On ALL US orders
On ALL US orders
Iron deficiency is the most common nutrient deficiency globally and is especially common in pregnant women when iron needs are highest. Iron deficiency is easy to screen for, yet you might be surprised to learn that many women aren’t getting proper testing. When left untreated, iron deficiency poses health risks to mothers and their babies.
Since treatment is quite simple, typically only requiring an increase in iron-rich foods and iron supplementation, it is important to be educated about iron during pregnancy and advocate for proper testing in the health care system. This article will provide the information required to do just that.
“Iron deficiency is the most common nutrient deficiency globally and is especially common in pregnant women when iron needs are highest. Iron deficiency is easy to screen for, yet you might be surprised to learn that many women aren’t getting proper testing. When left untreated, iron deficiency poses health risks to mothers and their babies.”
Keep reading to learn more about:
Let’s dive into this important topic!
What Is Iron Deficiency Without Anemia?
Anemia is a condition where you don’t have enough healthy blood cells to transport the amount of oxygen required by cells and tissues throughout the body. You may be familiar with iron deficiency anemia, the most common form of anemia that is due to low iron status. (Source 1)
Of note, anemia may also be caused by low folate (also known as vitamin B9 or folic acid) or low vitamin B12 status as these nutrients are required for the methylation cycle that builds blood cells. Autoimmunity is another cause of anemia.
Iron deficiency anemia is diagnosed with a blood test for hemoglobin (also spelled haemoglobin). Hemoglobin is the iron-containing protein structure in red blood cells that carries oxygen. Iron deficiency anemia is diagnosed when hemoglobin is at or below 13 g/dL (130 g/L) for men and 12 g/dL (120 g/L) for women. (Source 2)
However, it’s possible to have iron deficiency without anemia. This means that iron levels and iron stores are low, but the hemoglobin level remains within the normal range.
Serum ferritin is the most sensitive blood test for iron deficiency and represents iron in its storage form. Where hemoglobin may be the last place for iron to deplete, ferritin will be the first. Ferritin levels below 30 μg/L suggest iron deficiency independent of other iron labs, especially when iron deficiency symptoms are present. (Source 2) Some research suggests that levels above 45 μg/L is a more optimal range. (Source 3)
To see a full list of iron labs, such as hematocrit, along with functional (optimal) ranges, see my article, Iron Supplements – Pregnancy, Postpartum and Menorrhagia.
Symptoms Of Iron Deficiency
Iron deficiency symptoms may be the same as symptoms of anemia. It’s possible to have prolonged, severe and even debilitating symptoms related to iron deficiency, without meeting the diagnostic criteria for anemia.
Possible symptoms of low ferritin concentrations include:
In some cases iron deficiency is misdiagnosed or mistaken for other conditions including subclinical hypothyroidism, chronic fatigue, fibromyalgia, HPA-axis dysfunction (“adrenal fatigue”) or over training. (Source 2)
Risk Factors For Iron Deficiency
Inadequate iron intake from iron-rich foods will cause low iron status. While it’s possible to meet iron requirements from diet alone, it’s important to note that certain people or populations may have higher needs, especially growing children, those who menstruate and pregnant women.
Risk factors to consider include:
Iron Deficiency In Pregnancy
Iron needs increase in pregnancy from 18 mg per day for menstruating women to a Recommended Dietary Allowance (RDA) of 27 mg per day during pregnancy. (Source 6)
Iron requirements are similar to pre-pregnancy needs during the first trimester, but then ramp up in the second trimester and third trimester due to an increase in blood volume, the growth of the placenta and the needs of the developing baby.
Because of these increased needs, pregnant women are more at risk for iron deficiency and related health problems. In addition, many women enter pregnancy in an iron-deficient state or have a hard time eating iron-rich foods during pregnancy because of nausea and food aversions. Blood loss during delivery also contributes to iron deficiency increased risk during the postpartum period.
In a Canadian study of over 44,000 women, only about 60 percent of pregnant women received a ferritin test during pregnancy, leaving a full 40 percent who did not. Of those who received a ferritin test, 71 percent received the test at their first prenatal visit during the first trimester, before iron needs dramatically increase. (Source 7)
Women were likely to only receive the single ferritin test without follow up in the second trimester or later. Iron testing may be even less likely for those with a lower socioeconomic status. It’s also important to note that the women in this study did not need to pay out-of-pocket for ferritin testing, which many women may have to in the United States health care system, presenting a further barrier to proper assessment of iron levels.
Of the women in the study who did have serum ferritin tested, 50 percent had low levels of ferritin and 25 percent had severe iron deficiency. (Source 7)
Such a prevalence of iron deficiency is concerning because iron deficiency in pregnancy is linked to negative outcomes for both mother and her baby, including:
Because of how common iron deficiency is in pregnancy, it is important to include ferritin, the standard measure of iron deficiency, as a regular screening test in prenatal obstetrics care. It’s a matter of public health.
How To Reverse Iron Deficiency
Luckily, iron deficiency (with or without anemia) is quite easy to prevent and treat. Here are some action steps focusing on evaluation, diet and iron supplementation:
It may be helpful to use an online tracking tool (such as cronometer.com) to see if you are meeting your dietary iron needs. Or, for personalized guidance, especially if you eat a plant-based diet or are preparing for pregnancy, work with a functional medicine-oriented Registered Dietitian or another knowledgeable clinician.
Today, it is more common for high quality multivitamins, including prenatal vitamins, to also be iron-free so that each person may add iron only when needed and be able to adjust dosages.
Core Med Science’s Liposomal Multivitamin with Active B Complex, Minerals and Antioxidants doesn’t contain iron for these reasons.
Liposomal Iron Supplements
For those who actually do need to supplement with iron, liposomal iron supplements are a superior option. When iron is packaged in a liposome, a phospholipid membrane that mimics our own cells, supplemental iron absorption increases. (Source 9) This means that you may require a lower dose but get better results.
Liposomal iron also solves the problem of gastrointestinal side effects because it is much better tolerated, especially for those with sensitive stomachs or with morning sickness that makes taking iron supplements more challenging.
Core Med Science’s Liposomal Iron offers this superior absorption and tolerance. It is available in a convenient (and tasty!) liquid form so it’s easy to adjust the dose to your needs. Be sure to work with your doctor for proper dosing and monitoring.
With 50 percent of pregnancies affected by iron deficiency, it is important to have regular ferratin screenings and supplement with liposomal iron in order to maintain optimal iron levels.