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Iron recommendations for pregnant women


During pregnancy a woman’s iron needs increase, and it is estimated that 18 percent of pregnant women are iron deficient. But how much iron to supplement is not a matter of “one for all.” Each woman needs to be evaluated to determine her own iron needs.

Why is iron so important during pregnancy?

  • Adequate iron stores are essential for early infant brain development, are needed to support the large increase in blood volume that occurs during pregnancy,
  • Iron adequacy may also be important for mother-child bonding during infancy.3-8
  • Iron deficiency in the mother can lead to iron deficiency in her breast-fed infant, which may impair health and future intelligence.9 

On the other hand, over-supplementation of iron can also be problematic for the mother and the developing baby. Supplementation in non-deficient pregnant women increases their likelihood of iron overload and oxidative stress.  This means too much iron can increase inflammation and disease potential.  Specifically, high blood levels of iron are associated with elevated blood pressure in pregnant women, and both too  low or too high iron stores are associated with delivering a low birthweight baby.11-15

In recent years, researchers have begun to support the idea of individualized iron supplementation recommendations, rather than blanket guidelines for all pregnant women. Research scientists studying this issue have concluded that recommending a fixed dose of iron to avert deficiencies in all women does not result in optimal outcomes and more iron is not necessarily better.  It is safest to use the minimum effective dose. The evidence is substantial that those women who have plenty of iron stores (documented by blood tests) to support a healthy pregnancy should not take any supplemental iron.13,16,17

To be consistent with the current science, and to make the best decision to maximize the health of both mother and child, my iron recommendations for pregnant women (below) are more intricate than standard recommendations; and tailored to individual needs.  Not every pregnant woman needs the exact same amount of iron. The goal of iron supplementation should be to achieve the “sweet spot” of adequacy for the baby’s development without excess, based on monitoring the mother’s iron status during pregnancy.   It is wise to learn your iron status starting early in pregnancy and use this information to decide the appropriate level of supplementation to complement a health-promoting diet:

 

Ferritin <30 ng/ml OR hemoglobin <11 g/dl:

Gentle Prenatal: 2 capsules daily (18 mg iron)

Additional supplemental iron, 15-25 mg/d, one daily or as directed by physician

 

Ferritin 31-70 ng/ml AND hemoglobin >11 g/dl:

Gentle Prenatal: 2 capsules daily (18 mg iron)

 

Ferritin 71-80 ng/ml AND hemoglobin >11 g/dl:

Gentle Prenatal: 1 capsule daily (9 mg iron)

Women’s Daily Formula + D3: 1 capsule daily

 

Ferritin >80 ng/ml AND hemoglobin 11-12.5 g/dl

Gentle Prenatal: 1 capsule daily (9 mg iron)

Women’s Daily Formula + D3: 1 capsule daily

 

Ferritin  >80 ng/ml AND hemoglobin >12.5 g/dl:

Women’s Daily Formula + D3: 2 capsules daily (no iron)

 

Note that in some cases, especially autoimmune diseases, ferritin may become elevated due to inflammation even if iron stores are normal or low. If your ferritin is >80, your physician can see if it is consistent with a robust hemoglobin.  So if your hemoglobin is below 12, the extra iron during pregnancy may still be advised even with the higher ferritin.  These guidelines are intended to be an aid for you and your physician, but It is best to discuss your iron status with your physician before discontinuing or reducing supplementation.

 
References
  1. Mei Z, Cogswell ME, Looker AC, et al. Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. Am J Clin Nutr 2011;93:1312-1320.

  2. Cogswell ME, Looker AC, Pfeiffer CM, et al. Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003-2006. Am J Clin Nutr 2009;89:1334-1342.

  3. Dietary Supplement Fact Sheet: Iron. Office of Dietary Supplements National Institutes of Health. http://ods.od.nih.gov/factsheets/iron. Accessed January 20, 2012.

  4. Murray-Kolb LE, Beard JL. Iron deficiency and child and maternal health. Am J Clin Nutr 2009;89:946S-950S.

  5. Armony-Sivan R, Kaplan-Estrin M, Jacobson SW, et al. Iron-deficiency anemia in infancy and mother-infant interaction during feeding. J Dev Behav Pediatr 2010;31:326-332.

  6. Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol 2006;13:158-165.

  7. Gautam CS, Saha L, Sekhri K, et al. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Medscape J Med 2008;10:283.

  8. Cunningham FG. Protocols for High-Risk Pregnancies: An Evidence-Based Approach, Fifth Edition. APPENDIX B Laboratory Values in Normal Pregnancy. 2010.

  9. Beard JL. Why iron deficiency is important in infant development. J Nutr 2008;138:2534-2536.

  10. Waldmann A, Koschizke JW, Leitzmann C, et al. Dietary iron intake and iron status of German female vegans: results of the German vegan study. Ann Nutr Metab 2004;48:103-108.

  11. Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr 2005;81:1218S-1222S.

  12. Pena-Rosas JP, De-Regil LM, Dowswell T, et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012;12:CD004736.

  13. Pregnancy: Does every pregnant woman need daily iron supplements, and what are the possible adverse effects? PubMed Health 2010.

  14. Song QY, Luo WP, Zhang CX. High serum iron level is associated with an increased risk of hypertensive disorders during pregnancy: a meta-analysis of observational studies. Nutr Res 2015;35:1060-1069.

  15. Pena-Rosas JP, De-Regil LM, Garcia-Casal MN, et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2015:CD004736.

  16. Milman N Oral iron prophylaxis in pregnancy: not too little and not too much! J Pregnancy 2012;2012:514345.

  17. Alizadeh L, Salehi L. Is Routine Iron Supplementation Necessary in Pregnant Women With High Hemoglobin? Iran Red Crescent Med J 2016;18:e22761.