Iron Deficiency During Pregnancy
Pregnant individuals may require additional supplemental iron beyond 27 mg to meet requirements in later pregnancy, given the high rates of iron deficiency observed in this clinical trial, despite consumption meeting 100% of the RDA [1].
Iron in Pregnancy
Iron requirements increase with advancing gestation and are ∼10-fold higher by late pregnancy to accommodate the expansion of red blood cell mass and iron transfer to the placenta and fetus [2].
Iron Deficiency Symptoms in Pregnant Women
Maternal iron deficiency, anemia, and iron-deficiency anemia are most prevalent in the third trimester, and may result in symptoms of fatigue, restless leg syndrome, pica, hair loss, and irritability (often dismissed as normal symptoms of pregnancy), and have been associated with impaired neonatal growth and neurocognitive development [3-9].
Iron Deficiency in Pregnant Women
Although the majority of pregnant individuals in the United States (∼70%) [10] and Canada (∼90%) [1] report consumption of prenatal multivitamins and standard formulations typically contain 20–27 mg of elemental iron, there are concerns that this may not be sufficient to prevent iron deficiency with advancing gestation [12, 13].
Iron stats in North America
70%
United States
90%
Canada
Incidence and Prevalence
The true prevalence of iron deficiency in an unselected population may be even higher than the 80% in later pregnancy found in this clinical trial population, underpinning the urgency for action to improve iron-deficiency screenings and treatment [1].
Treatments
As treatment with oral iron is recommended in those with probable iron deficiency ferritin <30 μg/L) [14].
- Cochrane KM, Hutcheon JA, Karakochuk CD. Iron-Deficiency Prevalence and Supplementation Practices Among Pregnant Women: A Secondary Data Analysis From a Clinical Trial in Vancouver, Canada. J Nutr. 2022 Oct 6;152(10):2238-2244. doi: 10.1093/jn/nxac135. PMID: 35687377; PMCID: PMC9535446. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535446/
- Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000 Jul;72(1 Suppl):257S-264S. doi: 10.1093/ajcn/72.1.257S. PMID: 10871591. - https://pubmed.ncbi.nlm.nih.gov/10871591/
- Benson CS, Shah A, Frise MC, Frise CJ. Iron deficiency anaemia in pregnancy: A contemporary review. Obstet Med. 2021 Jun;14(2):67-76. doi: 10.1177/1753495X20932426. Epub 2020 Jul 7. PMID: 34394714; PMCID: PMC8358243. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8358243/
- Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015 Dec;55(12):2799-806. doi: 10.1111/trf.13252. Epub 2015 Aug 4. PMID: 26246160. - https://pubmed.ncbi.nlm.nih.gov/26246160/
- Juul SE, Derman RJ, Auerbach M. Perinatal Iron Deficiency: Implications for Mothers and Infants. Neonatology. 2019;115(3):269-274. doi: 10.1159/000495978. Epub 2019 Feb 13. PMID: 30759449. - https://pubmed.ncbi.nlm.nih.gov/30759449/
- Alwan NA, Cade JE, McArdle HJ, Greenwood DC, Hayes HE, Simpson NA. Maternal iron status in early pregnancy and birth outcomes: insights from the Baby's Vascular health and Iron in Pregnancy study. Br J Nutr. 2015 Jun 28;113(12):1985-92. doi: 10.1017/S0007114515001166. Epub 2015 May 6. PMID: 25946517; PMCID: PMC4498461. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498461/
- Radlowski EC, Johnson RW. Perinatal iron deficiency and neurocognitive development. Front Hum Neurosci. 2013 Sep 23;7:585. doi: 10.3389/fnhum.2013.00585. PMID: 24065908; PMCID: PMC3779843. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779843/
- Wiegersma AM, Dalman C, Lee BK, Karlsson H, Gardner RM. Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders. JAMA Psychiatry. 2019 Dec 1;76(12):1294-1304. doi: 10.1001/jamapsychiatry.2019.2309. PMID: 31532497; PMCID: PMC6751782. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751782/
- Georgieff MK. Long-term brain and behavioral consequences of early iron deficiency. Nutr Rev. 2011 Nov;69 Suppl 1(Suppl 1):S43-8. doi: 10.1111/j.1753-4887.2011.00432.x. PMID: 22043882; PMCID: PMC3266848. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266848/
- Saldanha LG, Dwyer JT, Andrews KW, Brown LL. The Chemical Forms of Iron in Commercial Prenatal Supplements Are Not Always the Same as Those Tested in Clinical Trials. J Nutr. 2019 Jun 1;149(6):890-893. doi: 10.1093/jn/nxz042. PMID: 31149713; PMCID: PMC6698632. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698632/
- Bartholomew, Sharon. What mothers say: The Canadian Maternity Experiences Survey. Public Health Agency of Canada, 2009.
- O'Brien KO, Ru Y. Iron status of North American pregnant women: an update on longitudinal data and gaps in knowledge from the United States and Canada. Am J Clin Nutr. 2017 Dec;106(Suppl 6):1647S-1654S. doi: 10.3945/ajcn.117.155986. Epub 2017 Oct 25. PMID: 29070557; PMCID: PMC5701721. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701721/
- Tang, Grace, et al. "Prevalence of iron deficiency and iron deficiency anemia during pregnancy: a single centre Canadian study." Blood 134 (2019): 3389.
- Government of British Columbia, British Columbia Ministry of Health . Iron deficiency—diagnosis and management. Vancouver (British Columbia): British Columbia Ministry of Health; 2019.
Could you be experiencing iron deficiency?
Iron deficiency can show up in many ways, like extreme fatigue, pale skin, or difficulty concentrating. Take our easy quiz to detect possible warning signs and take action early.
How talk to your doctor about iron deficiency
Talking to your doctor about iron deficiency doesn’t have to be complicated. Share your symptoms and concerns, ask for a blood test to check your iron levels, and explore options for managing your health together. Early diagnosis can make a big difference.
Could you be experiencing iron deficiency?
Iron deficiency can show up in many ways, like extreme fatigue, pale skin, or difficulty concentrating. Take our easy quiz to detect possible warning signs and take action early.
How talk to your doctor about iron deficiency
Talking to your doctor about iron deficiency doesn’t have to be complicated. Share your symptoms and concerns, ask for a blood test to check your iron levels, and explore options for managing your health together. Early diagnosis can make a big difference.
Could you be experiencing iron deficiency?
Iron deficiency can show up in many ways, like extreme fatigue, pale skin, or difficulty concentrating. Take our easy quiz to detect possible warning signs and take action early.
How talk to your doctor about iron deficiency
Talking to your doctor about iron deficiency doesn’t have to be complicated. Share your symptoms and concerns, ask for a blood test to check your iron levels, and explore options for managing your health together. Early diagnosis can make a big difference.