did not appear to be underweight. Therefore, intervention cannot be rigid and rigid; it must be flexibly adjusted to be effective.

In the final analysis, prenatal care intervention is never a high-end "treatment", and there is no standard answer that is universally applicable. It is nothing more than breaking down the dry medical knowledge into small things that every pregnant mother can actually do - you tell her about "iron supplements and vitamin supplements" for a long time. "The absorption rate of vitamin C increases by 200% when taken together." Instead of telling her directly, "Just drink half a cup of orange juice when taking iron supplements." You list a bunch of fancy recipes for her, but why not first ask people what they like to eat and what they can eat, and whether the effect is good or not. In fact, it is all hidden in these small details that no one pays attention to.