By Andrea Bartels CNP NNCP RNT
30 Apr 2021
It's well documented that pregnancy increases iron demands. The RDI-minimum to prevent deficiency symptoms in menstruating females---is 18 milligrams per day. But requirements double in pregnancy to 36 milligrams per day due to the increase in blood volume as well as the fast developmental growth of the placenta and fetus.
Iron-deficiency is the most common cause of anemia-a condition of poor oxygen-carrying capacity of our red blood cells. Women who have prenatal anemia have an increased risk of miscarriage, as well as to developing infections and pre-eclampsia-a type of prenatal hypertension. To add to the list of scary stats, women with anemia of pregnancy are twice as likely to experience premature labour and three times as likely to deliver a baby of low birth weight. After giving birth, these same women have symptoms of cognitive impairment and behavioural difficulties that may be part of postpartum depression.
Studies have also linked iron deficiency with increased risk of post-partum hemorrhage, and women who deliver via cesearean section had two times greater the chance of needing a blood transfusion than women who were not iron-deficient. Keep in mind that some blood loss is a normal part of the child-birthing experience, reducing iron levels even more-but the loss is more pronounced after a c-section. So it's really critical to maintain a good iron status throughout the pregnancy.
Impact of Iron Deficiency on the Unborn Child
Iron deficiency during pregnancy can lead to serious problems, with more significant impact on fetal development occurring when it is low during the first trimester, compared to during the second and third trimesters. The higher incidence of premature birth and low birth weight in babies born to iron-deficient mothers actually increases the risk of infant mortality. Plus, low iron stores in infancy that are not corrected quickly can have long term consequences, especially with neurological function and energy metabolism within the brain. This puts the iron-deficient child at risk of problems such as poor cognition, social skill impairment, poor adaptive capacity and delayed motor and language development. Even ADHD and learning disabilities may be linked to chronically low iron status in developing children.
Breastfeeding Doesn't Help
It's sobering to realize that while there are many documented benefits of breastfeeding for both mom and her infant, moms with an iron-deficient pregnancy have no iron to pass onto her nursing baby. Equally disappointing, once iron deficiency is diagnosed in the infant of said mothers, the development problems mentioned above are not preventable, nor can they be resolved by supplemental iron. That's why women need to start thinking about ways to build and maintain their own iron levels pre-conception, not just during pregnancy.
Iron-Clad Advice for Aspiring Moms
Have your ferritin levels checked by your primary physician to know your iron status before you attempt to conceive. While the concept of optimum iron levels is debated among various healthcare providers, it is generally agreed that a ferritin level under 30 is sub-optimal in childbearing age women. If you've experienced chronic heavy periods, fatigue, lack of stamina, breathlessness, depression and hair loss, you will really feel a difference once you've begun iron supplementation.
Don't trust your prenatal multi alone to protect you from anemia of pregnancy. Run-of-the-mill prenatal multis prescribed by most medical doctors contain inorganic iron are poorly absorbed, which can contribute to nausea of pregnancy and constipation.
Choose a high-quality iron supplement. Carbonyl iron is a metallic iron with a spherical molecular shape that possesses a bioavailability superior to other non-heme iron sources at 69 percent (compared to 10 - 15% with most forms of iron). This can be attributed to its fine particle size, a unique shape that increases the surface area of the particle, as well as its highly porous properties. Pure Lab Vitamins' Carbonyl Iron product is formulated with ascorbic acid (a.k.a. vitamin C)---a well-known iron-absorption-enhancer that contributes necessary acidity to the iron absorption process. Because the compound is so well absorbed, unpleasant side effects expected from many other iron supplements are not typically experienced with carbonyl iron.
Be aware that some medications interfere with iron absorption. Antacids and PPIs used to treat GERD-a common problem, especially in the 3rd trimester of pregnancy-- neutralize the stomach acid needed for iron absorption to occur, significantly reducing its absorption. Because most of these drugs produce day-long acid-suppressing effects, this makes oral iron absorption next to impossible, no matter what time of day the supplement is taken.
Be aware of dietary iron-absorption-inhibitors. If you choose to follow a vegetarian diet during pregnancy, note that the absorption of non-heme iron found in plants is impaired by the other components in the diet such as oxalates (in greens), phytates (in whole grains), polyphenols (in berries, grapes, wine and tea), and calcium (in milk products). So, while all of these foods provide nutritional benefits, it is wise to ingest your iron supplement away from these foods.
Despite iron being the most common nutritional deficiency in the world, iron-deficiency anemia is actually a fairly easy and inexpensive problem to resolve, given time and good patient compliance in taking a high quality iron supplement. But it's even easier to prevent. Early detection of anemia is critical. Ask your primary care provider to check your ferritin and hemoglobin levels regularly.
Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19(2):164-174.
Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child's health. Saudi Med J. 2015;36(2):146-149. doi:10.15537/smj.2015.2.10289
American Society of Anesthesiologists. Women with anemia twice as likely to need transfusion after cesarean delivery. Accessed Apr.28th 2021.
Bener A, Kamal M, Bener H, Bhugra D. Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children. Ann Med Health Sci Res. 2014;4(Suppl 3):S291-S297.
Gautam CS, Saha L, Sekhri K, Saha PK. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Medscape J Med. 2008;10(12):283. Epub 2008 Dec 16.
Milman N. Postpartum anemia II: prevention and treatment. Ann Hematol. 2012 Feb;91(2):143-54.
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