Anaemia in Pregnancy – should I supplement?

Anaemia most commonly occurs in the second trimester of pregnancy. Before taking iron tablets though it’s important to consider the following:

• Never take iron tablets in pregnancy unless a blood test has confirmed that you are deficient. Links have been made between too much iron in the blood and lower birth weight babies. Less iron means thinner blood, which in turn means it can transport nutrients to the fetus more efficiently. Too much iron can prevent the transport of such nutrients.
• Ensure you are being tested for iron levels at an appropriate time. Do not get checked for anaemia right after an expanse in blood volume. When this occurs it will take some time for the red blood cells (which are what are used to measure iron levels) to catch up to the rise in volume. This can look like anaemia, when in fact it isn’t. Speak to your midwife or doctor about appropriate times to take a test.

If you have been advised to take iron tablets, make sure you are informed:

• Minerals in supplement form need to be ionised, ie they have to be bound to something. For example, a calcium citrate supplement will be a calcium ion + citric acid. This bond is what gets them successfully into your system without poisoning your cells. In the digestive system, the bond is broken and the mineral allowed to make it’s way to the cells where it’s needed. The bond can be strong or weak. A weak bond is without a doubt better as it breaks down easily, is gentle on the stomach and is easily absorbed.
• You doctor or mainstream midwife will prescribe your iron as ferrous sulphate. This is the strongest of the strongest bonds, (mainly because its extremely cheap for the government to subsidise) an inorganic mineral which is often prescribed in ridiculously high dosages (around 600mg pr day) due to the fact that you can’t absorb most of it. Side effects are usually constipation (not what you need more of in pregnancy) and intense stomach pain, due to your poor stomach struggling with mega doses of a supplement it has to fight to break apart.
• 600mg of ferrous sulphate will actually only give your body about 100mg of actual iron (called the elemental dose).

So my advice is to increase your levels through:

• Ensuring you are digesting and absorbing your food properly.
• Eating foods high in iron
• Supplementing with food source supplements – Spirulina Powder and Beetroot Extract are easy to get hold of in health food stores and are fabulous sources of iron
• Supplementing with appropriate iron tablets, with weak gentle bonds. This means you won’t need to take 600mg per day, as you’ll absorb much more of the smaller but more effective dose you do take, again reducing side effects.

Recommended iron supplement forms are iron or ferrous bound not with sulphate, but with:

• citrate
• glycinate
• EAP2
• picolinate
• fumarate

You simply have to look at the label of the iron supplement you are taking to see what the iron is attached to.

If you’re low in iron and worried, don’t be, it’s easy to remedy and some medical professionals don’t actually think it’s a problem, see quote below, taken from Fetal and Maternal Medicine Review (2001, vol 12, 159-175, Cambridge University Press)

As a haematologist I would like to present an alternative view to the belief that routine iron supplements during pregnancy are neither necessary or beneficial in developed countries and that advantages, if any, are far outweighed by widely publicized real and theoretical side effects.

For most clinicians it is difficult to accept that in well nourished populations the extra requirements of pregnancy are not met by a normal mixed diet. The haemodilution which occurs in healthy pregnancy because of the dramatic expanse in plasma volume has encouraged the acceptance of abnormally low haemoglobin levels as being physiological. Traditionally, obstetricians have believed that the only manifestation of iron deficiency during pregnancy is maternal anaemia which results in very few clinical manifestations and there are no other adverse sequelae for the mother and none at all for the fetus and infant. These concepts are supported by the fact that controlled trials do not demonstrate any obvious benefit of iron supplementation, particularly if the neonate is not subjected to long-term follow-up.