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Iron Deficiency Anemia and Pregnancy

Image Credit: Rob Pongsajapan on Flickr

I have a history of low iron levels, so I wasn’t all that surprised to find, early in my first pregnancy, that the numbers from my hemoglobin and hermatocrit (H&H) test had been low. When the same was true this second time around, I was prescribed, as I had been in the my previous pregnancy, an additional iron supplement on top of my prenatal vitamin. This means that if I follow my doctor’s suggestions, I am taking 212% of the daily value of iron. Because my iron levels returned to normal by the time of my first daughter’s birth, I was not terribly worried this time around, and began to ask a few more questions. I’d like to share a bit about what I have learned, and ask for any bits of advice you may have to share as well.

For those who aren’t familiar with these values and what they mean, as I wasn’t until very recently, hemoglobin is the protein in red blood cells, and is responsible for the delivery of oxygen to your body’s tissues. The amount of hemoglobin in blood is given as grams per deciliter. A normal hemoglobin (Hb) level for a female is between 12 and 16 g/dl1. Early in my first pregnancy, my hemoglobin level was 11.5 g/dl, and at 7 weeks gestation this time around, it was 11.8 g/dl. It is typical, however, for pregnant women to have a lower hemoglobin level, so anemia is not typically diagnosed in pregnancy unless a woman’s Hb level is less than 10 g/dl2 That said, levels tend to continue to decrease during early pregnancy, so according to Merck, my Hb level will likely dip down close to 10 g/dl without treatment, making me anemic eventually. I continued to take 210% of the DV of iron throughout my first pregnancy, and just before my daughter’s birth, my hemoglobin level had increased to a perfectly normal 13 g/dl.

As for hematocrit, it is a measure of the proportion of red blood cells to total blood volume, expressed as a percentage.  A normal hematocrit for a woman is between 36 and 48% 1, and anemia in pregnancy is not usually diagnosed until below 30%2. As with hemoglobin levels, hematocrit usually decreases as a pregnancy progresses. To use myself as an example again, my hematocrit early in my first pregnancy was 33.8%, and a few weeks ago was measured at 34.6%. By the time of my daughter’s birth, it had increased to 38%.

When I looked at my numbers from my first pregnancy and compared them to what’s happening this time around, I noticed two things. First of all, I gave birth less than two years ago, have continued to nurse, and was off my prenatal for a good eight months before getting ready to conceive – and my levels are better than they were at this point in my first pregnancy. I was pretty excited about this, and it made me think that some of the simple lifestyle changes (I’ll get into those in a minute) I made to help my body absorb iron more readily may have made a bigger difference than the mega dose of iron I was taking in supplement form. The other thing that hit me however, has to do with the way pregnancy works.

You see, the body undergoes many changes during pregnancy, and one of them is a massive increase in blood volume. I knew this, as most of you probably do as well, but the relationship between this fact and my iron levels didn’t hit me until this time around. My body is producing a large amount of blood, but it’s mostly plasma. The obvious result is lower concentrations of red blood cells – hemodilution2. Simple, right? Realizing this has not made me stop trying to up my iron intake, but it has helped me relax. The dip in my iron levels is to be expected and my past experience shows that, with care, it will reverse. My body is actually working just as it should.

It’s also comforting to consider my almost two year old’s history thus far. She was exclusively breastfed for the first seven months of her life, with no supplementation of any kind. When she began solids, she ate a vegan diet. Because of my history of low iron levels and our vegan lifestyle, I opted to have her levels checked at nine months of age rather than twelve months as is standard in her pediatrician’s office, just to put my mind at ease. Her levels were perfectly normal, without supplementation. It seems that, while my levels weren’t optimal, my body was still able to give her what she needed. I know this is how pregnancy tends to work, but it’s comforting to have seen proof!

As I have worked to ensure adequate iron intake and absorption for myself, I have learned a few things. Here are some simple things I keep in mind as I work to maintain adequate iron levels.

Image Credit: Buchman Photo on Flickr

  • If you take a supplement, be aware that calcium taken with iron will hinder absorption and Vitamin C will help. I like to eat an orange or a kiwi just before taking my iron, and I try to time my intake of calcium rich foods for later in the day.
  • Tea and coffee also inhibit iron absorption (decaf, too), so try to time your intake of these beverages as far apart as you can from your most iron rich meals and/or supplements. Not so with alcohol, and red wine actually contains a fair amount of iron 6!
  • Be aware that many foods with a reputation for being iron rich actually contain compounds that inhibit iron absorption, effectively canceling out the nutritional benefit of the iron they contain. One such food is spinach.
  • Cooking in cast iron increases the iron content of your meal.
  • Liquid iron (I use Floradix) seems to work better for me than capsules, and many others feel the same.
  • Simple additions to foods you already eat can boost iron content. Blackstrap molasses to sweeten your oatmeal adds a great iron boost. Making rice with dinner? Toss in some lentils to boost the iron and the protein content! The iron rich foods I list on my Daily Food Log for Vegetarian and Vegan Children are all things I try to add into ordinary meals, especially during pregnancy.

Do you tend to have low iron levels in pregnancy, or all the time? What tips and tricks do you have for upping your intake?

  1. Billet, H. 1990. Clinical methods: the history, physical, and laboratory examinations. 3rd Ed. Boston, MA: Butterworths. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK259/
  2. Blackwell, S. 2008. Anemia in pregnancy. In the merck  manual for healthcare professionals.  Whitehouse Station, NJ: Merck Sharp and Dohme Corp.
  3. Billet, H. 1990. Clinical methods: the history, physical, and laboratory examinations. 3rd Ed. Boston, MA: Butterworths. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK259/
  4. Blackwell, S. 2008. Anemia in pregnancy. In the merck  manual for healthcare professionals.  Whitehouse Station, NJ: Merck Sharp and Dohme Corp.
  5. Blackwell, S. 2008. Anemia in pregnancy. In the merck  manual for healthcare professionals.  Whitehouse Station, NJ: Merck Sharp and Dohme Corp.
  6. Of course too much alcohol brings many other health problems, and it’s definitely not recommended for pregnant women.

15 Responses to Iron Deficiency Anemia and Pregnancy

  • Jess says:

    Melissa,
    Thanks for this! I have been told I am borderline anemic. Which means not anemic enough to be treated, but anemic enough to feel bad. I will most definitely try out your tips and see how they work!

    Oh and I finally snagged your button :)

    • melissa says:

      My pleasure, Jess! It all seems so simple, but it’s information I didn’t know three years ago, so I’m glad to share it :) Thanks so much for grabbing my button! I want to find time to update my own blogroll soon!

  • Anna says:

    I was anaemic after Abi was born (I left 2 pints of blood on the floor!) and was prescribed pills. They made me horribly constipated, not something you want to be post-partum. A veggie friend told me about floradix and it saved my butt – literally! Other than that – for me it is back to remembering that pregnancy is not a medical condition, it is a state of being that our bodies are designed to cope with, everything else being equal. Therefore, it does not surprise me to learn that anaemia is normal in pregnancy, nor that doctors like to treat it!

    • melissa says:

      It really does all come back to the idea that pregnancy is a normal state of being – great point! I didn’t want to seem all advertise-y, so I went with the photo of cast iron pans instead, but I giggled a little at this floradix promo and almost used it instead ;) http://www.flickr.com/photos/lorenia/2666061742/

      • Anna says:

        That’s fab!

        I made up a little rhyme for my kids a few years ago to encourage them to “get regular!”. It went

        Have your morning poo
        The day wil go well with you.

        Miss your morning grump
        All day you’ll be in a grump.

        It’s all true!!!

  • Thanks for writing about an important topic! I am always anemic – and sometimes this is due to a slight iron deficiency. I’m a big fan of Floradix too!
    Charise @ I Thought I Knew Mama recently posted..Book Giveaway: “Salad People” – Healthy recipes to make with your toddler or preschoolerMy Profile

  • I really don’t know much about this at all, but I know more since I read your post:) Wow! cooking in a cast iron increases your iron content in your meal. Thank you for sharing this new to me information. Good for you for finding more information so you can have a healthier, and happier pregnancy!!

  • Amy says:

    Thanks for sharing! I had low iron levels some years ago, but been focused on being much healthier since and didn’t have any problems during pregnancy. When I first started BF-ing, Q-ball spit up a lot- like projectile, but this stopped when I stopped taking my extra pre-natals (I also read this from a few others on the LLL forum), so I was wondering if Annabelle would experience any side effects??

    • melissa says:

      I had never thought of how the extra supplement might affect my nursling. Annabelle has never shown an adverse reaction to anything I have taken, fortunately. I’m glad you found a solution to Q-ball’s spit up!

  • Rach says:

    I love this! What a great idea about the cast iron and tossing lentils in with the rice. I didn’t know that about spinach. What foods are really iron rich then? I take spatone when I remember which is a good liquid iron supplement.

  • tinsenpup says:

    Very interesting, Melissa. We really need to be well-researched, especially when it comes to diet. I saw a doctor today who kept describing my gluten and dairy free diet as “a very limited diet”. Seriously? The only question she asked about what I actually do eat rather than what I don’t was, “Do you eat a lot of meat?” Annoying.

  • Leanne says:

    We are going to start trying for a baby shortly but I wondered how you originally identified that you had low Iron levels, its something I would like a little more information on without, if possible visiting the doctors!

    • melissa says:

      Hi, Leanne. I first discovered my low iron levels several years back when I had my naturopath run some blood work to check my overall health. In both my pregnancies, checking the levels has been a standard thing at or before the first prenatal visit. If you don’t want to see an MD or OB, a ND might be more pleasant and personal for blood work?

      If you’re not having any symptoms of low iron, you could always just try to up your levels through diet for now, as it can’t hurt even if your iron is high – and then have your levels checked when you’re visiting a doctor for some reason or another anyway.

      Best wishes for your pregnancy-to-be!

  • I, too, had low iron during pregnancy which really surprised me considering I had never suffered before but it levelled out after Jesse was born. Totally makes sense after reading your explanation of why here. I stock up in these iron rich foods to make sure myself and Jesse don’t suffer again: Spirulina, pistachios, pumkin seeds, sesame seeds, quinoa, apricots and figs :)

  • kimia says:

    Such an interesting post Melissa! I’ve always had low iron levels since childhood, and reading that bit about spinach was so eye opening for me. Thank you for all this info, as always. :)

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