Iron deficiency & anaemia in pregnancy

What is iron deficiency in pregnancy?

During pregnancy, your body produces more red blood cells to support the growth of the fetus. Iron, amidst other nutrients, is essential for the production of red blood cells. Iron is a component of haemoglobin, which is a protein found in red blood cells needed to carry oxygen from the lungs to other parts of the body.

Anaemia

If your body does not receive sufficient iron, it may not be able to meet the body’s red blood cell demand, resulting in anaemia. Anaemia is a condition whereby the body does not have optimal amount of healthy red blood cells to carry oxygen to the mother’s and baby’s tissues.

Iron-deficiency anaemia affects more than 10% of pregnancies in high-income countries. It is the most prevalent and also the most neglected nutrient deficiency in the world, particularly among pregnant women (FIGO report). Severe anaemia during pregnancy increases your risk of premature birth, having a low birth weight baby, perinatal and neonatal mortality, need for blood transfusion, postpartum depression, and having a baby with iron deficiency.

Iron deficiency

Iron deficiency without anaemia may also occur, and are more common during pregnancy due to the increased requirements of iron during pregnancy. Iron deficiency on its own may cause tiredness, paleness, shortness of breath and headache.

Risk factors

• Have two closely spaced pregnancies

• Multiple pregnancy (Twins or more)

• Vomiting frequently due to morning sickness

• Don't consume enough iron in diet

• Heavy pre-pregnancy menstrual flow

• History of anaemia before your pregnancy

How do I check if I have iron deficiency or anaemia?

• A full blood count is done at 10 weeks and repeated at 28 weeks. A haemoglobin level <11.0 g/dl indicates anaemia. This should be connected to improve the tolerance of the mother to possible heavy bleeding at or after delivery.

• We now do serum ferritin test at 10 weeks and also at 28 weeks to test for iron-deficiency, according to the International guidelines. Ferritin levels <30 ng/ml indicate iron deficiency. Ferritin levels >= 100 ng/ml indicate that iron stores are adequate. Ferritin levels between 30-100 ng/ml are intermediate and may require iron replacement especially if there is anaemia, or symptoms of iron deficiency.

This should be treated as it may further improve the haemoglobin level, reduces the risk of excessive bleeding post-delivery and reduces the need for blood transfusion, and also reduce the symptoms of iron deficiency.

What should I do to increase the iron level in my blood?

Natural sources

Food sources rich in iron include lean red meat, poultry, fish, dark green leafy vegetables, dried beans. Iron from animal sources are more easily absorbed compared to iron from plant sources. To enhance the absorption of iron from plant sources and supplements, pair them with a food or drink high in vitamin C — such as orange juice, tomato juice or strawberries. If you take iron supplements with orange juice, avoid the calcium-fortified variety. Although calcium is an essential nutrient during pregnancy, calcium may decrease iron absorption.

Oral iron supplements

Women with iron deficiency anaemia should be given 100-200mg elemental iron three to four times a day. Oral iron supplementation is usually the first-choice treatment of iron deficiency anaemia because of its effectiveness and low cost. Iron(III) salts (e.g. Maltofer) are recommended because they have the same efficacy but less frequent adverse drug reactions than iron(II) salts.

However, if intake of oral iron supplementation does not improve iron levels after 2-4 weeks of consumption, there may be a problem in iron absorption. In such cases, intravenous iron infusion may be necessary.

Intravenous iron treatment

Intravenous iron treatment is an effective treatment for iron-deficiency.

This may be necessary if:

• Your iron levels do not improve after 2-4 weeks of oral iron supplementation in the third trimester

• Your body is unable to absorb oral iron

• You discontinue the oral iron therapy due to unacceptable side effects

• You have very low haemoglobin levels (e.g. antenatally <8.0g/dl and postnatally <9.0-10.0g/dl)

References:

1. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455

2. https://americanpregnancy.org/naturally/treat-iron-deficiency-naturally-pregnancy/

3. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.12740

4. https://www.healthline.com/nutrition/iron-deficiency-signs-symptoms#section6

5. https://www.ncbi.nlm.nih.gov/pubmed/17691593

6. https://www.ncbi.nlm.nih.gov/pubmed/17691594