Iron in pregnancy

We know there’s already a lot to think about during pregnancy (taking Vitamin D and folic acid daily, as well as ensuring you’re getting enough Omega-3s) – but iron’s equally as valuable and plays a big role in a happy and healthy pregnancy, too.

In this piece, we'll go over some of the key things you need to know, including:

• The role of iron in the body
• What iron deficiency anaemia is
• How much iron you need during pregnancy
• How to get more iron in your diet
• What you need to know about iron supplements
• Possible side effects of iron supplements

By clicking one of the links above, you can skip ahead to the section you want to read. That said, we'd recommend reading the whole piece.

Here’s everything you need to know about iron – why you need it, how to get it and how to avoid becoming anaemic or iron deficient while you’re expecting…

What is iron – and why is it important?

Essentially, iron is part of haemoglobin, which is the thing in your red blood cells that transports oxygen from A (your lungs) to B (the rest of your body).

It also helps keep lots of your body in tip-top shape, like: your cells, your nails, your skin and your hair.

We get our iron (a mineral) from iron-rich foods, such as nuts, legumes, leafy greens, dark chocolate and certain kinds of meat.

What’s iron deficiency anaemia?

If you don’t get enough iron, you’ve not got enough red blood cells to go around.

It’s hard to get enough oxygen, leaving you extremely fatigued and unable to fight infections properly.

That’s what you’d call iron deficiency, or iron deficiency anaemia. Annoyingly, it’s quite common in pregnancy.

There are several types of anaemia (stopping folate-deficiency anaemia is why you take folic acid during pregnancy) – but for the purposes of this piece, we’re just talking about the iron deficiency kind.

How much iron do you need in pregnancy?

Because women bleed once a month during their period, your typical adult woman needs about 18mg of iron per day. That’s about 10mg more than your average man needs. Likely, this’ll all come from a diet rich in iron.

During pregnancy, you’ll likely need a bit more than 18mg, as your body creates more blood to cater for you and your baby.

"As part of the many changes in pregnancy, your blood volume increases: put simply, you have more blood than you had before by approximately a whopping 50%," says MFM's consultant GP, Dr Philippa Kaye.

"So, for the average Caucasian European woman, your blood volume pre pregnancy is about 2,600ml. This increases by about a further 1,250ml during pregnancy.

"There is little rise in the 1st trimester but then it gradually increases up until approximately 34-36 weeks."

As a result, we’ve seen many reputable sites suggest the ideal amount for a pregnant woman is 27mg per day (but we’ve yet to find a specific recommendation from the NHS.)

We should add that having a mild form of anaemia is considered fairly normal during pregnancy, but a severe deficiency, if left untreated, can run the risk of your baby being born early, or smaller than expected.

Speak to your doctor about your iron intake, if you’ve got concerns you’re not getting enough, or if any of the below sounds familiar…

What are the signs and symptoms of iron deficiency anaemia in pregnancy?

Not only can it exhaust you, but there’s a high chance you’ll be looking rather peaky. Anaemia is commonly associated with paleness.

Unfortunately, most pregnant women don’t actually realise they’re iron deficient until more obvious, uncomfortable symptoms (via WebMD) have popped up:

• Feel short of breath
• Have a fast heartbeat
• Have a sore tongue
• Have cold hands and feet
• Crave strange substances such as dirt or clay
• Have brittle and spoon-shaped nails or hair loss
• Have sores at the corners of the mouth
• In severe cases, have difficulty swallowing.

How is iron deficiency anaemia diagnosed in pregnancy?

A complete blood count (CBC) test from your GP would show your haemoglobin levels, and determine whether you have a low red blood cell count.

"Your doctor or midwife doesn’t just look at the haemoglobin level in your blood," explains Dr Kaye, "because we expect this to be lower than normal.

"Blood is made up of a number of components, and as the volume of your blood increases during pregnancy, the red cells increase but not to the same degree - that's why pregnant women will generally have a dilutional [a mild form of] anaemia.

"So, we also look at the red cells themselves to see whether or not you are actually deficient in iron."

To summarise? It’s vital that you pay your GP a visit if any of those symptoms ring a bell, and you’re worried you might be anaemic.

How do you treat iron deficiency anaemia?

Diet and supplements are the key ways to nipping an iron deficiency in the bud. The best things you can do to keep your iron levels up are add some (more) iron-rich foods to your diet.

If you’re really deficient, your doctor might want you to take a supplement to boost your levels.

If you’re already taking a pregnancy multivitamin, you might already be getting a bit of extra iron. If you are, have a check of the pack and see if it includes iron.

How can you get more iron in your pregnancy diet?

There are lots of foods that contain iron – and some which have extra iron added in (these are called iron-fortified). If you need more iron in your diet, especially during pregnancy, here’s some stuff you can eat:

• Spinach and kale (but lots of it!)
• Quinoa
• Turkey
• Red meat
• Pumpkin seeds
• Legumes like beans, lentils and chickpeas
• Broccoli
• Tofu
• Dark chocolate (woohoo!)
• Oatmeal and rye
• Dried figs and apricots
• Iron-fortified breakfast cereals
• Prunes
• Raisins
• Red tart cherries
• Watermelon
• Nuts and peanut butter

Shellfish like oysters is also a good source of iron – but when pregnant you’ve got to make sure it’s properly cooked, and NOT eaten raw.

(Read more about seafood and shellfish safety guidelines for pregnant women.)

Organ meat (like liver, for example) is also a great source – but it’s recommended pregnant women don’t eat liver, and liver pate, because it contains a lot of Vitamin A, too much of which can affect your baby's eyesight.

(You can read more about why liver shouldn’t be eaten during pregnancy here.)

What types of iron supplements are there for pregnant women?

Your GP or midwife will prescribe you an iron supplement if they think you need one, Dr Kaye tells us.

However, you can also get them over the counter, in supermarkets or in places like Boots and Holland & Barrett. You can get them in tablet form, but also in liquid form. There are a variety of brands on the market.

(Again, chat to your GP or midwife before you start taking any new supplements during your pregnancy.)

One brand, Spa-tone, actually won a Bronze MadeForMums Award in the Hero Health Product category, for its Apple Liquid Iron Supplement.

One of our mum-to-be testers, Ceri, preferred it to the big iron tablets you can sometimes get, adding: "I was originally taking big iron tablets which often got stuck and made me feel sick.

"This liquid form of iron is amazing. It takes a second to drink and it hasn't got a nasty after-taste. It is quick to take and you can pop a sachet in your bag while you're out.

"I found it helped with my energy levels also and I felt less tired."

Indeed, lots of the mums on our forum have had their own struggles with certain types of iron supplements - as they're not the easiest pills to swallow (figuratively speaking).

"I've just gone onto iron tablets and am on 1 twice a day. I hate them, but as I keep being told, they are doing me good," says Annie, a member of our MadeForMums community.

"I am opting to try the sachets which you can buy from health shops instead of iron tablets as my midwife said iron tablets can upset the tummy," agreed Angela, another community member

Generally, on our forum, the consensus showed that the side effects of the tablets were so unpleasant and uncomfortable, most switched to a liquid brand, in the end.

"The iron tablets made me really constipated so they tried me on another type of tablets but that didn't help so I cut down the number of tablets I was taking.

"The midwife said that was okay, just to take what I could manage. Eventually they gave me the liquid iron which did help a bit," added community member Romy.

How should you take iron supplements?

Some pregnancy multivitamins already contain some iron. If you’ve got one, check if it includes iron, and if so how much is in it, and also have a look at what else is in the supplement.

This is because it’s generally recommended not to take iron at the same time as any calcium supplements, or while eating/drinking anything milky.

Ideally, iron supplements are best taken on an empty tum, so the body can fully absorb the iron. Orange juice helps with this, too.

Frustratingly, taking them without food can make it more likely you’ll experience not-so-ideal side effects. That said, if you struggle to take them without, it’s better to take them with food than not at all.

Dr Kaye adds: "If you do need treatment your midwife or doctor will generally prescribe you iron supplements.

"The best way to take these is with a glass of orange juice as the Vitamin C in the orange juice helps your body absorb the iron."

What are the possible side effects of iron supplements?

In our experience, side effects from iron supplements used to treat anaemia aren’t uncommon – in fact, one of our team had an awful time with her supplement.

Possible side effects include:

• Stomach pain
• Constipation
• Diarrhoea
• Nausea
• Vomiting.

There's also one rather, erm, weird, side effect, too: "Iron supplements will turn your poo black, so don’t be surprised!" says Dr Kaye.

"They can also cause constipation, so make sure you are drinking plenty of water and getting lots of fruit and veg.

"If that isn’t enough, see your local pharmacist (don’t forget to tell them you are pregnant) to see which laxatives may be suitable."

On top of all that, you also need to make sure you’re not getting too much or too little iron. The best way to do that is to have your supplement prescribed by your doctor, or approved by your GP/midwife.

When should you start taking iron supplements in pregnancy?

There’s no suggested start date, really – but we would suggest running any plans to start a new supplement by your GP or midwife just to be safe.

In your 1st GP appointment about your pregnancy, it’s a good idea to chat to your doc about what you need to take (like folic acid and Vitamin D) and also seeing if an iron supplement could benefit you and your baby.

If you’re further into your pregnancy or have been diagnosed with iron deficiency anaemia by your doc, then follow their recommendations for treatment, as it’ll be tailored to your specific circumstances.

Images: Getty Images

Read more:

• Folic acid - what you need to know
• Vitamin D in pregnancy - why you need to take it
• How to get healthy Omega-3s in your pregnancy diet