Iron deficiency in pregnancy

Iron deficiency anaemia affects 42% of pregnant people. Without adequate iron stores, anaemia can develop that effects the mother and unborn child. Iron is needed to form all body cells, building the placenta, increasing maternal iron stores and of course creating all tissues in the unborn child.

Iron forms part of proteins involved in DNA synthesis and energy production, giving women strength and energy through pregnancy and postpartum. Iron is needed for placental function and oxygenation and to reduce miscarriage risk

Positive effects of iron in pregnancy
  • Cognition in the mother and baby: Iron is required to bring oxygenated red blood cells to the brain. As the brain develops, it requires iron for building new brain cells and the nervous system.
  • Fetal brain and organ development: Iron is important for the metabolism and function of nerves in the brain, affecting babies brain function post-birth. During fetal development, iron-dependent enzymes are essential for organ development, particularly the brain, through myelination of nerve cells, neurotransmitter synthesis and gene expression.
  • Immunity: Iron increases the functions of immune cells and regulates enzymes that control the production of antimicrobial cells.
  • Reduced risk of antenatal and postnatal depression: Iron prevents depression and anxiety through adequate neurotransmitter metabolism and myelination of nerves in the brain of the mother.
  • Increased exercise capacity: Iron is a part of red blood cells, transporting oxygen to tissues and is a cofactor in aerobic metabolism, increasing exercise capacity for the mother.
  • Preterm birth prevention: Adequate levels of iron rich haemoglobin reduce the chance of hypoxia induced stress response and oxidative damage in utero.
How much iron do you need?

Blood volumes increase by 40-50% by the 24th week of pregnancy, meaning an increased demand for iron. Below are the recommended dietary intakes of iron for pregnant and non-pregnant women.

Pregnant womenNon-pregnant women
Age groupRDIRDI
14-18 years27 mg/day15 mg/day
19–30 years27 mg/day18 mg/day
31-50 years27 mg/day18 mg/day
Recommended dietary intake (RDI) of iron for pregnant women and non-pregnant women
Consequences of iron deficiency in pregnancy
  • Symptoms in the mother: reduced cognition, pale skin, irritability, breathlessness, heart palpitations, hair loss, tinnitus, headaches and dizziness.
  • Consequences for the pregnancy: As the need for iron progresses, the pregnancy is effected with increased risk of premature delivery, intrauterine growth retardation, gestational diabetes, preeclampsia, postpartum haemorrhage, birth asphyxia and even infant and/or maternal death.
  • For the fetus: Iron deficient neonates can have a lower birth weight, have significantly reduced cognitive abilities and behavioural abnormalities that can persist even after iron repletion post-birth.
FoodIronFoodIron
Fortified weetbix14mgFlaxseeds5.73mg
Chicken/lamb liver11mgOctopus5.59mg
Pumpkin seeds10mgCashews5mg
Lentils (dry)9.1mgLamb5mg
Fortified breads8.23mgEgg 4.8mg
Navy beans6.4mgKangaroo4.2mg
Sardines6.1mgVegemite4.03mg
Peas5.9mgSpinach3.58mg
Beef5.8mgTofu2.9mg
Iron content of foods per 100g of intake
How can we prevent iron deficiency in pregnancy?
  • Some forms of iron in food are more readily absorbed, for example the iron from meat has better absorption than plant sources of iron. A diverse diet of meat and vegetables together is recommended to increase iron levels in pregnancy.
  • Vegan and vegetarian mothers are more at risk of iron deficiency than meat eaters, as are women from limited socioeconomic backgrounds. Teen-mothers are also at a higher risk due to the iron needs for their own growth. If you are at risk, more frequent check-ins with your healthcare team is warranted to reduce chances of iron deficiency.
  • Reach the RDI by eating a variety of iron rich foods throughout pregnancy.
  • Legumes, rice and beans can bind to iron, therefore avoid intake of supplements at the same time.
  • Intake of iron can be increased by taking it at the same time as vitamin C.
  • See your doctor to get blood tests during preconception and throughout pregnancy to determine if you have iron deficiency.
  • Do not supplement iron without first being tested for deficiency, as high iron can have detrimental effects to mother and baby.
  • If you are severely deficient in iron, an intravenous iron transfusion can be used in the third trimester of pregnancy to bring iron levels to within range.
  • Space out your supplement dose to 2–3 times weekly, as opposed to daily, as this is as effective as daily supplementation, with fewer side effects.

If you would like pregnancy, preconception or postpartum nutritional or naturopathic care, book in with me HERE via zoom or in person in Brisbane, QLD.

References:

  1. Cusick SE, Georgieff MK, Rao R. Approaches for Reducing the Risk of Early-Life Iron Deficiency-Induced Brain Dysfunction in Children. Nutrients [internet] 2018 Feb 17 [cited 2021 May 9];10(2):1-4. Available from: https://doi.org/10.3390/nu10020227
  2. Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron deficiency anemia in pregnancy. Womens Health (Lond) [internet] 2015 Nov [cited 2021 May 12];11(6):891-900. Available from: https://doi.org/10.2217/whe.15.35
  3. Raffaeli G, Manzoni F, Cortesi V, Cavallaro G, Mosca F, Ghirardello S. Iron Homeostasis Disruption and Oxidative Stress in Preterm Newborns. Nutrients [internet]. 2020 May 27 [cited 2021 May 10];12(6):1-21. Available from: https://doi.org/10.3390/nu12061554
  4. Nairz M, Weiss G. Iron in infection and immunity. Molecular aspects of medicine [internet]. 2020 Oct [cited 2021 May 5];75(2020):1-18. Available from: https://doi.org/10.1016/j.mam.2020.100864
  5. National Health and Medical Resource Council, Nutrient reference values for Australia and New Zealand including recommended dietary intakes [internet]. National Health and Medical Research Council. c2006, [updated 2017; cited 2021 May 10]; 171-174. Available from: https://www.nhmrc.gov.au/about-us/publications/nutrient-reference-values-australia-and-new-zealand-including-recommended-dietary-intakes#block-views-block-file-attachments-content-block-1
  6. Brannon PM, Taylor CL. Iron supplementation during pregnancy and infancy: uncertainties and implications for research and policy. Nutrients [internet]. 2017 Dec 6 [cited 2021 May 12];9(12):1-17. Available from: https://doi.org/10.3390/nu9121327
  7. Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child’s health. Saudi Med J. [internet] 2015 Feb [cited 2021 May 10];36(2):146-9. Available from: https://doi.org/10.15537/smj.2015.2.10289
  8. Milman N, Paszkowski T, Cetin I, Castelo-Branco C. Supplementation during pregnancy: beliefs and science. Gynecol Endocrinol. [internet]. 2016 Jul [cited 2021 May 9];32(7):509-16. Available from: https://doi.org/10.3109/09513590.2016.1149161
  9. Means RT. Iron deficiency and iron deficiency anemia: implications and impact in pregnancy, fetal development, and early childhood parameters. Nutrients [internet]. 2020 Feb 11 [cited 2021 May 12];12(2):1-15. Available from: https://doi.org/10.3390/nu12020447
  10. Stuetz W, Gowele V, Kinabo J, Bundala N, Mbwana H, Rybak C, et al. Consumption of Dark Green Leafy Vegetables Predicts Vitamin A and Iron Intake and Status among Female Small-Scale Farmers in Tanzania. Nutrients [internet]. 2019 May 7 [cited 2021 May 9];11(5):1-18. Available from: https://doi.org/10.3390/nu11051025
  11. National Health and Medical Resource Council [internet]. Canberra; c2017. Nutrient reference values for Australia and New Zealand What are nutrient reference values? 2017 Sep 22 [cited 2021 May 17]; [about four screens]. available from: https://www.nrv.gov.au/introduction#:~:text=RDI%20%3D%20EAR%20%2B2SDEAR,that%20greater%20variation%20is%20probable.
  12. Food Standards Australia and New Zealand [internet], Australian Food composition database, release 1.0. c2019. [cited 2021 May 17]; [about six screens]. available from: https://www.foodstandards.gov.au/science/monitoringnutrients/afcd/Pages/foodsbynutrientsearch.aspx?nutrientID=FE
  13. Cerami C. Iron Nutriture of the Fetus, Neonate, Infant, and Child. Ann Nutr Metab. [internet] 2017; [cited 2021 May 13];71(3):8-14. Available from: https://doi.org/10.1159/000481447
  14. Yılmaz E, Yılmaz Z, Çakmak B, Gültekin İB, Çekmez Y, Mahmutoğlu S, et al. Relationship between anemia and depressive mood in the last trimester of pregnancy. J Matern Fetal Neonatal Med. [internet]. 2017 Apr [cited 2021 May 9];30(8):977-982. Available from: https://doi.org/10.1080/14767058.2016.1194389
  15. Garzon S, Cacciato PM, Certelli C, Salvaggio C, Magliarditi M, Rizzo G. Iron Deficiency Anemia in Pregnancy: Novel Approaches for an Old Problem. Oman Med J [internet] 2020 Sep 1 [cited 2021 May 10];35(5):1-9. Available from: https://doi.org/10.5001/omj.2020.108
  16. Achebe MM, Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood [internet]. 2017 Feb 23 [cited 2021 May 15];129(8):940-949. Available from: https://doi.org/10.1182/blood-2016-08-672246
  17. Wiegersma AM, Dalman C, Lee BK, Karlsson H, Gardner RM. Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders. JAMA Psychiatry [internet]. 2019 Dec 1 [cited 2021 May 9];76(12):1294-1304. Available from: https://doi.org/10.1001/jamapsychiatry.2019.2309
  18. Auerbach M. Commentary: Iron deficiency of pregnancy – a new approach involving intravenous iron. Reprod Health [internet]. 2018 Jun 22 [cited 2021 May 17];15(96):109-115. Available from: https://doi.org/10.1186/s12978-018-0536-1
  19. Col Madendag I, Eraslan Sahin M, Madendag Y, Sahin E, Demir MB, Acmaz B, et al. The Effect of Iron Deficiency Anemia Early in the Third Trimester on Small for Gestational Age and Birth Weight: A Retrospective Cohort Study on Iron Deficiency Anemia and Fetal Weight. Biomed Res Int. [internet] 2019 Nov 22[cited 2021 May 8];2019:1-4. Available from: https://doi.org/10.1155/2019/7613868
  20. Vashishth A, Ram S, Beniwal V. Cereal phytases and their importance in improvement of micronutrients bioavailability. 3 Biotech. [internet]. 2017 May [cited 2021 May 9];7(1):42. Available from: https://doi.org/0.1007/s13205-017-0698-5
  21. Api O, Breyman C, Çetiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. Turk J Obstet Gynecol. [internet] 2015 Sep [cited 2021 May 7];12(3):173-181. Available from: https://doi.org/10.4274/tjod.01700
  22. Zhang Q, Lu XM, Zhang M, Yang CY, Lv SY, Li SF, et al. Adverse effects of iron deficiency anemia on pregnancy outcome and offspring development and intervention of three iron supplements. Sci Rep. [internet]. 2021 Jan 14 [cited 2021 May 9];11(1):1-11. Available from: https://doi.org/10.1038/s41598-020-79971-y
  23. Mishra A, Marwah S, Divedi P, Dewan R, Ahluwalia H. A Cross-Sectional Study of Barriers in Prevention of Anemia in Pregnancy. Cureus [internet]. 2021 Jan 20 [cited 2021 May 9];13(1):1-10. Available from: https://doi.org/10.7759/cureus.12802
  24. Frayne J, Pinchon D. Anaemia in pregnancy. Aust J Gen Pract. [internet] 2019 Mar [cited 2021 May 10];48(3):125-129. Available from: https://doi.org/10.31128/AJGP-08-18-4664
  25. Dewey KG, Oaks BM. U-shaped curve for risk associated with maternal hemoglobin, iron status, or iron supplementation. Am J Clin Nutr. [internet]. 2017 Dec [cited 2021 May 9];106(6):1694S-1702S. Available from: https://doi.org/10.3945/ajcn.117.156075
  26. Froessler B, Gajic T, Dekker G, Hodyl NA. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet [internet]. 2018 Jul [cited 2021 May 12];298(1):75-82. Available from: https://doi.org/10.1007/s00404-018-4782-9
  27. Pena-Rosas JP, De-Regil LM, Gomez Malave H, Flores-Urrutia MC, Dowswell T. Intermittent oral iron supplementation during pregnancy. Cochrane Database Syst. Rev. [internet]. 2015 Oct 19 [cited 2021 May 12];10:1465-1858. Available from: https://doi.org/10.1002/14651858.CD009997.pub2
  28. Madendag IC, Sahin ME, Madendag Y, Sahin E, Demir MB, Acmaz B, et al. The Effect of Iron Deficiency Anemia Early in the Third Trimester on Small for Gestational Age and Birth Weight: A Retrospective Cohort Study on Iron Deficiency Anemia and Fetal Weight. Biomed Research Int. [internet]. 2019 Nov 22 [cited 2021 May 15];2019;1-4. Available from: https://doi.org/10.1155/2019/7613868
  29. Taylor CL, Brannon PM. Introduction to workshop on iron screening and supplementation in iron-replete pregnant women and young children. Am J Clin Nutr. [internet]. 2017 Dec [cited 2021 May 9];106(6):1547S-1554S. Available from: https://doi.org/10.3945/ajcn.117.155747

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