Why Is Extra Iron Needed During Pregnancy

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Why is extra iron needed during pregnancy? Well, because it’s important for the baby’s development. Here’s what you should know!

As a preggers mama, you probably already know that your pregnancy vitamins must contain extra folic acid and iron. But why is this? Why is it important to take in more than the daily recommended value of those ingredients during the first trimester of pregnancy? Let’s find out.

Why Is Extra Iron Needed During Pregnancy

Iron is needed for healthy red blood cells for both you and your baby. Red blood cells carry oxygen around your body to your organs and tissues, as well as to your baby.

In pregnancy, the amount of blood in your body increases by almost 50%. Some women become short of red blood cells, which is called anaemia. If you are anaemic, you may lack energy and feel very tired. Your doctor or midwife will find out whether you have anaemia through your routine antenatal blood tests. If you are having twins or multiple babies, you are more likely to be low in iron.

How Much Iron Is Needed Daily In Pregnancy

If your blood tests show that you are anaemic, your doctor or midwife will give you an iron supplement. If you do not have anaemia, you do not need to take an iron supplement.

Iron supplements can cause some side effects, like stomach pain, constipation and your poo may be black. Find out more about taking iron supplements.

Getting iron from your food

Most people should be able to get all the iron they need by eating a healthy, balanced diet. Some food has more iron than others.

The follow foods are all good sources of iron:

  • red meat, oily fish and eggs
  • green leafy vegetables such as broccoli or spring greens
  • beans, such as red kidney beans, black-eyed peas, baked beans and chickpeas
  • soya beans and soya products, such as tofu
  • nuts and dried fruit, such as dried apricots
  • wholemeal bread and fortified breakfast cereals.

Foods to help the body absorb iron

As well as choosing foods that contain iron, it is important to make sure you are eating foods that help iron get absorbed into your body. Some foods and drinks also stop iron from being absorbed, so it is important to be aware of these too.

Fruits and vegetables containing vitamin C can help the body absorb iron. These include:

  • kiwi fruit
  • oranges
  • potatoes
  • cauliflower
  • broccoli
  • brussels sprouts
  • parsley.

Drinking tea and coffee (including decaf versions) can stop iron being absorbed into your body, especially drinking them with a meal. It is important to cut down on your caffeine intake in pregnancy anyway, find out more about caffeine and pregnancy.

Importance of Iron During Pregnancy

Among healthy human beings, pregnant women and rapidly growing infants are most vulnerable to iron deficiency (Bothwell et al., 1979). Both groups have to absorb substantially more iron than is lost from the body, and both are at a considerable risk of developing iron deficiency under ordinary dietary circumstances. During pregnancy, more iron is needed primarily to supply the growing fetus and placenta and to increase the maternal red cell mass (Hallberg, 1988).

Iron deficiency is common among pregnant women in industrialized countries, as shown by numerous studies in which hemoglobin concentrations during the last half of pregnancy were found to be higher in iron-supplemented women than in those given a placebo or no supplement (Table 14-1) (Chanarin and Rothman, 1971; Dawson and McGanity, 1987; Puolakka et al., 1980b; Romslo et al., 1983; Svanberg et al., 1976a; Taylor et al., 1982; Wallenburg and van Eijk, 1984). This higher hemoglobin concentration as a result of an improved iron supply not only increases the oxygen-carrying capacity, but it also provides a buffer against the blood loss that will occur during delivery (Hallberg, 1988).

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Iron is essential for the production of hemoglobin, which functions in the delivery of oxygen from the lungs to the tissues of the body, and for the synthesis of iron enzymes, which are required to utilize oxygen for the production of cellular energy (Bothwell et al., 1979).

Definition of Anemia and Iron Deficiency

Anemia is defined as a hemoglobin concentration that is more than 2 standard deviations below the mean for healthy individuals of the same age, sex, and stage of pregnancy. Although iron deficiency is the most common cause of anemia, infection, genetic factors, and many other conditions can also lead to anemia. Iron depletion is generally described in terms of three stages of progressively increasing severity (Bothwell et al., 1979):

1.depletion of iron stores
2.impaired hemoglobin production (or iron deficiency without anemia)
3.iron deficiency anemia

The first stage, depletion of iron, is characterized by a low serum ferritin level. This stage is the most difficult to define because it involves an arbitrary decision about how low iron stores should be before they are considered depleted. This is a particularly thorny issue with respect to pregnancy, because storage iron, estimated from bone marrow aspirates (or less directly by the serum ferritin), is low or absent in most women during the third trimester, whether (Svanberg et al., 1976a) or not (Heinrich et al., 1968; Svanberg et al., 1976a) they have received an iron supplement.

For this reason, the subcommittee considered low iron stores in late pregnancy to be physiologic and reserved the term iron deficiency for the second and third stages. The second stage, impaired hemoglobin production , is recognized by laboratory tests that indicate an insufficient supply of iron to developing red blood cells, such as low ratio of serum iron to total iron-binding capacity (Fe/TIBC), low mean corpuscular volume (MCV), and/or elevated erythrocyte protoporphyrin (EP), but with a hemoglobin concentration that remains within the normal reference range. Iron deficiency anemia (the third stage) refers to an anemia (e.g., hemoglobin values below the 5th percentile in Figure 14-1) that is associated with additional laboratory evidence of iron deficiency, such as a low serum ferritin level, low serum Fe/TIBC, low MCV, or an elevated EP level (also see the section Laboratory Characteristics of Impaired Hemoglobin Production).

Why is iron important during Pregnancy?

Pregnancy increases your blood supply by up to 50 percent. That’s where iron comes in. Iron is used by the body to make red blood cells. An increase in blood supply means that you’ll need more red blood cells and more iron to make those blood cells.

When you don’t have enough iron in your body, you can develop anemia. Anemia is the most common blood condition for pregnant women to develop.

Anemia during pregnancy can put you and your baby at a higher risk for several complications, including pre-term birth and low birth weight.

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Among nonpregnant women between the ages of 20 and 44, estimated percentages of impaired iron status varied according to model used: 9.6 ± 1.3% (standard error of the mean [SEM]) as determined by the ferritin model, and 5.4 ± 0.5% as determined by the MCV model. Iron deficiency anemia (two or three abnormal values and hemoglobin < 11.9 g/dl) among nonpregnant white women aged 20 to 44 was less than 2% as determined by both models.

If the prevalence of iron deficiency among pregnant women were no higher than the 5 to 10% reported in NHANES II for nonpregnant women of childbearing age, there would be little basis for considering routine iron supplementation during pregnancy. However, it is generally agreed that both iron needs and prevalence of iron deficiency increase substantially during pregnancy (Hallberg, 1988). In a paper on the worldwide prevalence of anemia written for the World Health Organization, the global prevalence of anemia was estimated at 51% among pregnant women, compared with 35% among women in general, including pregnant women (DeMaeyer and Adiels-Tegman, 1985). Most of the anemia was attributed to iron deficiency. The higher prevalence for pregnant women is consistent with the estimated high iron needs during pregnancy (Bothwell et al., 1979; Hallberg, 1988; see also section Iron Requirements for Pregnancy).

The most convincing evidence that pregnant women in industrialized countries often cannot meet their iron needs from diet alone comes from three careful longitudinal studies from northern European countries. Groups of iron-supplemented and unsupplemented pregnant women were followed with laboratory studies from early pregnancy at 4-week intervals (Puolakka et al., 1980b; Svanberg et al., 1976b; Taylor et al., 1982). In all these studies, the hemoglobin values in the unsupplemented group were significantly lower than those in the supplemented group after 24 to 28 weeks of gestation. The mean difference was 1.0 to 1.7 g/dl between weeks 35 and 40 of gestation. In the latter two studies, the means were more than 2 standard deviations apart during this period, indicating a high prevalence of impaired hemoglobin production because of lack of iron in the unsupplemented group. Thus, even though are no good prevalence data for iron deficiency during pregnancy, it is reasonable to infer that the prevalence is high.

Two sets of laboratory criteria were used to estimate the prevalence of impaired iron status, which was defined as two or three abnormal laboratory test results out of a set of three tests for iron status. This approach had been found to be more reliable in relation to anemia than the use of any single test (Cook et al., 1976). In the so-called MCV model, MCV, Fe/TIBC, and EP were used for the analysis; these laboratory results were available for most subjects. In the ferritin model, the serum ferritin concentration was substituted for the MCV and probably represents an earlier stage of iron deficiency. Impaired iron status in either model can be considered to be equivalent to iron deficiency, taking into consideration that infection and chronic disease can be confounding factors by mimicking the laboratory abnormalities of iron deficiency.

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