From the Guidelines
During pregnancy, if your hemoglobin (Hb) is on the lower side, even with a normal Mean Corpuscular Volume (MCV), it is crucial to take iron supplements in addition to folic acid to prevent iron deficiency anemia and its complications. The U.S. Preventive Services Task Force recommends screening for iron deficiency anemia and iron supplementation in pregnant women to improve maternal health and birth outcomes 1. Iron deficiency anemia during pregnancy can lead to premature birth, low birth weight, and maternal fatigue if left untreated. Key points to consider include:
- Folic acid (400-800 mcg daily) is essential for preventing neural tube defects and should be started before conception and continued throughout pregnancy.
- For low hemoglobin indicating iron deficiency anemia, an iron supplement (60-120 mg elemental iron daily) is recommended, even with a normal MCV, as MCV changes can lag behind hemoglobin drops 1.
- Iron supplements should be taken between meals with vitamin C to enhance absorption, and avoided with calcium, coffee, or tea which can reduce absorption.
- Side effects of iron supplements may include constipation and nausea, which can be managed by starting with a lower dose and gradually increasing.
- Always consult your healthcare provider before starting any supplements during pregnancy to ensure appropriate dosing for your specific situation, as the usual dose prescribed in early pregnancy is 30 mg of elemental iron per day, but higher doses may be necessary in populations at increased risk for iron deficiency anemia 1.
From the Research
Iron Deficiency Anemia During Pregnancy
- Iron deficiency anemia is a common condition during pregnancy, characterized by low hemoglobin (Hb) levels and/or low iron stores 2.
- The most common cause of microcytic anemia, which is defined as the presence of small red blood cells, is iron deficiency 2.
- However, in cases where the Mean Corpuscular Volume (MCV) is normal, iron deficiency may still be present, and iron supplements may be necessary to correct the anemia 3, 4.
Treatment of Iron Deficiency Anemia During Pregnancy
- Oral iron supplements, such as ferrous sulfate, are often recommended as the first-line treatment for iron deficiency anemia during pregnancy 3, 4, 5.
- Intravenous iron may be considered in cases where oral iron is not effective or not tolerated, or in cases of severe iron deficiency anemia 3, 4.
- Folic acid is often given in combination with iron supplements to prevent folic acid deficiency, which can also cause anemia 3, 6.
Effectiveness of Iron Supplements During Pregnancy
- Studies have shown that both oral and intravenous iron supplements can effectively increase hemoglobin and ferritin levels in pregnant women with iron deficiency anemia 3, 4.
- However, intravenous iron may restore iron stores faster than oral iron, and may be more effective in cases of severe iron deficiency anemia 3.
- The choice of iron supplement and treatment regimen should be individualized based on the severity of the anemia, the presence of any underlying medical conditions, and the patient's preferences and tolerance 4, 5.