The Role of Iron Infusions in Pregnancy: Ensuring Maternal Health and Fetal Well-being

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The Role of Iron Infusions in Pregnancy: Ensuring Maternal Health and Fetal Well-being (Dr. Lorna Ciccone ND with Dr. Anita Komonski ND)

Iron deficiency during pregnancy is a common issue, affecting 30% of pregnancies in Canada (1). Pregnant people require much more iron, especially in the 2nd and 3rd trimesters when most of the iron transfer to the baby occurs.

A pregnant individual typically has about 2500 mg of iron stored in their body. During pregnancy, an additional 1000 mg of iron is needed to support both the pregnant individual and the growing baby. This amount is equivalent to roughly 177 full-sized steaks or about 20 steaks per month over the nine months of pregnancy. (For vegetarians and vegans – this is 1kg of tofu per day!!) 

Due to this increased demand, pregnant people are at a higher risk of developing iron deficiency or iron deficiency anemia (IDA). Iron deficiency is a condition where the body has insufficient iron to meet its needs. Iron deficiency anemia (IDA) is a specific condition resulting from prolonged or severe iron deficiency that impacts red blood cell production. 

During pregnancy, an additional 1000 mg of iron is needed to support both the pregnant individual and the growing baby. This amount is equivalent to roughly 177 full-sized steaks!

Iron deficiency anemia IDA in pregnancy has been linked to several complications, including low birth weight, small for gestational age size, preterm birth, the need for blood transfusions, postpartum hemorrhage (2,3), and long-term neurocognitive effects in children. Those with IDA also have a higher risk of intrauterine growth restriction, low neonatal iron status, preeclampsia, and postpartum hemorrhage(4) as well as increased likelihood of postpartum depression (5). 

Prompt correction of IDA is considered best practice.  Due to the large increase in demand for iron in the 2nd and 3rd trimesters, prevention of IDA requires screening and rapid treatment of low iron stores (low ferritin) in 2nd or 3rd trimester (either orally or with infusions).  

Symptoms

The symptoms of iron deficiency and IDA can overlap with normal pregnancy symptoms, making it easy to miss. These symptoms include:

  1. Fatigue
  2. Shortness of Breath
  3. Weakness
  4. Dizziness
  5. Irritability
  6. Mood Changes

In addition, symptoms of low iron levels can include: hair loss, headache, restless legs, frequent illness, heart palpitations, cold hands and feet.

Dietary adjustments and oral supplements are usually the first treatment options for iron deficiency and IDA. However, some pregnant individuals may struggle to increase their iron levels through these means, especially later in pregnancy when fetal demands are higher. Due to the limited absorption of iron in the gut, it can become very difficult, if not impossible, to treat iron deficiency and IDA with oral supplements alone by the third trimester.

Iron infusions bypass the gut by delivering iron directly into the bloodstream, providing a rapid treatment for iron deficiency and IDA. This is a key benefit of iron infusions during pregnancy.

Iron infusions are typically very well tolerated, though there are potential risks and side effects, including allergic reactions, nausea, headaches and body aches. The decision to undergo iron infusions should be discussed with a primary care provider, and weighed against alternative treatments and the severity of the iron deficiency.

It’s important for pregnant individuals to communicate openly with their healthcare providers about their symptoms, concerns, and preferences regarding iron supplementation. Routine prenatal care typically includes screening for iron deficiency (serum ferritin) and monitoring hemoglobin levels to identify those who may benefit from additional interventions like iron infusions. 

To summarize, iron infusions play a key role in managing iron deficiency and IDA during pregnancy, protecting the health of the pregnant individual, and supporting fetal growth and development. While they offer significant benefits for some people, it’s essential for pregnant individuals to work closely with their healthcare providers to determine the most appropriate treatment based on their needs and circumstances. With proper monitoring and care, iron infusions can contribute to a healthier pregnancy.

  1. Tang G, Lausman A, Abdulrehman J, et al. Prevalence of iron deficiency and iron deficiency anemia during pregnancy: a single centre Canadian study. Blood 2019;134(Suppl 1):3389
  2. Young MF, Oaks BM, Tandon S, et al. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci 2019; 1450: 47–68.
  3. Peña-Rosas JP, De-Regil LM, Dowswell T, et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012;12:CD004736.
  4. Annamraju, H., & Pavord, S. (2016). Anaemia in pregnancy. British journal of hospital medicine (London, England : 2005), 77(10), 584–588. https://doi.org/10.12968/hmed.2016.77.10.584
  5. Azami, M., Badfar, G., Khalighi, Z., Qasemi, P., Shohani, M., Soleymani, A., & Abbasalizadeh, S. (2019). The association between anemia and postpartum depression: A systematic review and meta-analysis. Caspian journal of internal medicine, 10(2), 115–124. https://doi.org/10.22088/cjim.10.2.115