9 Iron Deficiency Tells – How To Avoid Pregnancy Fatigue and Regain Your Glow

You may know that women of reproductive age have additional iron demands, mostly due to menstrual losses each month. Australian data shows that 2 in 5 females are not achieving adequate iron from their diets alone (ABS, 2011-12), and iron requirements only increase in pregnancy, particularly in the second and third trimesters.

It is crucial to optimise iron levels prior to pregnancy where possible. If deficiency is identified, you want to avoid worsening iron deficiency and the feelings of fatigue, poor concentration and low mood that come along with an insufficient amount of this essential mineral.

What Is Iron?

Iron is an essential mineral found in the centre of red blood cells (called haemoglobin), it’s primary role in red blood cells is to pick up oxygen from your lungs and transport it to your around your body.

Adequate iron also supports healthy immune function.

How Do I Know I’m Iron Deficient? 9 Symptoms.

Iron deficiency can be sneaky, for some you will feel some of the symptoms outlined below, for others, they may not feel much difference at all. This is why it’s so important to get checked with a simple blood test from your GP.

Some common symptoms of iron deficiency include:

  • Fatigue
  • Restless legs
  • Lack of concentration
  • Pale appearing skins
  • Feeling dizzy
  • Feeling short of breath
  • Cold hands and feet
  • Brittle nails
  • Pica: craving and/or eating non-food items such as dirt, washing powder or ice.

Getting your iron levels tested is quite simple. You can request a test via your GP or obstetrician-gynaecologist especially if you’re pregnant or planning a pregnancy. You would also want to request a test if you are experiencing symptoms or if increased risk of iron deficiency as you have heavy menstrual losses, you’re vegetarian or vegan (as plant-based sources of iron are not as well absorbed) or you don’t eat red meat. Other reason may include if you have certain gastrointestinal disorders such as Coeliac Disease or Inflammatory Bowel Diseases.

There are a number of metrics that are tested to assess iron status and your level of deficiency. The key measures to note are:

  • Ferritin: this is your body’s storage marker for iron. If this marker is low, it’s usually the first indication of iron depletion. The accepted standard for females preparing for pregnancy or during pregnancy is 30 ug/L or above is considered an acceptable standard. 25% of your body’s iron stores are in the form of ferritin. If this is low, it can leave you feeling a lot more tired than usual!
  • Transferrin: this is your body’s transporter protein, when this is low this is indicative of iron deficiency.
  • Haemoglobin: your red blood cells, when this count is low, it is considered iron deficiency anaemia.

Speak to your doctor for individualised advice based on your unique circumstances and blood tests.

Iron Deficiency in Pregnancy – What Are the Risks?

Being iron deficient in pregnancy can worsen the feelings of tiredness. Growing a human is a lot of hard work! You may think now that your period is on a break, that iron requirements should drop. Well they do in the first trimester but shortly after that 12-week mark, your iron demands quickly rise as your blood volume starts to expand to support you and your baby. More haemoglobin means you need more iron!

Supporting healthy blood supply and oxygenation is important for you to feel your best and to support baby’s growth and development too.

Iron deficiency anaemia in pregnancy is common and has been shown to affect 25% of women in pregnancy (RACGP, 2019). Whilst common, there are a variety of risks associated with iron deficiency anaemia that need to be considered including an increased risk of premature birth, low birth weight baby and postpartum depression (Juul, Derman and Auerbach, 2019; Wassef, Nguyen, St-Andre, 2019).

Iron deficiency anaemia, if severe, can impact regular ovulation too, which can affect fertility and pre-conception health. (Li et al., 2014). One study showed that those women who took iron supplements were less at risk of anovulatory infertility (Chavarro et al., 2006).

Checking your levels, and correcting as soon as possible with a combination of diet and/or supplementation therapy as discussed with your doctor and dietitian is crucial. It’s a common issue that pregnant women struggle to keep down iron supplements in the first trimester as they have been know to exacerbate nausea and constipation which are common symptoms during the early stages of pregnancy.

How to Avoid Iron Deficiency?

If you’re wondering how to avoid iron deficiency in the first place, then we need to be thinking about diet and nutrition as a starting point.

Non-pregnant women who menstruate need 18 mg per day, Pregnant women need 27 mg per day, Post-partum whilst breastfeeding and not menstruating 9 mg per day of iron is required.

Vegetarians and vegan require 80% more iron prior to, during and after pregnancy to support their needs, this can make it all the more challenging to achieve through diet alone.

as requirements skyrocket when combining pregnancy needs AND a plant-based diet together, equates to requiring a whopping 49 mg of iron each day! With 1 cup of legumes or beans providing about 4 mg of iron, that’s a lot of beans to eat in a day!

There are two sources of dietary iron, haem iron sources and non-haem iron sources.

Haem sources are those that “draw blood” i.e. meat, fish and seafood as well as poultry like chicken. The redder the meat, the more iron it contains! So for example beef and lamb contain more iron than chicken.  This form of iron is preferential as this is the form that your body absorbs best!

Non-haem iron sources such as tofu, nuts, seeds, legumes and beans, fortified wholegrains and even eggs (although not a plant, it doesn’t draw blood) also contains iron. However, this form of iron is poorly absorbed and is more susceptible to inhibitors such as the tannins found in tea or coffee, calcium-rich foods and other mineral supplements including calcium, zinc and magnesium. However, by spacing out your favourite hot drink and supplements from plant-based iron rich meals you can boost absorption.

Another tip is to combine with a source of vitamin C such as a piece of fruit, spinach, broccoli, tomatoes or capsicum, adding a squeeze of lemon or lime juice to your meal to boost absorption of non-haem iron sources.

If you’re concerned about your meeting your iron needs through diet, please speak to a fertility & prenatal dietitian to discuss individualised strategies to support you!

Choosing an Iron Supplement

You’ll find that with the increased requirements and pregnancy symptoms such as nausea, your diet might not be able to consistently meet the demands for iron. In order to get your iron levels in range, especially during pregnancy when demands are incredibly high, a high quality Iron supplement is a safe and effective way to improve iron status before, during and after pregnancy.

Iron supplements made from ferrous fumarate or ferrous sulfate are notorious for their constipating effects, and impacting digestion and even the colour of your poo turning black. This can be a big turn-off if you need to take them daily. Other forms of iron such as bisglycinate, amino acid chelate and polymaltose tend to be better in alleviating these digestive side effects.

Dosage is important too. Make sure if your iron levels are low, that you are taking at least 100 mg of iron daily. Smaller doses such as 24 or 27 mg can only help maintain your iron status if they are already within normal range. Speak to your health care provider for individualised dosage recommendations.

Speak to your doctor if your symptoms and iron status is not improving throughout any stage of pregnancy. There are other options for discussion such as iron infusions, however they are only given in the second and third trimesters.

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