Over one third of pregnant women in the United States are diagnosed with iron deficiency anemia. This condition may impact the energy, immunity, and birth experience for the mother while affecting the birth weight, health, intelligence, and behavioral development of the child. Scientific literature concludes that for many women iron intake from diet is not enough to alleviate this situation. Reasons for this may include constant heartburn, food aversions, and increased physiological demand.
Hemoglobin and Iron
Iron is the crucial part of a special carrier protein in red blood cells (RBCs) called hemoglobin (Hgb). This protein-iron combination is responsible for the transport of oxygen from the lungs to all the body’s tissues. When we are lacking iron, our RBCs tend to be smaller and don’t carry their full potential of oxygen. We need oxygen to burn fuels like carbohydrate and fat in the mitochondria of our cells, producing energy for the functions of life.
While as many as 40% of American women already have abnormally low stores of iron, pregnancy creates even higher demands. The mother needs more blood to feed the child while the child is developing their own circulatory system with a full complement of RBCs. This demand becomes pronounced towards the third trimester.
Some of the signs and symptoms of iron deficiency anemia are fatigue, pallor, headaches, heart palpitations, and dizziness when suddenly standing up. Women may also experience a phenomenon known as restless leg syndrome, especially during the last trimester.
Diagnosing Iron Deficiency
Diagnosing iron deficiency is relatively simple and relies on a simple lab test called a Serum Ferritin. Ferritin is a protein related to the storage of iron and its presence is directly related to the amount of iron in the body. Other tests like the complete blood count (CBC) can give us insights by showing us the size, quantities, and amount of hemoglobin in RBCs.
These tests involve one simple blood draw and can be ordered and interpreted by your health care provider.
Treating Iron Deficiency with Supplements
Using serum ferritin, the following guidelines are recommended by physicians:
Levels > 70 mcg/l -no supplementation
Levels 30-70 mcg/l –supplement with 40 mg / day
Levels < 30 mcg/l -supplement with 80-100 mg/day
To put things in perspective, the US recommended daily allowance for iron is about 30 mg/day.
When supplementing with iron during pregnancy the strategy is to get the lowest dose that will make the most difference. Iron is an oxidant and too much may generate free radicals that damage the body’s tissues. It is important to use an absorbable form that does not cause gastrointestinal problems like heartburn, nausea, or constipation.
Recommended forms of Iron Supplements:
- ferrous bisglycinate a.k.a. “gentle iron”
- iron picolinate
- iron citrate
- ferric ammonium citrate (liquid)
Less desirable forms:
- ferrous gluconate
- ferrous sulfate - This form is the most commonly recommended by allopathic physicians but is the worst offender when it comes to nausea and constipation.
How to Take Iron Supplements
Iron should be taken before bed time or between meals when the stomach has a more acidic environment. A glass of orange juice can help facilitate better absorption. Zinc should not be taken at the same time and soy should be avoided completely if one is iron deficient. Soy suppresses the absorption of iron through several documented mechanisms.
Too much iron can be a bad thing. While iron is crucial for oxygen transport, loose iron in our systems may be responsible for free radical production which damages our cells. Taking large amounts of iron can be toxic and even lead to death. In fact, the leading cause of fatal poisoning in children less than six years old is from iron. Iron supplements should always be stored in childproof containers.
When experiencing iron deficiency associated with pregnancy, iron supplementation is often necessary. Armed with the above knowledge, one can address this challenge while avoiding the GI pitfalls associated with iron supplementation.
Sources
Kumar. Clinical Medicine, 6th ed., Elsevier, (2005)
Beers, The Merk Manual, 18th ed., Merk Research Laboratories (2006)
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