Iron deficiency in pregnancy

Iron-deficiency anemia can make you feel tired or exhausted. Severe anemia can lead to complications in pregnancy. For instance, it can weaken the immune system and increase the risk of infections. It also increases the risk of the baby weighing too little at birth (low birth weight). Mild anemia usually doesn’t affect the child, though.

Severe anemia is rare in healthy pregnant women who eat a balanced diet. In women who don't (or can’t) eat a balanced diet, though, anemia can become a serious health problem.

According to German health authorities, pregnant or breastfeeding women need 20 to 30 milligrams (mg) of iron per day. It can be particularly difficult for vegetarians to get that amount of iron in their diet alone.

Pregnant women regularly have blood tests as part of their standard check-ups. That way, iron-deficiency anemia can be detected early on and treated using iron supplements.

At the start and towards the end of pregnancy, hemoglobin levels above 11 grams per deciliter are considered to be normal. Between the fourth and sixth months of pregnancy, a small drop to 10.5 grams per deciliter is also considered to be normal. If the hemoglobin levels drop below that, the iron levels in the blood are measured too. This can help to determine whether the low hemoglobin levels are caused by a lack of iron.

Ferritin levels are also measured: That tells you how full your body’s iron reserves are.

We normally get iron in the food we eat. Meat is especially rich in iron that can be absorbed well by the bowel. Liver is particularly high in iron.

It is harder for the body to absorb iron from plant-based foods. But some plants are good sources of iron too. These include cereals, for instance in the form of whole-grain breakfast cereals, and legumes such as lentils and beans. Green leafy vegetables like lamb’s lettuce and spinach contain some iron, too.

Iron can be taken as a dietary supplement as well. These are available without a prescription in the form of tablets and liquid drops.

Iron supplements are usually already recommended for pregnant women whose iron reserves are going down, in order to prevent anemia. They are also a good idea if a more severe iron deficiency or iron-deficiency anemia is diagnosed. Then the doctor will usually prescribe a higher dose of iron supplements. You take them daily or every couple of days, depending on how severe the iron deficiency is. The supplements can reduce symptoms of the deficiency, such as tiredness.

Iron can also be given as an infusion (a drip). But that is only recommended if the body doesn't absorb enough iron through the bowel. Iron infusions are only an option from the fourth month of pregnancy.

Pregnant women with normal blood iron levels sometimes take iron supplements to prevent anemia. But iron supplements are only a good idea if your doctor has diagnosed anemia or a significant iron deficiency. Too much iron can be harmful as well. When it comes to iron intake, finding the right balance is key. If you have a mild iron deficiency, getting more iron in your diet is often enough.

When taken in higher doses, iron supplements can cause gastro-intestinal symptoms such as constipation, nausea, vomiting and diarrhea. When taken on an empty stomach, they can damage the lining of the stomach. Infusions can cause short-term side effects such as a headache, back pain, itching or hot flashes.

Some experts recommend only taking iron supplements once or twice a week rather than every day – but at a higher dose (such as 120 mg). Research has found that iron supplements can even prevent anemia when taken only once a week. The idea is that taking iron supplements less often will enable women to take them for longer, and lower the likelihood of side effects. But it’s not clear whether that is really the case.

Like all other medications, iron tablets should be kept out of reach of children. Even if iron is “only” a natural mineral, an accidental overdose can be life-threatening for children. You should then call the emergency services (112 in Germany and many other countries, 911 in the U.S.), followed by a poison control center. People living in Germany can reach these centers here.