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Low Iron Levels / Anemia


Are you feeling tired, lightheaded or dizzy? Have you been experiencing a racing heart or shortness of breath? While feeling tired is a perfectly normal part of recovering from pregnancy and birth, it’s important not to ignore symptoms that could point to a common but serious postnatal issue: postnatal anemia.


Postnatal anemia indicates low hemoglobin in the red blood cells, which is most commonly caused by iron deficiency (De Benoist, 2008). Iron plays an important role throughout women’s lives, especially during pregnancy and the postnatal period. It’s a vital component of hemoglobin, which helps to carry oxygen throughout the body. Women, however, are at high risk of being deficient due to the demands of pregnancy as well as blood loss from menstruation and delivery.


Iron deficiency after birth is especially common. Studies have found that the prevalence of anemia 1 week postpartum for women who had normal vaginal births is 24%-26% in those who did not take any supplements. This percentage rises to a staggering 50-80% for women in developing countries (Milman, 2011). If you delivered via C-section, you are also more likely to suffer from anemia because you tend to lose double the amount of blood during delivery.


What are the symptoms of postnatal anemia?

Any combination of the following symptoms could be a sign that you have anemia. The symptoms can last 6 to 12 months.

  • Fatigue

  • Frequent headaches

  • Shortness of breath

  • Dizziness

  • Emotional instability, in particular extreme irritability

Postnatal anemia can also lead to higher risks for postpartum depression and urinary tract infections and can lead to reduced production of breastmilk. Since fatigue and depression can greatly affect the daily routine of a mother and her ability to care for her children, iron deficiency is an important issue to address for both mother and baby.


What causes postpartum anemia?

The biggest causes of postpartum anemia are iron deficiency during pregnancy, and blood loss and hemorrhage during and after delivery, particularly for women who have had multiples or Cesarean sections.

  • If you’ve been diagnosed with anemia during pregnancy, you are at higher risk of developing anemia after birth as well. During pregnancy, the body’s demands for iron increases threefold to provide enough nutrition for the growth of the fetus and placenta. For many women, it is challenging to keep up with these demands, and their iron stores become depleted, resulting in about 25% of Western women who suffer from iron deficiency anemia. In fact, anemia from iron deficiency accounts for 75% of all anemia that women experience during pregnancy (Horowitz, 2013). For women who carry multiples, the risk of developing anemia is even higher, since the iron requirements increase with each baby. 

  • Postpartum hemorrhage. A typical delivery results in about 500 ml of blood loss and a Cesarean can yield in 1000 ml of blood loss. An estimated 2.9% of women in the U.S. experience postpartum hemorrhage, where she experiences excessive bleeding during or after delivery (Bateman, 2010). Typically after birth, the uterus contracts to expel the placenta and compress the blood vessels in the area where it was attached. Of the various ways postpartum hemorrhage can occur, the main cause is uterine atony, a condition in which these contractions fail to restrict the vessels after delivery. The result is that the uterus continues to bleed, leading to hemorrhage. It’s not surprising then, that the more blood you lose during this process, the more iron you lose as well. A small study on women who experienced postpartum hemorrhage found that 80% of the women who needed emergency hysterectomies as a result of severe uterine atony were anemic during pregnancy. So it’s a bit of a catch-22: if you’re anemic during pregnancy, you’re at higher risk of experiencing postpartum hemorrhage. If you experience postpartum hemorrhage, you’re likely to develop postnatal anemia. 


It’s clear that maintaining the necessary levels of iron is important for both you and baby.


So how can you help your body increase iron?


Nutrition plays a big role in the prevention and treatment of postpartum anemia. The best way to nourish your body is through iron-rich foods. You can get dietary iron through two forms: heme and non-heme. Heme iron is highly bioavailable, with 15-35% available to be absorbed by the body with little effect from other dietary factors, while the non-heme form has a much lower bioavailability at 2-20% (Hurrell, 2010). I recommend eating foods that are rich in heme-iron and boosting absorption with vitamin C. You can also cook using a cast-iron skillet to fortify your food with iron.



Foods that are high in heme-iron:

  • Red meats

  • Organ meats

  • Turkey

  • Chicken

  • Clams

  • Shrimp

  • Fish


What about supplements?

Increasing your iron stores through diet alone can be challenging, so supplementation may be necessary depending on your level of depletion. A great option that Mother Nutrient offers is to take grass-fed beef liver capsules that are easy to take, high in heme-iron, and are easily absorbed. The liver is nutritionally potent, packed with iron and vitamin B12, and has been traditionally used to aid postpartum women to restore their energy and nutrient stores after pregnancy and birth.


In more serious cases of iron deficiency anemia, you may be prescribed a supplement from your medical provider. While ferrous sulfate and ferrous fumarate are commonly prescribed iron supplements, I recommend taking ferric triglycinate or ferrous bisglycinate, which studies indicate results in fewer gastrointestinal issues (which is already common in the postnatal period) while being equally effective (Milman, 2014). Mother Nutrient offers an easy-to-take chewable iron chelate supplement that is highly bioavailable, great-tasting, and non-constipating.


It’s always recommended to consult with a medical professional to determine where your iron levels are. For recommendations about ways to boost your iron intake and address other related postnatal issues you may be experiencing, Mother Nutrient can provide practical, valuable, natural and holistic solutions.


Mother Nutrient Can Help!


In addition to the range of supplements, superfoods and probiotics we offer, Mother Nutrient also has a free Wellness Quiz that creates a customized nutrition report based on your answers to questions about your diet, lifestyle, and pregnancies. You will get recommendations on specific products, diet, and lifestyle changes that may help you. 



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Did you have iron deficiency after your birth? What helped you? Tell me in the comments!



References

Bateman B, Berman M, Riley L, Leffert L. The Epidemiology of Postpartum Hemorrhage in a Large, Nationwide Sample of Deliveries. Anesthesia & Analgesia. 2010;110:1368-1373.


De Benoist B, McLean E, Egli I, Cogswell M, editors. Geneva: WHO Press, World Health Organization; 2008. WHO/CDC. Library Cataloguing-in-Publication Data. Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia; p. 40.


Horowitz KM, Ingardia CJ, Borgida AF. 2013, Anemia in pregnancy. Clin Lab Med. 2013;33:281–91.


Hurrell R, Egli I. Iron bioavailability and dietary reference values. The American Journal of Clinical Nutrition. 2010;91:1461S-1467S.


Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Annals of Hematology. 2011;90:1247-1253.


Milman N, Jønsson L, Dyre P, Pedersen P, Larsen L. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. Journal of Perinatal Medicine. 2014;42.

Updated: Oct 2, 2019



Pregnancy is a very special time for a woman, a time of so many physical and emotional changes. Feeling your baby kick for the first time and watching it grow inside of you is no less than an amazing experience. And while some women really enjoy being pregnant, other women, like me, can experience a slew of not-so-great symptoms and complications.

The most common pregnancy complication around the world is anemia, or iron deficiency. In the United States, 24.1% of pregnant women are reported to have anemia (WHO, 2010). When you have anemia, your hemoglobin levels are low (<11g/dL), meaning you do not have sufficient red blood cells to carry oxygen to the tissues in your body. While there are several possible causes of anemia during pregnancy, the most common cause is iron deficiency.


Common symptoms you may experience from iron deficiency include:

● fatigue

● chest palpitations

● pale skin

● Irritability

● shortness of breath

● Dizziness

● Difficulty sleeping (Abu-ouf, 2015, Abbaspour, 2014)



Why is anemia so common during pregnancy?

Pregnancy is a critical time because of the increased needs of iron to support the placenta, growing baby, red blood cell production and 50% increase in plasma volume. (Erdman, 2012, McMahon, 2010). This is why the recommended daily intake of iron increases from 18mg pre-pregnancy to 27mg during pregnancy.


The problem is, many women do not have adequate stores of iron even before beginning their pregnancy and therefore become deficient as the needs for iron increases with each trimester (Turner, 2003). This lack of iron could stem from an iron-deficient diet, poor absorption of iron in the gut, blood loss from pre-pregnancy menstruation or other medical conditions (Abbaspour, 2014). Those who have a history of anemia, have short intervals between pregnancies, and those who carry twins or triplets are at higher risk of experiencing iron deficiency too.



What is the big deal?

A number of studies have linked iron deficiency and anemia to a variety of complications for both the baby and mother. A 1992 study by Scholl et al. found that iron-deficiency anemia during the first two trimesters of pregnancy led to a twofold increased risk for preterm delivery and a threefold increased risk for delivering a low-birthweight baby. Other studies have reported similar findings, as well as neurodevelopmental delays, and higher risks of developing pre-eclampsia, needing blood transfusion at birth, and thyroid autoimmunity or dysfunction in mothers (Cogswell, 2003, Ronnenberg, 2004, Veltri, 2016, Breymann, 2015, Ali, 2011, Scanlon, 2000). And the complications don’t end when the pregnancy is over. The probability of hemorrhage during birth skyrockets when the mother is anemic during pregnancy. One study looking at the relationship between anemia during pregnancy and uterine atony, the main cause of postpartum hemorrhage, found that 80% of the women who underwent emergency hysterectomies following severe hemorrhaging were anemic during pregnancy (with a hemoglobin level <7 versus 12.5% of the non-hysterectomized group) (Frass, 2015).


All of these risks point to the importance of having adequate levels of iron before, during, and after your pregnancy.



The good news is that anemia is totally preventable

You can increase your intake of iron by incorporating iron-rich foods into your diet. Animal products that contain the most absorbable heme iron, such as organ meats (liver, heart), oysters, beef, clams, lamb, poultry, and sardines are the best food sources of iron. Other sources include legumes and dark leafy greens.


You can increase your body’s absorption of iron by consuming these iron-rich foods with vitamin C (fruits, tomatoes, spinach, cabbage, cauliflower, potatoes, and other green leafy vegetables) (Gautam, 2008). You can also increase the iron in your food by cooking in cast iron pots. Studies have reported increases anywhere from 2 to 24 times the amount of iron in the food compared to cooking in other pans (Kroger-Olsen, 2002).


Cooking and eating with organ meats may not be appealing to many pregnant women, so an alternative is to take a desiccated liver supplement like Mother Nutrient’s Grass-fed Beef Liver Capsules. You can get all the benefits of obtaining high levels of iron (and many other important nutrients) without the taste of liver.



Iron supplementation

When diet alone is not sufficient to increase your iron levels, the next step is to take an iron supplement. Iron supplementation is known to increase maternal iron levels, increase birth weight, and reduce risks for low birthweight in deficient mothers, especially when started in early pregnancy (Ronnenberg, 2004, Mcmahon, 2010).

Iron supplements have a bad rap for their taste and causing constipation. Recent studies looking at different forms of iron supplementation found that compared to the commonly prescribed ferrous sulfate, iron bisglycinate reported fewer side effects and is better absorbed (Melamed, 2007, Milman, 2014).


Mother Nutrient is now offering a chewable iron chelate (ferrous glycinate) supplement that is gentle on the stomach, has great taste and is non-constipating. It delivers the highest dose of 30 mg of iron and is safe for pregnant and lactating mothers as well.


It’s clear that maintaining iron levels throughout pregnancy is important. It is always beneficial to have your doctor monitor your iron levels before and during your pregnancy (done through blood tests checking hemoglobin, hematocrit, and ferritin levels) so that you can nourish your baby and yourself with the necessary amounts of iron.




For more helpful nutritional tips, product deals, and new post notifications, sign up for our newsletter on our website. When you join you will receive a free guide, "Top 10 Postnatal Nutrition Tips!"


Did you know we also have a free wellness quiz on our website that will give you a personalized nutrition report, including targeted product recommendations?


Recommendations are based on specific questions that you answer about your health, energy, diet, birth, etc.



Are you experiencing iron deficiency during your pregnancy? Share your experience with me in the comments below!


If you know a mama who can benefit from this post, share by clicking next to the title!





References

“Worldwide Prevalence on Anaemia 1993-2005.” World Health Organization, World Health Organization, 5 Nov. 2010, https://www.who.int/vmnis/database/anaemia/anaemia_status_summary/en/.

Abu-Ouf, Noran, and Mohammed Jan. “The Impact of Maternal Iron Deficiency and Iron Deficiency Anemia on Child’s Health.” Saudi Medical Journal. 2015;36(2):146–149., doi:10.15537/smj.2015.2.10289.

Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19(2):164–174.

Erdman JW, MacDonald I, Zeisel SH. Present knowledge in nutrition. 10th ed. Washington, DC: International Life Sciences Institute; 2012

Mcmahon, Lawrence P. “Iron Deficiency in Pregnancy.” Obstetric Medicine. 2010; 3(1):17–24., doi:10.1258/om.2010.100004.

Turner RE, Langkamp-Henken B, Littell RC, Lukowski MJ, Suarez MF. Comparing nutrient intake from food to the estimated average requirements shows middle- to upper-income pregnant women lack iron and possibly magnesium. J Am Diet Assoc 2003;103:461–6

Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr 1992;55:985-8

Scholl T. Iron status during pregnancy: Setting the stage for mother and infant. Am J Clin Nutr. 2005;81:1218S-1222S.

Cogswell, Mary E, et al. “Iron Supplementation during Pregnancy, Anemia, and Birth Weight: a Randomized Controlled Trial.” The American Journal of Clinical Nutrition. 2003;78 (4):773–781., doi:10.1093/ajcn/78.4.773.

Ronnenberg AG, Wood RJ, Wang X, Xing H, Chen C, Chen D, Guang W, Huang A, Wang L, Xu X: Preconception hemoglobin and ferritin concentrations are associated with pregnancy outcome in a prospective cohort of Chinese women. Journal of Nutrition. 2004;134(10): 2586-91

Veltri, Flora, et al. “Prevalence of Thyroid Autoimmunity and Dysfunction in Women with Iron Deficiency during Early Pregnancy: Is It Altered?” European Journal of Endocrinology. 2016; 175(3):191–199., doi:10.1530/eje-16-0288.

Breymann, Christian. “Iron Deficiency Anemia in Pregnancy.” Seminars in Hematology. 2015; 52(4):339–347., doi:10.1053/j.seminhematol.2015.07.003.

Ali, Abdelaziem A, et al. “Severe Anaemia Is Associated with a Higher Risk for Preeclampsia and Poor Perinatal Outcomes in Kassala Hospital, Eastern Sudan.” BMC Research Notes. 2011;4(1), doi:10.1186/1756-0500-4-311.

Scanlon KS, Yip R, Schieve LA, Cogswell ME. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol 2000;96:741–8.

Frass, K. Postpartum hemorrhage is related to the hemoglobin levels at labor: Observational study. Alexandria Journal of Medicine. 2015; 51(4):333-337

Gautam CS, Saha L, Sekhri K, Saha PK. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Medscape J Med. 2008;10(12):283.

Kroger-Ohlsen M, Trugvason T, Skibsted L, Michaelsen K. Release of Iron into Foods Cooked in an Iron Pot: Effect of pH, Salt, and Organic Acids. Journal of Food Science. 2002;67:3301–3.

Melamed, Nir, et al. “Iron Supplementation in Pregnancy—Does the Preparation Matter?” Archives of Gynecology and Obstetrics, 2007;276(6):601–604., doi:10.1007/s00404-007-0388-3.

Milman N, Jonsson L, Dyre P, Pedersen PL, Larsen LG. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med. 2014 Mar;42(2):197-206.

Content found on this website is not considered medical advice. Please consult with a physician before making any medical or lifestyle changes.

© 2019 Mother Nutrient

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