What Should I Know about Iron Deficiency Anemia During Pregnancy?

Read time: 6 minutes

What to know about iron deficiency anemia while pregnant

• Why is iron important
• How much iron is needed by age
• Why iron needs increase during pregnancy
• Recognize symptoms and risks associated with iron-deficiency anemia
• Learn ways to increase dietary and supplemental iron intake and maximize absorption

What is iron?

Iron is a critical component of hemoglobin and myoglobin, the proteins found in red blood cells that carry oxygen through our bodies.¹ Without adequate iron, our bodies cannot produce enough healthy red blood cells to support our oxygen needs. Iron is also important for how our cells function and is a component of some hormones.¹

Since our bodies cannot make iron, we depend on food and dietary supplementation to meet our needs.²

There are two types of dietary iron

1) Heme iron from animal-based foods like meat, fish, and poultry.

Heme iron is generally better absorbed than non-heme iron.³

2) Non-heme iron from plant-based foods such as nuts, fruits, vegetables, tofu, as well as fortified cereals and grains.

While non-heme is not absorbed quite as well as iron from animal products, a diet rich in vitamin C may help increase its absorption. Aim to include a food rich in vitamin C when you eat iron to help make the most of your meal.

Other foods we eat in conjunction with iron can impact absorption as well. For example, the calcium in dairy products and the tannins in coffee and tea can affect absorption of both types of iron.

The good news is that while these nutrients may impact the ability of the body to absorb iron over the course of one meal, long term studies do not indicate that diets rich in tannins or calcium affect total iron status over time.^{6, 7}

If you’re iron deficient or concerned about how much iron is in your diet, our team of registered dietitian nutritionists, fellow moms, and lactation specialists, are available from Monday – Friday 8 am – 6 pm (ET) to help figure out what may be going on. Chat now!

How much iron is needed?

The Recommended Daily Allowance (RDA) for iron is below.

Since non-heme iron is poorly absorbed, the RDA for vegetarians and vegans is 1.8 times higher than for people who eat meat , fish, and poultry.¹ If you avoid meat and other animal products, be sure to increase your iron intake accordingly and chat with your health care provider about your iron intake.

*Note that the numbers for infants aged 0 – 6 months are Adequate Intakes (AIs), since there is not enough data to establish an RDA.¹ The AIs provide guidance to help get a level of iron that is nutritionally adequate.

• Infants* 0 – 6 months: 0.27 mg
• Infants 7 – 12 months: 11 mg
• Toddlers 1 – 3 years: 7 mg
• Children 4 – 8 years: 10 mg
• Children 9 – 13 years: 8 mg
• Adolescent females 14 – 18 years: 15 mg
• Adolescent males 14 – 18 years: 11 mg
• Women 19 – 50 years: 18 mg
• Men 19 – 50 years: 8 mg
• Older adults 50 + years: 8 mg
• Pregnancy: 27 mg
• Lactation: 9 mg¹

Iron needs during pregnancy and lactation

As you can see, iron recommendations increase during pregnancy to help meet your and your baby’s higher needs. This greater demand for iron is due to higher blood volume and oxygen demand, as well as the growing infant’s needs.⁷

Interestingly, iron needs go down during lactation. This is because a woman’s menstrual cycle typically stops while she is breastfeeding.^{7, 8} However, should you be iron deficient going into your postpartum period, your iron needs are likely higher.⁸ Chat with your health care provider if your iron numbers are low.

Read about: Which Nutrients do I Need During Pregnancy?

How do you know if you are iron deficient?

A simple blood test can determine whether you have iron deficiency anemia (IDA), the official name for too little dietary iron. Testing is done routinely during pregnancy, most commonly at the first prenatal visit and again around the beginning of the third trimester (although each healthcare provider may have their own schedule for testing).⁹

The Institute of Medicine also recommends an iron screening for high-risk women at their first postpartum visit.⁹

Who is most at risk for developing iron deficiency anemia?

Many pregnant women have insufficient iron stores to meet the demands of pregnancy. In fact, 17-31% of pregnant women in North America have iron deficiency anemia.¹¹

The women most at risk for IDA are:

• Those who are pregnant with multiples
• Women who had a short recovery time after the last pregnancy
• Those who had IDA in a previous pregnancy
• Women who have a history of poor nutritional intake
• Women who follow a diet that is not high in heme iron.^{7, 10}

Additionally, any pregnant woman who is vomiting frequently due to morning sickness (which interferes with the proper absorption of dietary nutrients), can become low in iron.¹⁰

If you are concerned about IDA, chat with your doctor to best understand your risk and recommendations.

Read about: Strategies for Managing Morning Sickness

Symptoms of Iron Deficiency Anemia

Some physical symptoms of early IDA to look out for may include:

• Feeling persistently fatigued despite adequate sleep
• Headaches
• Dizziness
• Heart palpitations
• Difficulty concentrating¹²

As iron deficiency progresses, so do the symptoms:

• Brittle nails
• Desire to eat ice and other non-food items (called Pica)
• Feeling lightheaded when you stand up
• Pale skin color
• Shortness of breath
• Mouth ulcers
• Hair loss¹²

*The above possible symptoms list of IDA is not a fully inclusive list. Always contact your health care provider if you are experiencing any symptoms of concern and/or if you feel you may be low in iron.

Helping avoid iron deficiency anemia

Along with an iron-rich diet, the American College of Obstetricians and Gynecologists recommends taking a prenatal vitamin that includes iron to help you get enough.¹³ Research indicates that taking a prenatal vitamin containing iron helps reduce the risk of maternal anemia by up to 70% and iron deficiency by up to 57%.¹⁴

Chat with your health care provider to see if your prenatal vitamin is meeting all your needs.

Tips for getting enough iron in your diet

Incorporate iron-rich foods at every meal and snack

Eat plenty of iron-rich plant-based foods such as beans, dark leafy greens, dried fruit (such as raisins and apricots), iron-fortified whole grains, green peas, enriched pastas, and cereals (look for ones with less than 4g sugar and more than 4g fiber).

If you eat animal foods, choose lean protein sources like seafood and poultry as well as heme-rich lean red meat and pork.

Here’s a cheat sheet of foods with amounts of choline by serving:

• Breakfast cereal fortified with 100% DV iron, 1 serving: 18 mg
• White beans, canned, 1 cup: 8 mg
• Lentils, cooked, ½ cup: 3 mg
• Spinach, cooked, ½ cup: 3 mg
• Tofu, firm, ½ cup: 3 mg
• Kidney beans, ½ cup: 2 mg
• Pumpkin seeds, 1 oz: 2.5 mg
• Sardines, 3 oz: 2 mg
• Kidney Beans, canned, ½ cup: 2 mg
• Beef, 3 oz: 2 mg
• Potato, baked, 1 medium: 2 mg
• Cashew nuts, roasted, 1 oz: 2 mg
• Chicken, roasted, 3 oz: 1 mg
• Rice, enriched, parboiled, ½ cup: 1 mg
• Raisins, seedless, ¼ up: 1 mg
• Pistachios, 1 oz: 1 mg
• Egg, hard boiled, 1 large: 1 mg¹

Getting the most out of your iron-rich foods and supplements

If much of your iron is coming from plant sources (non-heme iron), be sure to have vitamin C-rich foods in your day to help with absorption. Foods with vitamin C include: red and green bell pepper, oranges, kiwi, broccoli, strawberries, grapefruit, and tomatoes.

Avoid eating dairy products high in calcium (yogurt, milk, cheese, cottage cheese, etc) or drinking coffee and tea at the same time you eat high-iron foods and supplements as these may inhibit iron absorption. It is also possible that higher fiber foods, such as bran, whole grains, and raw vegetables, may interfere with iron absorption.¹⁵

Additionally, if your health care provider recommends taking an iron supplement, you may want to take it at a different time than your prenatal (which contains calcium), as well as at a different time than drinking coffee or tea.¹⁵

Try these meal and snack ideas which include foods that contain iron

Meals:

• Kale salad with grilled chicken and dried fruit of your choice, top with broccoli, chickpeas, and/or lentils. Try a homemade dressing of ½ clove minced garlic combined with olive oil, pepper and lemon juice
• Vegetarian taco salad with spinach, mixed greens, brown rice, black or pinto beans and salsa. Add cilantro if you like!
• Healthy Picadillo (beef hash, use lean beef. Or opt for ground turkey or chicken) with yellow, green, and red bell peppers, carrots, tomatoes, golden raisins, and green olives
• Lentil soup with added spinach
• Lettuce cups with tofu topped with veggies of your choice and guacamole

Snacks:

• Dried fruit (like raisins and apricots)
• Pumpkin seeds (try adding to your cereal along with strawberries for a boost of vitamin C)
• Raw broccoli and tahini dip
• Chickpea salad or roasted chickpeas
• Oatmeal topped with apples (look for a brand of oats fortified with iron)

Take your prenatal vitamin as directed by your healthcare provider

And check the nutrition facts label on any supplements you take to determine iron levels. And as always, speak with your health care provider about any supplements before taking them.

Speak with your healthcare provider if your iron supplement is causing nausea or upset stomach

Iron is best absorbed on an empty stomach. However, supplemental iron may cause nausea, and taking it on an empty stomach might make this symptom worse.¹⁵

If this is your experience, it may be possible to take smaller doses of iron throughout the day with food to ease any discomfort. You could also try a different form of supplemental iron, such as liquid instead of a pill, with the approval of your health care provider.

Emphasize a diet rich in fiber to combat any iron-induced constipation

Because supplemental iron may also cause constipation, a diet rich in fiber (think fruits, vegetables, nuts, and seeds) with plenty of water and physical activity is more important than ever.¹⁵

As you add in more fiber, be sure to also drink enough fluids to prevent more constipation. During pregnancy, your goal is to drink 8 to 12 (8 oz) cups of fluid per day to meet your needs.¹⁶

Read about: 6 Tips to help Manage Prenatal and Postpartum Constipation

If you suspect iron deficiency anemia, ask your healthcare provider for a blood test

If you are diagnosed with IDA, your healthcare provider can provide guidance in increasing your amount of supplemental iron.

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