Information on iron deficiency during pregnancy

Question:

Could you please send me some information about iron deficiency in pregnancy and how it can be treated and prevented?

Answer:

Possible causes of iron deficiency anaemia are:
# Inadequate iron intake due to a poor diet.
# Inadequate absorption of iron due to diarrhoea, intestinal disease, or interference by drugs such as antacids, cholestryramine, Tagamet, Zantac and tetracycline.
# Inadequate iron utilisation due to chronic gastro-intestinal disturbances.
# Increased iron requirements, which occur during infancy, adolescence, pregnancy and lactation.
# Increased excretion of iron because of excessive menstrual blood in females, haemorrhage from injury, chronic blood loss from a bleeding ulcer, bleeding haemorrhoids, oesophageal varices, ulcerative colitis, parasites and malignancy.

A marked increase in the maternal blood supply during pregnancy greatly increases the demand for iron. In total, the pregnant woman must have between 700 and 800mg of extra iron, most of which is needed during the last half of pregnancy, when the heaviest maternal and foetal demands occur.

Averaged over the entire pregnancy, this amounts to a daily increment of 15mg of iron. Adding this amount to the 15mg per day recommendation for non-pregnant women, brings the 1989 RDA for iron during pregnancy to a total of 30mg per day. Liver, kidney, beef, egg yolk, dried fruits, dried peas and beans, nuts, peanut butter, green leafy vegetables, molasses, wholegrain breads and fortified cereals are the best sources of iron. In most cases, women need to be supplemented, since it is difficult to meet the RDA through diet alone.

In fact, it has been recommended that all pregnant women with a well-balanced diet should take 30mg of ferrous iron supplement daily during the second and third trimesters. Further, for optimal absorption, the iron supplement should ideally be taken between meals and not with milk, tea or coffee.

Treatment Medication — the main treatment for iron-deficiency anaemia consists of oral administration of inorganic iron. Iron is best absorbed when the stomach is empty, however under these conditions it tends to cause gastric irritation.

Gastro-intestinal side effects of nausea, epigastric discomfort and distension, heartburn, diarrhoea and constipation can be minimised by increasing the dose slowly over a few days until the required amount is reached. In addition, iron should be given in at least three doses per day. Since side effects are dose-related, smaller dosages with a longer therapeutic programme have been suggested.

Diet Therapy — In addition to medication, attention should be given to the amount of absorbable iron in food. Liver, kidney, beef, egg yolk, dried fruits, dried peas and beans, nuts, peanut butter, green leafy vegetables, molasses, wholegrain breads and fortified cereals are the best sources of iron.

The bioavailability of iron in the diet is more important than the total dietary iron in correcting or preventing iron deficiency.

Nutritional factors enhancing iron absorption:
# The lower the iron stores in our bodies, the greater will be the rate of iron absorption.
# Heam-iron present in meat, fish and poultry (MFP) is much better absorbed than is non-heam iron, which is mainly present in eggs, grains, vegetables and fruits.
# MFP factors which are products of digestion of meat, fish and poultry increase the absorption of iron.
# Vitamin C and acidic foods (namely fruit) increase iron absorption.

Nutritional factors that decrease iron absorption:
# Carbonates, oxalates, phosphates and phytates (found in unleavened bread, unrefined cereals and soya beans) bind iron rendering it inabsorbable.
# Vegetable fibre inhibits non-heam iron absorption.
# Taken with meals, tea can reduce iron absorption by 50% through the formation of insoluble compounds with tannins found in the tea.
# EDTA (ethylenediaminetetra-acetic acid), a food preservative, causes a 50% reduction in non-heam iron absorption.
# Iron in egg yolk is poorly absorbed because of the presence of phosvitin. Also milk proteins and albumin reduce iron absorption.

Summary:
# Improve food choices to increase total dietary iron.
# Include meat, fish or poultry at every meal if possible.
# Include a source of Vitamin C at every meal. Examples include tomatoes, broccoli, Brussels sprouts, guavas, paw paw, pineapple and citrus fruits.
# Avoid drinking large amounts of tea with meals.
# Avoid high quantities of the preservative EDTA by checking food labels.