Haemoglobin levels in pregnancy
And the puerperium: a clinical study of 104 gases
with critical survey of the literature
One hundred and four cases of pregnancy, described
and considered in the light of previous work, have been
presented. It has been shown that the majority of
the cases could be considered normal in regard to the
blood picture which they presented and these normal
cases have been used to demonstrate the normal
behaviour of the blood in pregnancy and the puerperium.
The striking feature in pregnancy is the
occurrence of the hydraemia, which seems to have been
the cause of much confusion in the literature,
particularly when the results of iron administration
have been considered. We have endeavoured to show
that this reduction in the haemoglobin during the
second and most of the third trimesters of pregnancy
is physiological and not influenced significantly by
the administration of iron during pregnancy. The consideration of the iron treated groupsbore this out, while
a study of the initial haemoglobin levels at various
stages in pregnancy, and the haemoglobin levels at
various stages in groups treated for periods up to
20 weeks, also confirmed this since the general curve
of the haemoglobin level during pregnancy was
comparable in each group studied. The period of
gestation is therefore the chief factor in determining the haemoglobin level found in any normal case.
In the puerperium, the normal behaviour of the blood
was considered, and the treated groups, as previously
described, were shown to hold no advantage over the
normal.
The thesis therefore seems to be maintained, that . there is no advantage to be derived from iron administration in pregnancy, the puerperium or both, either
to the mother or child if the former be not anaemic.
It was shown that the incidence of anaemia in
pregnancy, exclusive of secondary anaemia, only
amounted to little over l0á and therefore it seems
reasonable to say, that routine iron therapy is not
justified in order to benefit this minority. The
anaemic cases can easily be found by routine haemoglobin estimation during ante -natal examinations.
The benefit of iron to anaemic cases, of the type
found in this series, is undoubted whether the anaemia
occurs in pregnancy or the puerperium and whether of
the primary nutritional or the secondary type.
The slight advantage in the puerperal recovery of
the blood from the administration of iron in pregnancy,
to those suffering from an iron lack as a result of
haemorrhage at delivery, has been shown, but the
numbers involved are so small as not to justify
routine iron therapy.
The onset of complications of pregnancy, labour
and the puerperium was not found to be related in any
way to iron therapy in normal cases and therefore
this also does not justify routine iron therapy.
Anaemic cases are probably more prone to septic
infection but not to the other complications of
pregnancy, labour or the puerperium; iron therapy by
restoring the blood level to normal increases the
resistance of these cases to infection.
Since this study was undertaken from a practical,
clinical standpoint, it may be said that the point of
chief interest is the need for routine haemoglobin
estimation in pregnancy in order to find out and treat
any anaemic cases. This seems more scientific and
sensible than the routine administration of iron in
pregnancy. The ideal, of course, would be the
prevention of anaemia in adult women by proper
dietary, which in addition would ensure an adequate
intake of other minerals and vitamins no less
important than iron. The attainment of this goal is
not yet in sight and until this ideal is reached it is
better that we should make good any deficiency known
to exist, either from a study of the diet and its
correction where possible or from clinical observation of any deficiency and its treatment as
exemplified by this study of anaemia, rather than
administering drugs routinely to many who have no
need of them.
