Did you know the physiological demand for Iron is 3x greater during pregnancy? The demand increases in the second trimester and peaks in the third. It is essential for our bodies for several reasons including post birth recovery, healing and production of breast milk. Pregnancy and breastfeeding is one of the main causes for low iron. Your health care provider will monitor your levels throughout your pregnancy and manage accordingly.
There is often a confusion between Iron deficiency and true Iron anaemia. To help clarify we define Iron and Haemoglobin and their differences below.
Haemoglobin and Iron
Iron is a component of haemoglobin and is important for producing haemoglobin (HB). Iron helps our bodies to function. It is important for our energy levels, immune system, mental health and muscle strength.
Haemoglobin (HB) is a protein found in our red blood cells and is vital for carrying oxygen around our bodies to our organs and tissues in order for them to survive.
Deficiency VS Anaemia
Iron Deficiency is low iron, Ferritin <30 mug/L with a normal HB.
Iron Deficiency Anaemia is low iron AND low Haemoglobin <110 g/L in first trimester, <105 g/L in second trimester and <100g/L postpartum (1), (2).
Symptoms
May include 1 or more
- Increased breathlessness
- Pale skin
- Brittle nails
- Dizziness
- Heart palpations
- Lethargy and tiredness
- Irritability (a difficult one to single out when pregnant!)
- low immunity
Note:Your baby will take what it needs from you. If you have low levels this doesn’t always mean your baby has low levels, it has just kindly left you with some spare!
Management
Diet:
Iron is best absorbed by the food we eat.
Haem Iron: Found in meats is readily absorbed by the body.
Non- haem Iron: Found in plants, is not as readily absorbed making it important to know what foods to pair with and avoid. Vegetarian diets can certainly provide sufficient iron.
Foods include:
- Red meat
- Poultry
- Seafood- oysters, sardines, oily fish
- Eggs
- Dark leafy greens
- Beans and lentils
- Nuts and Seeds
- Wholegrain breads and cereals
Supplements
Supplements are currently the first line of treatment. Supplements can be difficult to absorb by the gut, therefor important to know effective ways of taking it. Management will be advised based on your diet, levels and symptoms.
High dosage (100mg per tablet) can be bought over the counter. If you are experiencing unwanted side effects some recommendations are to treat the side affects safely, start on a lower dose daily or take the higher dose second daily.
Once starting oral Iron or increasing your dose you will need to continue for several weeks before assessing its effectiveness.
Evidence shows to take:
- 2 hrs away from food. Bedtime can be a good option.
- Avoid any foods with caffeine, dairy or calcium at that time.
- Take with Vitamin C
- Avoid taking with other medications even your multivitamin.
IV Iron Therapy
Is an option if the above isn’t working and/or not possible do to certain health conditions incl. Hyperemesis Gravidarum. Depending on your area of health and health care provider will depend on their threshold to transfuse.
Resources
https://mytransfusion.com.au/reasons-transfusion/iron-deficiency
https://www1.racgp.org.au/ajgp/2019/march/anaemia-in-pregnancy