Resources

Iron Deficiency and Anemia

What is anemia?

Anemia is not a disease; it a symptom of either a reduction of the number of red blood cells in the bloodstream, or not enough hemoglobin in each red blood cell. Since hemoglobin combines with and transports oxygen to the body cells for nourishment, any condition that reduces the number of red blood cells or decreases the hemoglobin concentration also lowers the amount of oxygen getting to the rest of the body.

Iron-deficiency anemia is the most common problem of pregnancy.

How do I know if I have anemia?

It is recommended that all pregnant people be tested for anemia in the first trimester, and then again around 28 -32 weeks – or as symptoms arise. A simple blood draw will check the hemoglobin currently circulating in the blood, as well as the amount of iron stored in the liver as ferritin (think of this as “backup” that can be used to replace lowered hemoglobin).

In pregnancy, anemia is defined as having HEMOGLOBIN LESS THAN 110

The DEGREE of anemia is diagnosed by testing FERRITIN levels. This helps direct the type and amount of treatment that careproviders may prescribe, but does NOT diagnose anemia.

Understanding your labs: fun fact, “normal” lab values are set for adult male bodies, which means that 100% of pregnant bodies will be flagged as anemic or “abnormal”, even if they do not meet the standard definition of anemia in pregnancy.

How might anemia affect me?

Being anemic going into labor, does NOT predispose a person to postpartum hemorrhage – but it can worsen its impact.

After the birth, anemia can make recovery take longer, can delay milk production, can put you at risk for infection, and can trigger difficulties in coping due to excessive tiredness and weakness. Ideally, the aim in pregnancy should not just be to avoid anemia, but to reach optimal hemoglobin levels so that your postpartum transition is as easy as possible.

Can anemia affect my baby?

During the last six weeks of pregnancy, the baby stores iron in its liver to supplement its needs for the first three to six months of life. Like with other nutrients, the pregnant person’s body prioritizes the baby’s needs over it’s own, thus it is rare that the baby will develop iron-deficiency anemia unless the pregnant person has extreme and ongoing iron deficiency.

What causes iron-deficiency anemia?

The cause of anemia in the large majority of cases is lack of absorption from nutritional sources. There is a strong genetic factor that affects a person’s ability to absorb iron. Some people have a genetic condition, called thalassemia, which reduces iron absorption to a large degree and these people are usually chronically anemic. Conversely, some people have a genetic condition called hemochromatosis, which increases iron absorption to such a degree that they are at risk of iron overload, and thus are usually advised to avoid taking iron supplements.

Anemia may also occur as a result of illness, or blood loss. Iron depletion is common among those who menstruate because of monthly blood loss. It is estimated that one third to one half of pregnant people begin their pregnancies with low iron, and about 1 in 10 of these people are already anemic.

Growing a baby increases iron requirements overall. In addition, in mid-pregnancy the amount of blood volume increases rapidly, peaking around 28-32 weeks. Because the blood plasma increases before the blood hemoglobin, this causes the relative concentration of hemoglobin to drop temporarily. This is normal and is referred to as hemodilution.

How do I optimize my iron levels?

* Eat iron-rich food sources at every meal

HEME iron is found only in animal sources and is absorbed more easily than NON-HEME iron, which is found in vegetable sources. Regardless, both types of iron are valuable, and may be absorbed effectively to boost iron levels. Combining heme and non-heme sources can help with absorption, e.g. spaghetti sauce with hamburger and spinach.

• For omnivores: eat meat at every meal
  • Beef … roast beef, hamburger
  • Giblets
  • Dark-meat poultry
  • Mussels, shrimp, clams, oysters 
• Add vitamin C-rich foods to your meals
• Add dark leafy greens to your meals
• Drink iron-rich smoothies: chia seeds, powdered beets, blueberries, spinach, pineapple/orange
• Drink iron-rich water made by boiling LUCKY IRON FISH in water (drink as water and/or make herbal tea)
• Make Iron Tonic, take 2 Tbsp daily with 250mg vitamin C [see recipe here]
• Make Iron-rich Bliss Balls, eat one per day [see recipe here]

* Avoid eating the following together with iron, as these block iron absorption (separate by at least one hour):

• Caffeine (coffee, tea, chocolate)
• Milk or dairy products
• Multivitamins, Calcium, Zinc, Magnesium
• Probiotics that are cultured with dairy

* Separate thyroid supplements (Synthroid) & iron supplements by four hours

* Get regular exercise, because it helps increase the body’s oxygen carrying capacity 

* Cook in a cast iron pan

Slow simmering, with red meat and vitamin-C rich foods, works best, e.g. spaghetti sauce made with hamburger in tomato sauce

Oral Iron Supplements

If you have severe anemia, or other approaches have not boosted your iron levels enough, your midwife will recommend oral iron supplements. The exact amount will depend your current labwork.

The downside of taking oral iron, is that side effects can include nausea and/or constipation. Additionally, iron overload can be toxic, causing liver damage. Anyone who is not anemic or who has hemochromatisis should not take iron supplements unless advised by a primary careprovider.

IV Iron Supplementation

For those have severe anemia – or moderate anemia unresponsive to oral supplementation – your midwife may recommend a referral for IV Iron supplementation.

When on an iron-boosting regime, you should re-test your hemoglobin and ferritin after 3-4 weeks of treatment, to verify that it is working. Your midwife can give you a requisition for this.