**5. Preventive measures**

In pregnancy, anemia is a major health problem especially in developing countries and it is also a common nutritional deficiency disease globally, approximately affecting two-fifths of pregnant women worldwide. During pregnancy, if anemia becomes severe it can lead to maternal and paternal harmful effects like preterm labor, low birth weight, and intrauterine fetal death. One of the leading causes is maternal mortality due to anemia. In order to prevent anemia during pregnancy preventive measures are required [42].

Multifactorial and nutritional deficiencies of iron, folate, and vitamin B12 are the leading causes of anemia in developing countries. Moreover, malaria and intestinal parasitic infections also contribute to anemia in pregnancy. The causes which contribute to anemia in pregnant women vary greatly by geographical location, season, and dietary practice. Iron deficiency anemia (IDA) is the most common type of anemia all around the world. According to the study, 75% of cases of anemia are due to iron deficiency [43]. Iron deficiency anemia (IDA), often coexists with a deficiency in other important micronutrients, that make it more harmful for fetal growth [44].

### **5.1 Supplements**

Iron intake and folic acid supplements are the keystones for the prevention of anemia in pregnancy. In earlier times these are the initial preventive measures suggested to the women in pregnancy to avoid anemia. The normal level of folic acid in approximately 25% of pregnant women is not sufficient to avert megaloblastic changes in the bone marrow. In developing countries, women in pregnancy should receive 40 mg daily supplementation of folic acid. 100 mg iron and 350 μg folate are present in fefol, women in pregnancy can take this supplement as standard oral preparation for prevention of anemia.

Due to physiological changes in pregnancy iron intakes are several times higher than in nonpregnant women [42]. To maximize iron intake and absorption all women should be given dietary information in pregnancy. 100-200 mg elemental iron should be suggested to women with iron deficiency anemia (IDA) [45].

The amount of iron in the diet, its bioavailability, and physiological requirements in pregnancy are some of the factors that contribute to iron absorption. Pregnant women should eat well-balanced meals that are rich in iron. Heme iron and non-heme iron are the 2 types of iron that are present in our meal or food.

#### **5.2 Dietary advice**

Animal flesh like red meat, poultry, and seafood contain dietary heme iron. Non-heme iron absorption is two to three-fold less than that of the heme iron. The meat in which organic compounds like peptides are present promotes the

#### *Anemia during Pregnancy and Its Prevalence DOI: http://dx.doi.org/10.5772/intechopen.99521*

absorption of iron from non-heme iron sources which are less bioavailable. It is difficult to absorb non-heme iron than heme iron but still non-heme iron forms about 95% of dietary iron intake. Iron absorption from non-heme sources can significantly increase by the use of Ascorbic acid. By the fermentation and germination of cereals and legumes, we can increase the bioavailability of non-heme iron in pregnancy. This results in the decline of phytate content, a component of food that hampers iron absorption. The use of tea and coffee shortly after a meal or with the meal hinders iron absorption because of the presence of tannins. Therefore, Pregnant women should avoid it.

The bioavailability of non-heme iron is enhanced by germination and fermentation of cereals and legumes which results in a decrease in the phytate content, a food constituent that hinders iron absorption. Tannins in tea and coffee hinder iron absorption on consumption with or shortly after a meal [42].
