The Importance of Monitoring and Managing Iron Deficiency During Pregnancy

Iron deficiency is a common concern during pregnancy, significantly impacting the health and well-being of both the mother and the developing baby. The increased demand for iron during pregnancy is critical for supporting the growing fetus and placenta. Monitoring iron levels throughout pregnancy is vital to prevent complications such as iron deficiency anemia, which can have long-term effects on both maternal and fetal health. In this blog, we’ll explore the symptoms, causes, and risks of iron deficiency during pregnancy and provide practical solutions, from dietary tips to effective supplementation strategies.

Understanding Iron Deficiency in Pregnancy

Iron is a crucial mineral responsible for producing hemoglobin, the protein in red blood cells that carries oxygen throughout the body. During pregnancy, a woman’s blood volume increases by up to 50%, meaning her body requires significantly more iron to meet the needs of both the mother and the developing baby. The fetus and placenta rely on this increased blood supply to receive adequate oxygen and nutrients.

If a pregnant woman doesn’t consume enough iron, her body depletes its iron stores, leading to iron deficiency. Left untreated, this can progress into iron deficiency anemia, a condition in which hemoglobin levels drop, reducing the body’s ability to carry oxygen efficiently.

Why Monitoring Iron Levels is Critical

Iron deficiency anemia during pregnancy is associated with several adverse outcomes for both mother and baby. For the mother, low iron levels can lead to:

• Postnatal depression
• Increased risk of infection
• Placental abruption
• Postpartum hemorrhage

For the developing baby, the consequences of maternal iron deficiency can be even more severe, including:

• Low birth weight
• Intrauterine growth restriction (IUGR)
• Preterm birth
• Delays in infant motor, cognitive, and neurological development
• Increased risk of iron deficiency anemia in infancy

Iron is essential for brain development, particularly for neural metabolism, neurotransmitter function, and myelination. Studies have shown that babies born with low iron stores are more likely to experience developmental delays, including difficulties with language, motor skills, and social-emotional functioning.

Symptoms of Iron Deficiency in Pregnancy

Recognising the symptoms of iron deficiency early in pregnancy is crucial to prevent more severe complications. Common symptoms include:

• Fatigue and Weakness: Experiencing pregnancy fatigue, feeling persistently tired or lacking energy is often one of the first signs.
• Pale Skin and Nails: A reduction in hemoglobin levels can cause pallor in the skin and nails.
• Shortness of Breath: Difficulty breathing, especially during physical activity, is a common symptom.
• Dizziness and Headaches: Inadequate oxygen supply to the brain can cause frequent dizziness and headaches.
• Heart Palpitations: Rapid or irregular heartbeats can occur due to low iron levels.
• Cold Hands and Feet: Poor circulation caused by reduced red blood cell production can lead to cold extremities.

If you experience any of these symptoms, it’s important to consult with your healthcare provider, who will likely perform a blood test to confirm whether you have iron deficiency or anemia.

The Difference Between Iron Deficiency and Iron Deficiency Anemia

It's important to differentiate between iron deficiency and iron deficiency anemia. Iron deficiency refers to low iron levels in the body, which, if left untreated, can progress to iron deficiency anemia. Anemia occurs when hemoglobin levels drop, affecting the oxygen-carrying capacity of red blood cells.

A healthcare provider will typically run an iron studies test, which includes:

• Ferritin: This measures the stored iron in your body.
• Transferrin: The protein that transports iron around the body.
• Transferrin Saturation: The percentage of transferrin carrying iron.
• Serum Iron: The level of iron in the blood, which fluctuates throughout the day.

In addition to these, a Full Blood Examination (FBE) will measure your hemoglobin levels to assess the oxygen-carrying capacity of your red blood cells. When ferritin and hemoglobin are both low, it confirms iron deficiency anemia.

Causes of Iron Deficiency in Pregnancy

Several factors can lead to iron deficiency during pregnancy:

1. Increased Iron Demand: The growing fetus and placenta require more iron, putting extra strain on the mother’s iron stores.
2. Inadequate Iron Intake: Many women may not consume enough iron-rich foods, especially if their diet is low in meat or iron-fortified products.
3. Poor Absorption: Conditions like celiac disease or poor gut health can impair iron absorption.
4. Low iron stores prior to pregnancy: Heavy menstrual periods before pregnancy or bleeding during pregnancy can further deplete iron stores.

Dietary changes can play a significant role in preventing iron deficiency, but often, these changes are not enough to meet the increased demands of pregnancy.

Why Many Women Struggle with Iron

Today’s dietary habits, which often include less meat and fewer iron-rich foods than those of our ancestors, can contribute to iron deficiency. Additionally, many prenatal vitamins contain both iron and zinc, two minerals that compete for absorption. This combination can limit the amount of iron absorbed from the prenatal supplement.

Modern diets are often lower in heme iron, the type of iron found in animal products, which is more easily absorbed than non-heme iron, the form found in plant-based foods. Additionally, factors like calcium intake, coffee, and tea consumption can hinder iron absorption.

Iron Deficiency Treatment and Dietary Solutions

Addressing iron deficiency during pregnancy is essential for both mother and baby. Treatment often involves a combination of dietary adjustments and supplementation.

1. Dietary Tips for Boosting Iron Levels

There are two types of dietary iron:

• Heme iron (found in animal products): Lean meats, poultry, fish, seafood, and organ meats like liver.
• Non-heme iron (found in plant-based foods): Legumes, tofu, tempeh, dark leafy greens, nuts, seeds, fortified cereals, and dried fruits.

To enhance the absorption of non-heme iron, pair it with foods rich in vitamin C, such as citrus fruits, strawberries, bell peppers, and broccoli. 

2. Iron Supplements

In many cases, dietary changes alone may not be enough to meet the increased iron demands of pregnancy. Your healthcare provider may recommend iron supplements. Common forms include ferrous sulfate and ferrous fumarate, but these often cause gastrointestinal discomfort, such as constipation, due to their low absorption rates. Iron bisglycinate such as IronBiotic is a gentler option with higher bioavailability, meaning it is absorbed more effectively and causes fewer side effects.

Shortcomings of Mainstream Iron Supplements

Not all iron supplements are created equal. Many over-the-counter options, such as ferrous sulfate, can cause significant gastrointestinal discomfort, including constipation, because of their lower absorption rates. These forms of iron often sit in the gut for extended periods, irritating the gut lining and altering gut flora. As a result, they are less effective and can cause inflammation in the body.

On the other hand, iron bisglycinate is better tolerated, has fewer side effects, and is more bioavailable. Lower doses are often sufficient, which reduces the risk of oxidative stress and gut microbiome disruption caused by excess iron.

Research suggests that taking iron supplements every second day may increase absorption. High doses of iron increase levels of a protein called hepcidin, which regulates iron absorption and prevents iron overload. After a high dose of iron (such as 65 mg or more), hepcidin levels remain elevated for 24-48 hours, inhibiting further iron absorption. By taking a lower dose every other day, you can maximise absorption and reduce the risk of gastrointestinal side effects.

Maintaining Iron Levels Before and During Pregnancy

The key to maintaining healthy iron levels during pregnancy is to start early, ideally before conception. Women who enter pregnancy with suboptimal iron levels are at a much higher risk of developing iron deficiency anemia during pregnancy. This deficiency can lead to sleep issues throughout pregnancy, as low iron levels reduce oxygen flow, causing fatigue and restless sleep, which can ultimately impact baby development. The pre-conception window, typically 3 months before pregnancy, is an ideal time to check iron levels and correct any deficiencies, supplementing as needed.

Throughout pregnancy, regular blood tests are essential to monitor iron levels. Unfortunately, in many healthcare settings, iron levels are only checked once during pregnancy, usually around the 28-week mark. However, iron levels can start dropping as early as the first trimester, and iron deficiency during the first trimester can have a more negative impact on fetal growth than anemia developing later in pregnancy. Regular testing, ideally once per trimester, can help catch and address any issues early.

Practical Tips for Maintaining Iron Levels

• Iron-rich foods: Incorporate both heme (animal-based) and non-heme (plant-based) iron into your diet.
• Vitamin C: Consume vitamin C-rich foods alongside non-heme iron sources to improve absorption.
• Avoid inhibitors: Limit consumption of calcium, coffee, tea, and zinc at the same time as iron-rich foods or supplements, as these can inhibit absorption.
• Choose the right supplement: Opt for iron bisglycinate, which is better absorbed and has fewer side effects than other forms of iron.

Conclusion

Iron deficiency during pregnancy is a common but manageable condition. Monitoring iron levels and understanding the difference between iron deficiency and anemia is key to preventing complications. By incorporating iron-rich foods into your diet, choosing the right supplement, and ensuring regular monitoring throughout pregnancy, you can safeguard both your health and your baby’s development. Always consult with your healthcare provider before making any changes to your diet or supplementation routine. With proper care, you can address iron deficiency and ensure a healthy pregnancy for both you and your baby.