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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 as well as collecting carbon dioxide for transport to the lungs, 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.
How might anemia affect me?
| Tiredness Paleness Dizziness Heart palpitations Shortness of breath | Nausea Loss of appetite Hair loss Constipation Slow healing | General weakness Susceptibility to infection Desire to eat non-foods:ice, clay, paint, dirt, etc. |
Being anemic does not predispose a person to postpartum hemorrhage, but it can worsen its impact. Anemic mothers take longer to recover postpartum, and experience more difficulties coping due to excessive tiredness and weakness. Ideally, the aim in pregnancy should not only be to avoid anemia, but to reach optimal hemoglobin levels so that your postpartum transition is as easy as possible.
How 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 mother’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 mother is severely iron deficient.
What causes iron-deficiency anemia?
The cause of anemia in the large majority of cases is nutritional deficiency. Anemia may also occur as a result of illness, or blood loss such as can occur at birth.
Iron depletion is common among those who menstruate because there is 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 healthy baby increases iron requirements. 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 is anemia diagnosed?
Iron-deficiency anemia is the most common problem of pregnancy. It is recommended that all pregnant people be tested for anemia at their first prenatal visit, and then again around 28 -32 weeks or as symptoms arise. A simple blood draw will check the hemoglobin concentration in the blood, as well as the amount of iron stored in the liver as ferritin (think of this as “backup”). If diagnosed with nutritional anemia, it is recommended to have follow-up testing after 3-4 weeks of treatment.
What are my options for treatment?
Prevention
If you are not anemic, a nutritious diet high in iron-rich foods will help keep you that way. Regular exercise can also help prevent or treat anemia, because it helps increase the body’s oxygen carrying capacity.
If you are taking multivitamins, it is important to remember that these should be in addition to, not a substitute for, a nutritious diet. Although multivitamin supplements for pregnancy contain iron, this iron frequently causes side effects such as nausea, diarrhea, heartburn and/or constipation leading to worse nutrition habits! As well, the iron in multivitamins is usually blocked from being absorbed by the calcium and zinc content.
Iron overload can be toxic, causing liver damage. Anyone who is not anemic or who has thalassemia should not take iron supplements.
Mild anemia
Treatment depends on how severe your anemia is, what other approaches you may have already tried, and what your body tolerates. Speak to your midwife about options for supplmentation.
Iron-rich foods
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.
Increasing iron absorption
- Do not take calcium or zinc supplements at the same time as iron, since they combine in the intestine and prevent absorption. Consume concentrated sources of calcium at different times than iron sources.
- Eating foods high in vitamin C with your iron will increase absorption.
- Cooking in cast-iron will aid in increasing hemoglobin levels.
- Minimize caffeinated tea and coffee, or drink between meals only – the polyphenols decrease iron absorption
- Combine heme and non-heme sources of iron in the same meal.
| Heme IRON sources | Serving | Iron (mg) |
| Mussels* | 75 g (2 ½ oz) | 5.0 |
| Beef | 75 g (2 ½ oz) | 2.4 |
| Shrimp* | 75 g (2 ½ oz) | 2.3 |
| Sardines* | 75 g (2 ½ oz) | 2.0 |
| Turkey/Lamb | 75 g (2 ½ oz) | 1.5 |
| Tuna/herring/mackerel* | 75 g (2 ½ oz) | 1.0 |
| Chicken | 75 g (2 ½ oz) | 0.9 |
| Pork | 75 g (2 ½ oz) | 0.8 |
| Salmon (canned*/wild) | 75 g (2 ½ oz) | 0.6 |
| Flatfish (flounder/sole/plaice)* | 75 g (2 ½ oz) | 0.3 |
| *Due to mercury content, limit certain fish/shellfish to no more than 12 ounces total per week. | ||
| Pregnant women should not eat liver, as the high vitamin A content can be harmful to the baby. | ||
| Non-heme IRON sources | Serving | Iron (mg) |
| Pumpkin seeds, kernels, roasted | 60 mL (1/4 cup) | 8.6 |
| Tofu, medium firm or firm | 150 g (3/4 cup) | 2.4 – 8.0* |
| Infant cereal, dry | 28 g (10 Tbsp) | 6 – 7* |
| Soybeans, dried, boiled | 175 mL (3/4 cup) | 6.5 |
| Instant enriched oatmeal | 1 package | 4.2 – 6.0* |
| Lentils, cooked | 175 mL (3/4 cup) | 4.9 |
| Enriched cold cereal | 30 g | 4.0* |
| Dark red kidney beans, boiled | 175 mL (3/4 cup) | 3.9 |
| Blackstrap molasses | 15 mL (1 Tbsp) | 3.6 |
| Refried beans | 175 mL (3/4 cup) | 3.1 |
| Cream of wheat, instant, prepared | 175 mL (3/4 cup) | 3.1 |
| Soy beverage | 250 mL (1 cup) | 2.9 |
| Wheat germ, ready to eat, toasted, plain | 30 g (2 Tbsp) | 2.7 |
| Chickpeas, canned | 175 mL (3/4 cup) | 2.4 |
| Soybeans, green, boiled | 125 mL (1/2 cup) | 2.4 |
| Tahini, sesame seed butter | 30 g (2 Tbsp) | 2.3 |
| Lima beans, boiled | 125 mL (1/2 cup) | 2.2 |
| Swiss chard, boiled | 125 mL (1/2 cup) | 2.1 |
| Asparagus, canned | 6 spears | 2.0 |
| Potato, baked, with skin | 1 medium | 1.9 |
| Bagel | 1/2 | 1.8 |
| Cherries, sour | 125 mL (1/2 cup) | 1.8 |
| Shredded Wheat | 30 g | 1.8* |
| Quinoa, cooked | 125 mL (1/2 cup) | 1.7 |
| Seaweed, agar, dried | 8 g (1/2 cup) | 1.7 |
| Beets, canned | 125 mL (1/2 cup) | 1.6 |
| Prune juice, canned | 125 mL (1/2 cup) | 1.6 |
| Cream of wheat, regular, prepared | 175 mL (3/4 cup) | 1.5 |
| Green peas, boiled | 125 mL (1/2 cup) | 1.3 |
| Sunflower seeds, kernels, roasted | 60 mL (1/4 cup) | 1.2 |
| Whole wheat bread | 35 g (1 slice) | 1.2 |
| Eggs | 2 | 1.1 |
| Oats, quick or large flakes, prepared | 175 mL (3/4 cup) | 1.1 |
| Pearled barley, cooked | 125 mL (1/2 cup) | 1.1 |
| Sauerkraut | 125 mL (1/2 cup) | 1.1 |
| Pasta, enriched, cooked | 125 mL (1/2 cup) | 1.0 |
| Molasses, fancy | 15 mL (1 Tbsp) | 1.0 |
| Raisins | 60 mL (1/4 cup) | 0.7 |
| Broccoli, cooked | 125 mL (1/2 cup) | 0.6 |
| Peanut butter | 30 mL (2 Tbsp) | 0.6 |
| * Iron amounts in enriched foods vary; check the label for accurate information. If the iron amount is given as a percentage of the daily value (DV), the standard used is 14 mg (or 7 mg for infant cereals). For example, if a serving of cereal has 25% of the daily value, it has 3.5 mg of iron (0.25 x 14 mg). |