Iron deficiency during pregnancy

Have your ferritin (your iron stores) checked!

When you are pregnant, you are often tired. You might be told “that is just part of it” or “try to get some more rest.” But what if that does not help? What if you notice that you are extremely tired and no longer feel like yourself? In that case, you may be dealing with an iron deficiency. Even if you have blood tests done and your Hb level is normal. Ask to have your ferritin checked, your iron stores. Thanks to new insights, we now know that this is often where the real issue lies. You can be tired because you truly have an iron deficiency, even when your Hb does not show it.

Symptoms of iron deficiency during pregnancy

Symptoms of iron deficiency often start subtly. Pregnancy is intense by nature, so feeling more tired is not unusual. However, there is a difference between normal pregnancy fatigue and exhaustion. And that exhaustion is exactly what happens with iron deficiency: you deplete your reserves. And you feel it. If you have iron deficiency during pregnancy, you may experience some of the following symptoms:

• Severe fatigue
• Shortness of breath more quickly during exertion (such as climbing stairs)
• Dizziness
• Difficulty concentrating
• Hair loss
• Pale skin
• Restless legs

Are you not pregnant but do you have these symptoms? Then you may also have an iron deficiency. In that case, have your blood checked as well and ask specifically for a ferritin measurement. Why that matters is explained below.

Ferritin or Hb? Here is how it works

When blood tests are done because of fatigue, the focus is usually on your Hb level, hemoglobin. This is the protein in your blood that transports oxygen. If that value was “normal,” no further testing was done in the past. The conclusion then was: no iron deficiency. And you were advised to take it easy. We now know better. Even if your Hb is fine, a low ferritin level still means iron deficiency. Here is why: ferritin shows how much iron you have in storage. Those stores are depleted first, before your Hb starts to drop. Only when Hb drops do we call it anemia. But a low iron store already has noticeable effects.

Wallet and bank account

Hb and ferritin are closely connected. We often explain it like this: “Hb is your wallet, ferritin is your bank account.” As long as there is still some money in your wallet, things seem fine. But if your bank account is already empty, you will notice sooner or later. A shortage in iron stores, ferritin, is therefore felt earlier than it shows up in your Hb level. In addition, the lower limit for ferritin in women used to be 10, while for men it was 30. An unexplained and unjustified difference. Today, more and more general practitioners and laboratories set the lower limit for women at 60. We do as well. If you come to us with fatigue complaints, we always check your iron by also measuring ferritin. And if it is below 60? Then we advise treatment with supplements.

Iron tablets

If your ferritin level is too low, we will advise iron tablets. You may experience side effects at first. That is unpleasant, but know that for most women these side effects decrease after about 1 or 2 weeks. After that, you will notice you have more energy and feel more like yourself again. However, just as Hb is the last to drop, it is also the first to rise again. So you may start feeling better fairly quickly while your ferritin stores are not yet fully replenished. That is why you should not stop supplementing too early. First you refill the wallet, only then the bank account.

During pregnancy, even with daily iron supplementation, Hb and ferritin levels can remain stable or even decrease. Your body simply uses much more iron during pregnancy. You produce about an extra liter of blood, and your baby and placenta also require iron. Another reason to correct iron deficiency with iron tablets when anemia is present.

Iron-rich nutrition

Of course, iron-rich food during pregnancy can only help. In fact, it is beneficial. With enough iron-rich foods such as red meat, whole grain products, legumes and green leafy vegetables, you can support your body to some extent. But if your ferritin level is too low, diet alone is not sufficient. You will also need supplements to effectively correct the deficiency.

Consequences of iron deficiency for you and your baby

If you deal with iron deficiency for a long time, it can have consequences. For you, it may mean having fewer reserves during childbirth, leading to a longer recovery and prolonged fatigue. For your baby, low iron stores can also have an impact. Your baby is fully dependent on your iron supply and will receive less iron if your ferritin level is too low. In cases of long-term, severe iron deficiency, there may be a slightly increased risk of low birth weight or preterm birth. This is not a reason to panic. But it is a reason to take ferritin seriously and inform your midwife if you have symptoms.

How much iron can you take during pregnancy?

You need more iron during pregnancy than usual. However, the correct dosage depends on your Hb and ferritin levels. Do not experiment with dosages yourself. Always consult your midwife or general practitioner.

Iron and vitamin C: good teamwork

Did you know that iron from supplements or food is absorbed less effectively when taken together with coffee, tea, milk or other calcium-rich products? It is better to take your tablet with water or a vitamin C-rich drink. Fruit itself contains little to no iron, but vitamin C helps your body absorb iron more efficiently. Oranges, kiwis, strawberries or mango are great options. You can also eat a piece of fruit with your iron tablet, whatever you prefer.

Frequently asked questions about iron deficiency during pregnancy

What are the symptoms of iron deficiency during pregnancy?

Severe fatigue, shortness of breath, dizziness, palpitations and concentration problems are common.

What does low ferritin mean during pregnancy?

It means your iron stores are low. You can already feel tired before your Hb drops.

Is iron deficiency dangerous during pregnancy?

Usually not. A mild deficiency is easy to treat. Severe or long-term iron deficiency can affect both mother and baby.

How do you correct iron deficiency during pregnancy?

With iron supplements tailored to your blood values. Your midwife or general practitioner can prescribe these.

How much iron can you take during pregnancy?

This varies per situation. Always consult your healthcare provider about the correct dosage.

Symptoms that may indicate iron deficiency? Visit our midwifery practice in Amsterdam-Zuid

At Verloskundigen Amsterdam Zuid, we do not stop at your Hb value. We listen to your story and we also test ferritin. Are you feeling extremely tired or do you have other symptoms that may be caused by iron deficiency? Contact us and we will discuss the options with you.