The importance of iron in pregnancy

The importance of iron in pregnancy

Feeling tired, sick, irritable or weak during pregnancy is a common occurrence for most women.

Often, women are generally told to ignore these symptoms as they are a "normal" part of the hormonal and bodily changes during pregnancy.

But for one in three women, these conditions could indicate a more severe disorder - iron-deficiency anaemia.

Although more common than most women may be aware of, this health problem is not normal; and it often goes undiagnosed and untreated, leaving many mothers and babies grappling with long-term health consequences.

Lack of iron

Iron comprises a vital component of our red blood cells, delivering vital oxygen through our body to ensure our continued survival.

According to consultant obstetrician and gynaecologist Dr Premitha Damodaran, women who are considering pregnancy and at risk of anaemia, need to start planning for their pregnancy and afterbirth period by taking the necessary measures to ensure that they have an optimal red blood cell count.

When the number of red blood cells falls below normal levels, less than 12-15mg/dL, women are at risk of developing the most common form of anaemia - iron-deficiency anaemia.

This condition arises when the body lacks iron as a result of an iron-poor diet; poor absorption by the body; side effects of certain medications; genetic conditions; heavy loss of blood; and pregnancy.

During pregnancy, women require additional iron to make more red blood cells to support the nutritional and oxygen needs of themselves and their baby.

It is estimated that a woman requires approximately 50% more iron during pregnancy, increasing the daily standard requirement from 15 to 27mg/dL per day.

Unfortunately, many women begin their pregnancy without having sufficient stores of iron to meet their body's increased demands, leading to iron-deficiency anaemia, which continues even after delivery.

Those who are at the highest risk of iron-deficiency anaemia after pregnancy include pregnant women diagnosed with iron-deficiency anaemia; those who have experienced excessive blood loss during delivery; women who have experienced multiple births; and those who are breastfeeding.

Because the symptoms of anaemia resemble common conditions encountered during pregnancy, like paleness, tiredness, fatigue, and shortness of breath, most women often disregard these symptoms, and think it as a normal part of carrying a baby to term.

However, if not identified and treated, iron-deficiency anaemia can lead to severe complications like miscarriage, premature delivery, low birth weight, and increased maternal mortality.

Diagnosis and treatment

Diagnosis and treatment

Anaemia during pregnancy is easily established by first determining the levels of haemoglobin in the body via a blood test.

It is recommended for a woman to speak to her doctor prior to pregnancy, and assess the level of haemoglobin in her body. (See Anaemia in pregnancy)

Unfortunately, women often only see their doctor when they are already pregnant, and by the time their blood test is done, most are already found to be suffering from mild anaemia.

In more severe cases, medical attention is required as these groups of women are at risk of having a premature delivery and having a baby with low birth weight.

Depending on the severity and cause of anaemia, treating this condition requires little more than following your doctor's advice and making some simple diet and lifestyle changes.

To boost iron supplies when you are trying to conceive, as well as during pregnancy and breastfeeding, women are encouraged to increase intake of iron-rich foods such as poultry, green leafy vegetables, nuts, liver, whole grains, dried fruits such as prunes and raisins, beans, melons, seeds like sesame, and tofu.

Doctors also routinely prescribe iron supplements to treat anaemia.

Patients are recommended to choose an iron formulation that their body can tolerate in order to optimise absorption of iron into the body, as well as helping to reduce common side effects like constipation.

Women can also consider choosing iron supplements with flavoured coatings that help mask the metallic taste of the iron.

To optimise the effectiveness of iron therapy, it is also recommended that mothers consume iron, folate, copper and zinc supplements, with food to reduce inhibitory effects.

A vitamin C supplement is recommended to be taken with meals as it is known to increase iron absorption, whereas tea and coffee reduce iron absorption if consumed one to two hours before taking the iron supplement.

A calcium supplement is also recommended to be taken separately from iron, such as during bedtime, to reduce inhibition of iron absorption.

Women should continue to take iron-rich food and supplements until they stop breastfeeding, or for six months after delivery, whichever comes later.

In severe and life-threatening aneamia, a woman may require hospitalization, blood transfusions, and iron injections.

"Women should always also ensure that their blood is healthy by taking blood tests when they plan to get pregnant, during pregnancy, and four to six weeks after delivery.

"They can always stay on top of their game by acquiring a sufficient amount of iron from their daily diet, as well as supplementation that helps increase blood haemoglobin levels," says Dr Premitha.

She adds that women should seek immediate medical assistance if they experience symptoms like paleness, tiredness, fatigue, and shortness of breath, which might indicate anaemia.


1. Zulkifli A, Rogayah J, Hashim MH. Anaemia during pregnancy in rural Kelantan. Mal J Nutr. 1997; 3: 83-90.

2. Sandstrom B.Micronutrient Interactions: Effects on absorption and biovailability.British Journal of Nutrition 2001; 85(2):181-185

3. Stolzfus RJ, Dreyfuss ML. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. International Nutritional Anemia Consultative Group (INAGG). puloblications/micronutrients/guidelines_for_iron_supplementation.pdf

4. Clinical practice guidelines. The management of anemia in pregnancy and chronic kidney disease. Academy of Medicine of Malaysia. 2007.

This article is courtesy of Merck Malaysia. For more information, e-mail The information provided is for educational purposes only and should not be considered as medical advice.

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