Iron: during pregnancy doubles the need

The new recommendations of the World Health Organization on pregnancy have been released. Among the many indications, there are also those related to the diet and the necessary supplements, which confirm the importance of iron intake in the months of waiting.

Why the need increases

Between the ages of 18 and 49, a woman’s iron requirement is set at 10 mg per day, but during pregnancy it rises to 22 mg.

In this period of life the levels of this element depend on several factors:

– the basal needs of the future mother

– the needs of the foetus

– the needs of the placenta

– the reserves that will be needed by the baby in the first 3 months of life.

Another factor that comes into play is the increase in the volume of blood circulating in the body.

In fact, in this period the female organism undergoes some physiological changes to meet the needs of the baby that grows in the womb.

The blood, for example, becomes more diluted, that is, the concentration of red blood cells and hemoglobin, the protein that the blood cells themselves contain and which has the task of transporting oxygen, decreases.

Iron is a fundamental element for the formation of hemoglobin. The body has its own stores of this mineral, but during pregnancy they may decrease. For this reason, the expectant woman can experience anemia.

This happens despite the fact that, precisely during pregnancy, the ability to absorb iron increases and, at the same time, the disappearance of menstruation also stops the iron losses associated with the menstrual cycle.

The causes of anemia in pregnancy

According to WHO estimates, about 40% of pregnant women are anemic, and in one in two cases it is iron deficiency anemia. The need for this mineral increases especially in the last trimester of pregnancy, but the risk of anemia can arise already in the first months if the woman is predisposed.

In other cases, anaemia can be caused, for example, by a deficiency of folic acid, vitamin B12 or vitamin A, or by a state of chronic inflammation, by infections by parasites (for example malaria plasmodium, hookworm and schistosomes) or by hereditary diseases (such as thalassemia).

The most common cause of anemia during pregnancy, however, remains iron deficiency (which, moreover, is the most common nutritional deficiency). More than 15 million pregnant women worldwide are struggling with this problem precisely because of insufficient levels of this mineral.

The risks of an iron deficiency in pregnancy

If the haemoglobin level is too low, the chances of premature birth increase and other complications may arise. In addition, iron deficiency can interfere with the growth of the fetus and its development.

In fact, future mothers who suffer from iron deficiency anemia during pregnancy (ie iron deficiency) do not gain weight as much as would be necessary to ensure the health of the child.

In addition, these women are prone to weakened immune systems, have a placenta characterized by a high weight and risk that at birth their baby will have a low weight.

For this reason it is important, during the nine months, to keep the situation under control with periodic blood tests.

Alarm bells? A sense of general malaise, pallor, fatigue, headache and dizziness, nausea.

Diagnosis of iron deficiency anemia in pregnancy

During pregnancy we speak of anemia when the concentrations of hemoglobin in the blood fall below 11 g / dl.

The diagnosis of iron deficiency anemia comes when the reduction in hemoglobin levels is accompanied by an indicator of iron deficiency, such as a low concentration of ferritin in the blood.

Nutrition and supplements

When you want to have a baby it is important to be healthy. For this reason it is good to follow a healthy lifestyle and a varied diet, with foods that ensure the necessary supply of iron to the body.

In itself, the metabolism of this mineral is peculiar because about 90% of the daily requirement is satisfied by a source inside the body: red blood cells. To balance its levels, however, it is also necessary to rely on diet.

Proper nutrition must be maintained during all months of gestation. The main sources of iron are red meats, but fish, legumes, eggs, dark green leafy vegetables and dried fruit are also fine.

In particular, iron can be obtained by eating:

• beef, pork, horse and lamb, but also chicken and turkey
• pinto beans, dall’occhio and cannellini, lentils, peas, soybeans, chickpeas, lupins and broad beans
• well-cooked eggs
• well-cooked salmon and tuna (but not exceeding 150 g per week due to the risk of mercury contamination)
• broccoli, spinach, asparagus, green radicchio and cabbage (which, however, can inhibit the absorption of iodine, a very important nutrient during pregnancy)
• almonds, Brazil nuts, cashews, pistachios and walnuts (which, however, can have the same effect as cabbage on iodine absorption)
• dried fruit (plums, raisins, figs, peaches and apricots)
• whole grains (barley, rice, oats and millet), wholemeal bread, rusks, corn, buckwheat, durum wheat and wheat bran
• Unsweetened cocoa powder and dark chocolate
• The Muesli
• the liver (which, however, some experts do not recommend in pregnancy because of the high levels of vitamin A that may be present in it).

As for the doses, here are some indications on the portions to put at the table to take the right amount of iron.

In addition, in the months of waiting it is very useful to consume foods rich in vitamin C, such as citrus fruits and peppers, as it plays an important role in the process of absorption of iron present in foods of plant origin.

In fact, cereals, legumes, seeds, fruits and vegetables contain iron only in the “non-heme” form (ie not bound to the proteins that carry oxygen, ie hemoglobin and myoglobin), which is absorbed much less efficiently than “heme” iron (ie that bound to hemoglobin and myoglobin).

The absorption of “non-heme” iron also depends on the presence of molecules that can inhibit it:

• phytates (molecules present in foods of plant origin)
• polyphenols (especially those in black tea, but also those present in chili pepper and sorghum)
• Football
• proteins (in particular milk and eggs).

In addition, the consumption of red meat, fish and poultry has also been associated with increased absorption of iron present in foods of plant origin.

However, it is quite clear that, with so many factors at play, it can be easy not to be able to get all the necessary iron during pregnancy.

A possible strategy to cope with this problem is the consumption of iron-fortified foods, i.e. to which this nutrient has been added. For example, you can buy fortified cereals made of iron.

In some cases, however, even this solution is not enough. If nutrition alone is not able to provide the right amount of this precious nutrient, it may be useful to resort to supplements, always on the recommendation of the doctor or specialist.

When to Take Iron Dietary Supplements

Low-dose supplementation may be recommended for the prevention of iron deficiency and its consequences especially during the second and third trimesters of gestation.

The intake of 27 mg of iron per day allows you to cope with the increase in the synthesis of red blood cells in the mother.

In fact, the intake of iron supplements during pregnancy has been associated with a lower risk that at the end of gestation the mother suffers from anemia (with a reduction of at least 70%) and an iron deficiency (with a reduction of 57%).

In addition, compared to women who do not take iron supplements during pregnancy, those who use these supplements have a lower tendency to give birth to babies with a low birth weight.

The market offers different formulations (for example in capsules, tablets or orodispersible sachets), also in association with:

• molecules that facilitate the absorption of iron (such as the aforementioned vitamin C)
• vitamins (e.g. vitamin B12, or folic acid)
• mineral salts (such as zinc, copper, selenium and magnesium)
• other useful nutrients during pregnancy and lactation (such as omega 3).

Be careful though, because some foods or drinks (such as dairy products and coffee) can reduce its effectiveness; in addition, iron supplements can also trigger side effects such as constipation and diarrhea.

If on the one hand it is therefore clear the importance of preventing or counteracting a possible iron deficiency, on the other hand it is also good to avoid overdose. In fact, excessive amounts of iron intake has been associated with symptoms such as dizziness, stomach problems (nausea and vomiting), headache, shortness of breath and fatigue.

For all these reasons it is good to rely on your doctor to know if and how much iron to take during pregnancy, just as if you were to take medication.