ANEMIA (LOW IRON) IN PREGNANCY

The following information is directly from the Association of Ontario Midwives
https://www.ontariomidwives.ca/sites/default/files/2017-09/Iron%20deficiency%20anemia-KT.pdf

WHAT IS IRON DEFICIENCY ANEMIA?

Iron plays many important roles in your health. You need iron to make hemoglobin, a part of red blood cells that carries oxygen throughout the body. When you have iron deficiency anemia, you don’t have enough iron to make hemoglobin, so your body starts to make smaller and fewer red blood cells. Less hemoglobin and fewer red blood cells also means your cells can’t get the oxygen they need.

NORMAL CHANGES TO BLOOD VOLUME IN PREGNANCY

Pregnancy causes many changes in the body. One of the changes that happens in pregnancy is that the amount of blood in your body almost doubles. Blood is made up of red blood cells, white blood cells and fluid called plasma. The number of red blood cells doesn’t increase as much as the plasma. This process is called “hemodilution” because the blood cells get diluted when the plasma increases. Hemodilution is a healthy response to pregnancy and a common cause of anemia. If your iron is low at the start of your pregnancy, this normal process of hemodilution can lead to anemia.


HEMOGLOBIN is a part of red blood cells.
Hemoglobin carries oxygen throughout the body.

IRON is something your body needs in order to make hemoglobin. Iron is an essential nutrient, which means you have to get iron from your diet because your body can’t make it.

HEME IRON (also called organic iron) is found in meat. The body easily absorbs this type of iron.

NON-HEME IRON (also called inorganic iron) is mainly found in leafy greens, but is also found in meat, poultry and fish. This type of iron is less easily absorbed by the body.

FERRITIN is a protein that stores iron in your body. Your body can use the “backup” iron that is stored in ferritin when it doesn’t get enough iron from the food you eat.


HOW DO I KNOW IF I’M ANEMIC?

Having a blood test is the only way to know for sure if you have anemia. Your midwife will offer you a blood test to check your hemoglobin levels in early pregnancy and again around 30-32 weeks of pregnancy. You may be offered another blood test after your baby is born. Your midwife may also offer testing more frequently in pregnancy if there are concerns you might be anemic.

WHAT MIGHT INCREASE MY RISK OF HAVING ANEMIA?

A vegetarian or vegan diet may put you at higher risk for anemia because the iron found in vegetarian food sources is non-heme iron and is harder for the body to absorb.

Vitamin D deficiency may also increase the risk of anemia since vitamin D plays an important role in iron absorption. Your body produces vitamin D when your bare skin is exposed to sunlight. Anyone who keeps their skin mostly covered may be at higher risk of vitamin D deficiency. Because of our long winters, this can include most people who live in Canada!

A multiple pregnancy (twins or triplets) may put you at higher risk for anemia because the demands for iron are even higher than during a pregnancy with one baby.

It can take up to 18 months for the body to fully recover from a pregnancy, so two (or more) pregnancies less than a year apart can make it hard to maintain good iron stores.

People who have very heavy menstrual periods often have low iron because they lose a lot of blood every month. If you had heavy periods before becoming pregnant, you may be at higher risk of anemia during pregnancy.

If you are anemic during pregnancy you are also more likely to be anemic postpartum.

If you have a postpartum hemorrhage (losing too much blood after birth), you may be at higher risk for becoming anemic. For more information about postpartum hemorrhage, see Client Handouts page on OntarioMidwives.ca.

WHY TREAT ANEMIA?

It’s important to treat anemia so you feel better as quickly as possible and to maintain your overall health. It is also important to ensure that your iron levels are healthy if you are planning a future pregnancy. If your iron levels are very low in early pregnancy, there is a slightly higher chance that your baby will be born early or could be born smaller than expected (also called, “small for gestational age”). It is also important to treat anemia before you give birth. It is normal to lose some blood during labour and delivery, but low hemoglobin at the start of labour can put you at risk of worsened anemia after the baby is born. Depending on how severe your anemia is at the end of your pregnancy, your midwife may have recommendations about where you plan to give birth.

HOW IS ANEMIA TREATED?

If you are diagnosed with anemia, your midwife will discuss options for treatment. Iron pills or liquid supplements are usually the first choice to treat anemia during and after pregnancy.

There are lots of different iron supplements available in Canada. Iron is often included in multivitamins, including prenatal vitamins. Elemental iron is the form of iron that your body absorbs easily and different formulations of iron supplements contain different amounts of elemental iron. It is recommended that people who are diagnosed with iron deficiency anemia take supplements that provide about 50-100 mg of elemental iron each day.

There isn’t strong evidence showing that one brand of iron is more effective or causes less side-effects than any other. It can be confusing to choose which iron supplement to buy, especially since prices vary. Talk to your midwife about what supplement is right for you.

ACCESS TO IRON SUPPLEMENTS

Some health-care plans and Ontario Works will pay for over-the-counter medications (like iron) if a health-care provider writes a prescription. Check with your health plan or your Ontario Works caseworker to see if your iron supplements will be free or cost less with a prescription from your midwife.

DOS AND DON’TS FOR TAKING IRON

Iron is best absorbed on an empty stomach. Sometimes iron supplements can give you a stomach ache, make you constipated or give you diarrhea. If you are having unpleasant side-effects from taking iron, you can try taking iron right after meals instead of on an empty stomach, or try taking it before you go to bed. You can also talk to your midwife about starting at a lower dose and gradually increasing the dose. It is normal to notice dark coloured bowel movements when you are taking oral iron.

DO take your iron with vitamin C (citrus fruits like oranges, strawberries, tomatoes, or a 500-mg vitamin C tablet). Your body needs vitamin C in order to absorb iron.
DO keep taking iron supplements for at least three months even if you start to feel better, unless your midwife gives you different instructions. Your symptoms might improve quickly, but taking iron for the full three months ensures that you replenish your iron stores (ferritin).
DO talk to your midwife if the side-effects of iron are bothering you.
DO make sure that iron supplements are kept out of the reach of children. Iron can be toxic.

DON’T drink coffee or black teas at the same time you take iron. Tannins in coffee and tea stop your body from absorbing iron. Wait at least one hour after taking iron to have tea or coffee.
DON’T take your iron along with calcium. Avoid eating dairy (milk, yogurt, cheese), or taking calcium pills, or antacids (like Tums) within about an hour of taking iron supplements. Try to avoid combining iron-rich foods with foods rich in calcium (like dairy products). Calcium gets in the way of your body’s ability to absorb iron.

BOOSTING THE IRON IN YOUR DIET

If your midwife has diagnosed you with anemia, then food sources alone probably won’t be enough to improve your anemia. But it still helps to try to eat iron-rich foods as much as you can along with any supplements you may be taking. Dieticians of Canada has good information about iron and iron-rich foods. Please see: www.dietitians.ca/Your-Health/Nutrition-A-Z/ Minerals/Food-Sources-of-Iron.aspx.

ACCESS TO HEALTHY FOODS
If you are pregnant or have just had a baby and are receiving Ontario Works, you are eligible for an extra $40 a month through the Pregnancy/Breastfeeding Nutritional Allowance. Midwives can complete forms provided by Ontario Works caseworkers to access this funding for you.

OTHER TREATMENT
If your anemia is severe, or if it’s not getting better after you have tried oral iron supplements, your midwife may discuss a consult with an obstetrician to discuss other treatment options like getting iron through an IV (a needle in your arm).

ANEMIA AND DEPRESSION
The symptoms of anemia can sometimes be similar to symptoms of depression. If you are anemic either during your pregnancy or after your baby is born, you may feel like you are depressed. Anemia can also lead to depression. If you have any concerns about the symptoms below, talk to your midwife.

IRON RICH FOODS

NOTES & RESOURCES
Pregnant people should limit intake of liver to one serving every two weeks.

Iron is best absorbed when consumed with foods that contain vitamin C.

Calcium should be avoided when eating iron rich foods as it inhibits the body’s absorption of iron.

Caffeine may also inhibit iron absorption.

Association of Ontario Midwives – Iron Deficiency Anemia https://www.ontariomidwives.ca/sites/default/files/2017-09/Iron%20deficiency%20anemia-KT.pdf