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2016 | OriginalPaper | Buchkapitel

23. Anämie in der Schwangerschaft

verfasst von : Christian Breymann

Verlag: Springer Berlin Heidelberg

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Zusammenfassung

Anämien gehören zu den häufigsten Risikofaktoren in der Geburtshilfe und Perinatalmedizin. Die meisten internationalen Leitlinien empfehlen die zusätzliche Einnahme von 15–30 mg/Tag Eisen, um den im Verlauf der Schwangerschaft zunehmenden Eisenbedarf zu kompensieren.

Voraussetzung für die Abklärung einer Schwangerschaftsanämie ist die Festlegung des richtigen Cut-off-Werts für einen zu niedrigen Hämoglobinwert in Abhängigkeit des Gestationsalters; ein Hb-Wert <10,5 g/dl kann zu jedem Zeitpunkt der Schwangerschaft als diagnostischer Hinweis für eine Anämie gewertet werden und bedarf der Abklärung. Weiteres wichtiges Diagnostikum ist die Bestimmung des Ferritinwerts. Die Therapie richtet sich nach der Ursache und Schwere der Anämie. Auch leichtere Formen müssen konsequent behandelt werden, um einer Aggravation und peripartalen Komplikationen bei hohen Blutverlusten vorzubeugen. Sowohl intravenöse als auch orale Eisenpräparate zeigen Vorteile im Bezug auf Hämoglobin- und Ferritinanstieg.

Vorheriges Kapitel Hypertensive Schwangerschaftserkrankungen

Nächstes Kapitel Thromboembolische Komplikationen in Schwangerschaft und Wochenbett

ACOG Practice Bulletin No. 78. (2007) Hemoglobinopathies in pregnancy. Obstet Gynecol 109(1): 229–37

Al A, Unlubilgin E, Kandemir O, Yalvac S, Cakir L, Haberal A (2005) Intavenous verus oral iron for treatment of anemia in pregnancy. Obstet Gynecol 106:1335–1340CrossRefPubMed

al-Momen AK, al-Meshari A, al-Nuaim L, Saddique A, Abotalib Z, Khashogji T, Abbas M (1996) Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur J Obstet Gynecol Reprod Biol 69(2):121–124CrossRefPubMed

Auerbach M, Pappadakis J, Bahrain H, Auerbach A, Ballard H, Dahl N (2011) Safety and efficacy of rapidly administered one gram of low molecular weight iron dextran (INFeD) for the treatment of iron deficient anemia. Am J Hematol 86(10):860–862CrossRefPubMed

Ayub R, Tariq N, Adil M, Iqbal M, Junaid A, Jaferry T (2008) Efficacy and safety of total dose infusion low molecular weight dextran in the treatment of iron deficiency anemia during pregnancy. J Coll Physicians Surg Pak 18:424–427PubMed

Baker R, Greer F (2010) Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 126:1040–1050CrossRefPubMed

Bayoumeu F, Vial F, Zaccabri A, Agullès O, Laxenaire MC (2002) Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol 186:518–522CrossRefPubMed

Beguin Y, Lipcsei G, Thoumsin H, Fillet G (1991) Blunted erythropoietin production and decreased erythropoiesis in early pregnancy. Blood 78:89–91PubMed

Bencaiova G, Krafft A, Burkhardt T, Breymann C (2006) Variable efficacy of recombinant human erythropoietin in anemic pregnant women with different forms of heterozygous hemoglobinopathy. Acta Haematol 116(4): 259–65CrossRefPubMed

Bencaiova G, Burkhardt T, Breymann C (2012) Anemia, prevalence and risk factors in pregnancy. Eur J Intern Med 23:529–533CrossRefPubMed

Braga J, Marques R, Branco A, Jorge C (1996) Maternal and perinatal implications of the use of human recombinant erythropoietin. Acta Obstet Gynecol Scand 75:449–453CrossRefPubMed

Breymann C, Huch R (2008) Anemia in pregnancy and the puerperium, 3. Aufl. UNI-MED Science, Bremen. ISBN 978-3-8374-1022–1228

Breymann C, Major A, Huch R, Huch A (1995) Recombinant human EPO and parenteral iron in the treatment of pregnancy anemia: a pilot study. Feto Maternal Hematology Research Group University of Zurich, Zurich, Switzerland. J Perinat Med 23:89–98CrossRefPubMed

Breymann C, Zimmermann R, Huch R, Huch A (1996) Use of recombinant erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia. Eur J Clin Invest 26:123–130CrossRefPubMed

Breymann C, Visca E, Huch R, Huch A (2001) Efficacy and safety of intravenously administered iron sucrose with and without adjuvant recombinant human erythropoietin for the treatment of resistant iron-deficiency anemia during pregnancy. Am J Obstet Gynecol 184:662–667CrossRefPubMed

Breymann C et al (2007) www.sggg.ch/D/intern/expertenbriefe/22-D-Diagnostik-und-Therapie-der-Anaemie-in-der-Schwangerschaft-und-postpartal.pdf. Zugegriffen im 2007

Breymann C, Gliga F, Bejenariu C, Strizhova N (2008) Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. Int J Gynaecol Obstet 101:67–73CrossRefPubMed

Breymann C, Honegger C, Holzgreve W, Surbek D (2009) 22. Expertenbrief der Société Suisse de Gynécologie et d’Obstetrique (SSGO) Diagnostik und Therapie der Eisenmangelanämie in der Schwangerschaft und postpartal http://sggg.ch/files/Expertenbrief_No_22_0.pdf. Zugegriffen im 2009

Breymann C, Bian X, Blanco-Capito L, Chong C, Mahmud G, Rehman R (2011) Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med 39(2):113–121CrossRefPubMed

Bridges K (1990) Iron imbalance during pregnancy. In: Bern M, Frigoletto F (Hrsg) Hematologic disorders in maternal-fetal medicine. Wiley & Liss, New York, S 113–128

CDC (1989) CDC Criteria for anemia in children and childbearing-aged women. Morb Mortal Wkly Rep 38:400–404

Charache S (1990) Hemoglobinopathies. In: Bern M, Frigoletto F (Hrsg) Hematologic disorders in maternal-fetal medicine. Wiley & Liss, New York, S 171–181

Christoph P, Schuller C, Studer H, Irion O, Tejada BD, Surbek D (2012) Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose vs. Iron sucrose. J Perinat Med 13:469–474

Cook J, Finch C, Smith N (1976) Evaluation of the iron status of a population. Blood 48:449–455PubMed

Ekeroma A, Ansari A, Stirrat G (1997) Blood transfusion in obstetrics and gynaecology. Br J Obstet Gynaecol 104:278–284CrossRefPubMed

Fuchs D, Zangerle R, Dworzak E et al (1993) Association between immune activation, changes of iron metabolism and anaemia in patients with HIV infection. Eur J Haematol 50:90–94CrossRefPubMed

Gibson R (1990a) Assessement of iron staus. In: Gibson R (Hrsg) Principles of nutritional assessement. Oxford University Press, New York, S 349–376

Gibson R (1990b) Assessement of the status of folate and vitamin B-12. In: Gibson R (Hrsg) Principles of nutritional assessment. Oxford University Press, New York, S 461–486

Hallberg L (1994) Prevention of iron deficiency. Review. Baillieres Clin Haematol 7(4): 805–14CrossRefPubMed

Harris E (1992) New insights into placental iron transport. Nutr Rev 50:329–331PubMed

Hercberg S, Preziosi P, Galan P (2001) Iron deficiency in Europe. Public Health Nutr 55:91–101

Hollan S, Johansen K (1993) Adequate iron stores and the „nil nocere“ principle. Haematologia 25:69–84PubMed

Huch R, Huch A (1994) Erythropoietin in obstetrics. Hematol Oncol Clin North Am 8:1021–1040PubMed

Kaufer M, Casanueva E (1990) Relation of prepregnancy serum ferritin levels to hemoglobin levels throughout pregnancy. Eur J Clin Nutr 44:709–715PubMed

Khalafallah A, Dennis A, Ogden K (2012) Three-year follow up of a randomised clinical trial of intravenous verus oral iron for anaemia in pregnancy. BMJ Open 2(5):e000998CrossRefPubMedPubMedCentral

Krafft A, Frischknecht H, Breymann C (2004a) Haemoglobinopathy in pregnancy: diagnosis and treatment. Curr Med Chem 11:2903–2909CrossRefPubMed

Krafft A, Perewusnyk G, Hänseler E, Quack K, Breymann C (2004b) The effect of postpartum oral iron supplementation on haematologic parameters in iron deficient women without anaemia. BJOG 111:1–6

Krafft A, Bencaiova B, Breymann C (2009) Selective use of recombinant human erythropoietin in pregnant patients with severe anemia or nonresponsive to iron sucrose alone. Fetal Diagn Ther 25:239–245CrossRefPubMed

Krapels I, van Rooij I, Ocké M, West C, van der Horts C, Steegers-Theunissen R (2004) maternal nutritional status and the risk for orofacial cleft offspring in humans. J Nutr 134:3106–3113PubMed

Krawinkel M, Bethge M, Karib AO, Ahmet HM, Mirghani OA (1990) Maternal ferritin values and fetal iron stores. Acta Paediatr Scand 79(4):467CrossRefPubMed

Malek A (2009) In vitro studies of ferric carboxymaltose on placental permeability using the dual perfusion model of human placenta. Drug Res 60(6a):354–361

Mayhew TM, Charnock-Jones DS, Kaufmann P (2004) Aspects of human fetoplacental angiogenesis. Changes in complicated pregnancies. Placenta 25:127–139CrossRefPubMed

McCalla C (1994) Sickle cell disease in pregnacy. Postgrad Obstet Gynecol 14:1–5CrossRef

Milman N (2012) Oral iron prophylaxis in pregnancy – not too little and not too much. J Perinatol doi:10.1155/2012/514345 (epub)

Milman N, Agger A, Nielsen O (1994) Iron status markers and serum erythropoietin in 120 mothers and newborn infants; effect of iron supplementation in normal pregnancy. Acta Obstet Gynecol Scand 73:200–204CrossRefPubMed

Mitchell E, Robinson E, Clark P, Becroft D, Glavisch N, Pattison N, Pryor J, Thompson J, Wild C (2004) Maternal nutritional risk factors for small gestational age babies in a developed country: a case control study. Arch Dis Child Fetal Neonatal Ed 89:F431–F435CrossRefPubMedPubMedCentral

Murray-Kolb L (2012) Matenal mortality, child mortality, perinatal mortality, child cognition and estimates of prevalence of anemia due to iron deficiency. The CHERG report 2012

Punnonen K, Irjala K, Rajamaki A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89:1052–1057PubMed

Rehu M, Punnonen K, Ostland V, Heinonen S, Westerman M, Pulkki K, Sankilampi U (2010) Mternal serum hepcidin is low at term and independent of cord blood iron status. Eur J Haematol 85:345–352CrossRefPubMed

Reveiz L, Gyte GM, Cuervo LG (2007) Treatments for. Iron-deficiency anaemia in pregnancy. Cochrane Database Syst Rev 1:003094

Schaefer R, Schaefer L (1995) The hypochromic red cell: a new parameter for monitoring of iron supplementation during rhEPO therapy. J Perinat Med 23:83–88CrossRefPubMed

Seid M, Derman R, Banach W, Goldberg C, Rogers R (2008) Ferric carboxymaltose injection in the treatment of iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol 199:435.e1-7CrossRefPubMed

Spivak J (1995) Serum immunoreactive erythropoietin in health and disease. J Perinat Med 23:13–17CrossRefPubMed

USPSTF, US Preventive Services Task Force (1993) Routine iron supplementation during pregnancy. JAMA 15:2846–2854

Van Santen S, Kroot J, Zijderveld G, Wiegerinck E, Spaanderman M, Swinkels D (2013) The iron regulatory hormone hepcidin is decreased in pregnancy: a prospective longitudinal study. Clin Chem Lab Med 51:1395–1401PubMed

Van Wyck D, Martens M, Baker J, Mangione A (2007) Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstet Gynecol 110:267–278CrossRefPubMed

Wali A, Mushtaq A (2002) Efficacy, safety and compliance of intravenous iron sucrose and intramuscular iron sorbitol in iron deficiency anemia in pregnancy. J Pak Med Assoc 52:392–395PubMed

Warth J (1990) Sickle cell disease. In: Bern M, Frigoletto F (Hrsg) Hematologic disorders in maternal-fetal medicine. Wiley & Liss, New York, S 183–197

WHO World Health Organization (Hrsg) (2012) Englisch, Portugiesisch, Spanisch ISBN: 978 92 4 150199 6

Titel: Anämie in der Schwangerschaft
verfasst von: Christian Breymann
Verlag: Springer Berlin Heidelberg
Buch: Die Geburtshilfe
Print ISBN: 978-3-662-45063-5

Electronic ISBN: 978-3-662-45064-2

Copyright-Jahr: 2016
DOI: https://doi.org/10.1007/978-3-662-45064-2_23

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Zusammenfassung

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