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| |    Iron Supplementation in Pregnancy by Elisa Ross, MD reviewed and revised by Marjorie Greenfield, M.D. How much iron you need during pregnancy depends a lot on how much you already have stored in your bone marrow, as well as how much you get daily in your diet. For meat-eaters, the amount in any vitamin that is labeled "with iron" will probably be enough in the first half of pregnancy. Many practitioners will check a blood count (hemoglobin level) early in pregnancy and then again around the seventh month, and prescribe extra iron if needed. Some routinely recommend extra iron tablets to all their patients throughout pregnancy, especially for those with risk factors for deficiency in this mineral. Dietary sources of iron Here are some facts you should know about dietary sources of iron:
Babies are very good at getting all the iron they need from their mothers' storehouses of the mineral. They take more towards the end of pregnancy, as they get bigger and produce more red blood cells. It is rare for a newborn to have iron-deficiency anemia, even if the mother is low on iron herself. If they don't take supplements or watch their diet carefully, mothers, on the other hand, often end up slightly anemic by the end of pregnancy, partially because of changes in the fluid makeup of the blood and partially because of inadequate iron intake. There is some evidence that severe anemia is associated with low-birth-weight babies and preterm birth. It isn't clear if this is cause and effect, or if women who are very anemic have other problems (like poverty) that put them at greater risk. If a woman has a low red-blood-cell count when she goes into labor, she may get to a dangerously low level if she bleeds more than usual during childbirth. It is rare for a mother to need a blood transfusion around the time of delivery, but it makes sense that the higher the blood count in late pregnancy, the larger the safety net. Women who are Jehovah's Witnesses, or for other reasons would not accept blood transfusions under any circumstances, should be treated aggressively by their doctors during pregnancy so that they start labor with higher than normal red blood cell counts. Can I get too much iron? There is a condition in which the liver gets overloaded with iron, but this is extremely rare in healthy reproductive-age women. The most common iron-related problem in pregnancy is that taking two or three 325 mg iron supplements a day can cause abdominal cramping, dark green and grainy stools, and constipation. The body only can absorb the equivalent of two supplements at most, so taking any more is not helpful--and very hard on the digestive system. Even the small amount of iron in a prenatal vitamin can cause some women to become constipated; conversely, some actually get diarrhea from iron. What if I'm too nauseated for extra iron? Vitamins themselves have been known to cause constipation or gas. Some find that, especially at the beginning of pregnancy, vitamins or iron can make nausea worse. Since the need for iron increases in the second and third trimesters, it is reasonable to ask your practitioner if you can skip supplementation in early pregnancy if you are having a difficult time of it. If you want or need to take a vitamin, sometimes switching to a lower iron formulation really helps with tolerance. Formulations of supplemental iron-all available over-the-counter:
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