How Many Mg Of Iron Per Day When Pregnant


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One of the most confusing things a pregnant woman will face is how many mg of iron per day when pregnant. How much iron do you need, and how can you get it? Well in this article, I’ll going to discuss everything you ever wanted to know about Iron during pregnancy.

How Many Mg Of Iron Per Day When Pregnant

There are more than 60 studies on the use of iron supplements in pregnancy. A total of more than 40,000 women took part in the studies. The results show that, if women have normal iron levels, taking 30 mg of iron per day as a precautionary measure doesn’t have any noticeable health benefits for them or for their children. Although iron supplements were found to lower the risk of anemia, they didn’t influence the number of preterm births, the number of babies with a low birth weight (under 2,500 grams) or infections in pregnant women.

All mammalian life is dependent on a continuous supply of molecular oxygen. Molecular oxygen is carried to cells by noncovalent binding to the iron moiety in the hemoglobin of red blood cells. It is utilized within cells by noncovalent binding to the iron moiety in various microsomal and mitochondrial proteins, including myoglobin and cytochromes. Consequently, to efficiently utilize molecular oxygen all mammalian life is dependent on an adequate supply of iron. Surprisingly, in an era of high technology precision medicine, many pregnant women are iron deficient, anemic, and not receiving adequate iron supplementation.

Iron deficiency is prevalent in women and pregnant women

Women often become iron deficient because of pregnancy or heavy menstrual bleeding. During pregnancy, maternal iron is provided to supply the needs of the fetus and placenta. Additional iron is needed to expand maternal red blood cell volume and replace iron lost due to bleeding at delivery. In the National Health and Nutrition Examination Survey (NHANES) of 1988–1994, 11% of women aged 16 to 49 years were iron deficient. By contrast, less than 1% of men aged 16 to 49 years were iron deficient.1

In a NHANES study from 1999–2006, risk factors for iron deficiency included multiparity, current pregnancy, and regular menstrual cycles. Use of hormonal contraception reduced the rate of iron deficiency.2 Using the same data, the prevalences of iron deficiency during the first, second, and third trimesters of pregnancy were reported to be 7%, 14%, and 30%, respectively.3 In addition to pregnancy and menstrual bleeding there are many other medical problems that may contribute to iron deficiency, including Helicobacter pylori (H pylori) infection, gastritis, celiac disease, and bariatric surgery.

Iron deficiency is the leading nutritional deficiency around the world, with a huge impact on global health. As per the World Health Organization (WHO), it is estimated that 41.8% of pregnant women worldwide are anemic. At least half of this anemia burden is assumed to be due to iron deficiency. Iron Deficiency Anaemia (IDA) is now a raging issue in developing nations, that needs to be acted upon immediately.

Iron deficiency anemia may be associated with adverse pregnancy outcomes

In a retrospective study of 75,660 singleton pregnancies, 7,977 women were diagnosed with iron deficiency anemia when they were admitted for delivery. Compared with pregnant women without iron deficiency, the presence of iron deficiency increased the risk of:

  • blood transfusion (odds ratio [OR], 5.48; 95% confidence interval [CI], 4.57–6.58)
  • preterm delivery (OR, 1.54; 95% CI, 1.36–1.76)
  • cesarean delivery (OR, 1.30; 95% CI, 1.13–1.49)
  • 5-minute Apgar score <7 (OR, 2.21; 95% CI, 1.84–2.64)
  • intensive care unit (ICU) admission (OR, 1.28; 95% CI, 1.20–1.39).4

In a systematic review and meta-analysis of 26 studies, maternal anemia (mostly iron deficiency anemia) was associated with a higher risk of low birth weight (relative risk [RR], 1.31; 95% CI, 1.13–1.51), preterm birth (RR, 1.63; 95% CI, 1.33–2.01), perinatal mortality (RR, 1.51; 95% CI, 1.30–1.76), and neonatal mortality (RR, 2.72; 95% CI, 1.19–6.25).5

In a clinical trial, pregnant women were randomly assigned to receive folic acid alone; folic acid plus iron supplements; or 15 vitamins and minerals, including folic acid and iron. At delivery, women in the iron-folic acid and the 15 vitamin and minerals groups had higher hemoglobin concentrations than the folic acid monotherapy group. Among 4,697 live births, women in the iron-folic acid group had significantly fewer preterm births (<34 weeks’ gestation) than the folic acid group (RR, 0.50; 95% CI, 0.27–0.94; P = .031).6 Data from additional randomized trials are needed to further clarify the effect of iron supplementation on obstetric outcomes.

The diagnosis of iron deficiency is optimized by measuring serum ferritin

Serum ferritin measurement is an excellent test of iron deficiency. We recommend that all pregnant women have serum ferritin measured at the first prenatal visit and at the beginning of the third trimester to assess maternal iron stores. In pregnancy, the Centers for Disease Control and Prevention and the World Health Organization define anemia as a hemoglobin level of less than 11 g/dL or hematocrit less than 33% in the first and third trimesters. If a pregnant woman is not anemic, a serum ferritin level less than 15 ng/mL indicates iron deficiency.7 Some experts believe that in pregnant women who are not anemic, a serum ferritin level between 15 and 30 ng/mL may also indicate iron deficiency.8If the pregnant woman is anemic and does not have another cause of the anemia, a serum ferritin level less than 40 ng/mL is indicative of iron deficiency.7

Ferritin is an acute phase reactant and levels may be falsely elevated due to chronic or acute inflammation, liver disease, renal failure, metabolic syndrome, or malignancy. Some women with iron deficiency due to bariatric surgery or malabsorption also have vitamin B12 and, less commonly, folate deficiency, which can contribute to the development of anemia (see “Diagnosis of anemia, iron deficiency, and iron deficiency anemia in pregnancy.”) Clinicians are often advised that a mean corpuscular volume demonstrating microcytosis is the “best test” to assess a patient for iron deficiency. However, reduced iron availability and low ferritin precede microcytosis. Hence microcytosis is a lagging measure and iron deficiency is diagnosed at an earlier stage by ferritin.

Iron Deficiency: Here Are Some Visible Signs And Symptoms In Pregnant Women

Diagnosis of anemia, iron deficiency, and iron deficiency anemia in pregnacny

Requirements for a diagnosis of anemia in pregnancy
The American College of Obstetricians and Gynecologists recommends obtaining a hemoglobin and hematocrit test at the first prenatal visit and at the beginning of the third trimester of pregnancy.1

If the hemoglobin concentration is less than 11 g/dL, or hematocrit is less than 33%, anemia is present.2,3

If anemia is diagnosed, additional testing to investigate potential causes of anemia includes hemoglobin electrophoresis and measurement of vitamin B12 and folate levels. Many obstetricians perform hemoglobin electrophoresis on all their pregnant patients as part of the routine prenatal screen.

Symptoms of anemia in pregnancy

You might not have any symptoms of anemia in pregnancy, especially if your anemia is mild. Sometimes tiredness – because your body is getting less oxygen circulation – is the only symptom you notice. Since it’s common to feel tired during pregnancy, many women don’t realize that a lack of iron is making them feel more tired than normal.

Fatigue and weakness are the most common symptoms of severe anemia. Other symptoms – which may start out mild and develop slowly – include:

  • Headache
  • Dizziness, feeling lightheaded when you stand up
  • Hair loss
  • Craving nonfood items (pica) or ice to suck or chew on
  • Leg cramps, and/or an unpleasant urge to move your legs during periods of inactivity (restless legs syndrome)
  • Palpitations, rapid heartbeat
  • Chest pain
  • Irritability or poor concentration
  • Spoon-shaped nails
  • Glossy tongue
  • Cracks in the corners of your mouth
  • Brittle nails
  • Blue color in the whites of the eye
  • Pale complexion. Pale lips, inner eyelids, and inside your mouth
  • Shortness of breath
  • Sore or inflamed tongue
  • Mouth

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