Preventing Iron Deficiency Anemia During Pregnancy

Iron is incredibly important to the human body, especially during pregnancy. Despite this, iron deficiency anemia is incredibly common for pregnant women. What is iron deficiency anemia, what are its risks for both mom and baby, and how can pregnant women prevent it?

Dr. Alan Lindemann, an obstetrician from North Dakota nicknamed the “Rural Doc.” Dr. Lindemann has over 40 years of experience, has delivered over 6,000 babies, and has made it his mission to support women in taking charge of their health and pregnancies.

Dr. Lindemann provided us with some insight on preventing iron deficiency anemia during pregnancy:

1) Why Is Iron Important During Pregnancy? 

Pregnant women make several units of blood during pregnancy. Your body’s production of blood requires iron; creating additional blood requires even more iron. While you are pregnant, iron is used by your baby to develop neurologically, including the myelin sheath of its nerves and its neurotransmitters.

2) What Is Iron Deficiency Anemia? 

Anemia occurs when your blood lacks adequate healthy red blood cells. Iron deficiency anemia occurs when your body doesn’t have enough iron to make red blood cells. Symptoms of iron deficiency anemia can be fatigue, pale skin, fast heartbeat, shortness of breath, headaches, and cold hands and feet. 

3) How Is Iron Deficiency Anemia Diagnosed? 

Your healthcare provider can check whether or not you are anemic by doing a blood test for ferritin and hemoglobin (Hgb). Ferritin stores iron in your blood cells and releases iron as your body needs it. These levels will be low for a long time before you develop iron deficiency anemia. Your ferritin level can tell you of low Hgb levels to come. Hemoglobin in your blood carries oxygen to your cells. A blood test for ferritin levels in your body should show 45-150 mg/ml. If your ferritin levels are 30-45 mg/ml, you are considered to have low ferritin levels. If you have ferritin levels of less than 30 mg/ml, you have iron deficiency anemia. Normal blood levels of Hgb are 10.9-14 grams per deciliter (g/D), but in pregnancy, your Hgb level should remain 13 or below. If your Hgb level falls below 10.9, you are anemic. A Hgb level of less than 7 is considered severe anemia. 

4) What Are The Risks of Iron Deficiency Anemia During Pregnancy? 

In mothers with iron deficiency anemia in pregnancy, there is a greater risk for many of the pregnancy complications such as transfusion, c-section, amniotic sac infection, blood clots in leg veins or the pelvis, pre-eclampsia, and eclampsia, and postpartum blood clots. For the baby, there are also risks for respiratory distress syndrome, Apgars of less than 7, and the baby winding up in the neonatal intensive care unit (NICU).

5) Is Iron Deficiency Common in Pregnant Women? 

Yes. Iron deficiency is present in about 50% of pregnant women, with about 12% developing iron deficiency anemia. It takes three months for your body to create hemoglobin. During your first trimester, your body starts producing plasma. About 3% of pregnant women will become anemic in the first trimester of their pregnancy. During your second trimester, your body begins making hemoglobin out of the plasma. About 2% of women will become anemic during their second trimester. In the third trimester, when your body is beginning to add iron to your hemoglobin, about 11% of pregnant women will become anemic.

6) How Do I Prevent Iron Deficiency Anemia in Pregnancy? 

Iron, folate, and vitamin B12 are found in prenatal vitamins, but you may also be given an iron supplement as well. Iron supplements for pregnancy come in two forms: iron gluconate and iron sulfate. Iron gluconate creates fewer problems for pregnant women having difficulty with nausea, but it has less available iron than iron sulfate. The iron sulfate not only causes more nausea but also causes more constipation because of the greater amount of iron absorbed. 

7) What If I Can’t Take Iron Gluconate or Iron Sulfate?

Since nausea and vomiting are common problems in pregnancy, physicians have a problem finding an iron medication that will avoid nausea, vomiting, and constipation. When I was a resident 45 years ago, we gave all pregnant women on their first visit prenatal vitamins, iron sulfate, and Bendectin, a medication common and available at that time for the treatment of nausea. Today, Unisom and vitamin B6 are equivalent to Bendectin. I would recommend that when nausea becomes manageable, you should try to switch to iron sulfate. If the iron sulfate can’t be tolerated and you are taking iron gluconate, continue with the iron gluconate but check your ferritin and Hgb levels to be sure you are not becoming low in iron or anemic. If you discover that you cannot tolerate any of the oral iron supplements, iron can be given intravenously.

8) What Are Common Sources of Iron in Our Diet? 

Some foods are rich in iron. Red meat is a good source of iron. If you prefer to avoid red meat, red fruits and vegetables contain iron. Red grapes. The peels of red apples. Beets. Work with your physician to find a solution to getting enough iron that works best for you. Check your ferritin and hemoglobin levels at the onset of your pregnancy and then again at about 24 weeks, or more often if your levels are low, to begin with.

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About Dr. Lindemann:

An obstetrician and maternal mortality expert, “Rural Doc” Alan Lindemann, M.D., teaches women and their families how to create the outcomes they want for their own personal health and pregnancy. A former Clinical Associate Professor at the University of North Dakota, he served as a clinical faculty member and preceptor with medical students in rural rotations. In his nearly 40 years of practice, he has delivered around 6,000 babies and achieved a maternal mortality rate of zero! Learn more at

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