Ideal Iron/Ferritin Levels for Preconception Planning
Women planning pregnancy should aim for a serum ferritin level above 30 μg/L, ideally above 70 μg/L, to ensure adequate iron stores for the increased demands of pregnancy. 1, 2
Target Ferritin Ranges Before Conception
The optimal preconception ferritin level depends on your starting iron stores, as approximately 40% of women of reproductive age have ferritin ≤30 μg/L, representing unfavorable iron status for pregnancy 1, 2:
Ferritin-Based Supplementation Strategy
Ferritin >70 μg/L: No iron supplementation needed beyond standard prenatal vitamin (27 mg elemental iron) 1
Ferritin 31-70 μg/L: Start 30-40 mg ferrous iron daily for 2-3 months before conception 1
Ferritin ≤30 μg/L: Start 60-100 mg ferrous iron daily for 3-6 months before conception 1
Ferritin <15 μg/L: Indicates depleted iron reserves; requires therapeutic doses of 100 mg ferrous iron daily 2
Why These Targets Matter
Adequate iron status at conception requires body iron reserves ≥500 mg, but only 15-20% of women naturally have stores of this magnitude. 2, 3 This is critical because:
Iron requirements increase dramatically during pregnancy, from 0.8 mg/day in the first trimester to 7.5 mg/day in the third trimester 2, 4
Women beginning pregnancy with depleted iron stores (ferritin <12 μg/L) deliver babies weighing on average 192 grams less, even when supplemented with moderate daily iron during pregnancy 5
Iron deficiency increases risk of preterm delivery, prematurity, and small-for-gestational-age birthweight 2
Hemoglobin Targets
While ferritin is the most specific indicator of iron stores 1, hemoglobin should be maintained in the normal range for non-pregnant women (≥12 g/dL) 6. However, ferritin is far more important than hemoglobin for preconception assessment, as hemoglobin alone is inadequate for detecting iron deficiency 1.
Practical Implementation
Check ferritin levels before attempting conception to identify women who need supplementation. 1 This is essential because:
More than 90% of Scandinavian women have dietary iron intake below the recommended 15 mg/day 2
Only about one-fourth of women of childbearing age meet recommended dietary allowance for iron through diet alone 7
Women lose an average of 0.3-0.5 mg iron daily through menstruation, with 10% experiencing heavy menstrual bleeding (>80 mL/month) that significantly increases iron loss 7
Special Considerations
For women with hemochromatosis planning pregnancy, the approach differs: avoid iron deficiency but maintain ferritin >45 μg/L by reducing phlebotomy intensity, as iron deficiency poses risks for adverse maternal and fetal outcomes. 6
Take iron supplements between meals for optimal absorption, and continue supplementation for the full recommended duration (2-6 months depending on initial ferritin level) before conception. 2