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Iron deficiency anemia

in pregnant women
Anna Elizondo

Iron deficiency anemia
• What is iron deficiency anemia (IDA)?

IDA in pregnant women is defined as having less than 11 g/dl of
hemoglobin in blood

• Why is iron important?
• Hemoglobin/respiration
• Oxygen  cellular respiration/glycolysis
• 60-70% of Fe in the body in Hb – iron is the most abundant
trace element in humans

• RBCs
• Contain hemoglobin
• 4 protein chains – 2 beta and 2 alpha
• Heme group: a porphyrin ring that surrounds an
iron molecule
• For each hemoglobin molecule 4 oxygen
molecules can bind

Life cycle of red blood

RBCs last for about 120 days. Can’t self repair  no nucleus. Contents
recycled! 1-2 mg lost per day from sloughing of cells from the mucosal
lining of the gastrointestinal tract, skin, and renal tubules
About 3 million new red blood cells enter the bloodstream each second

Why is iron important?
• Synthesis of DNA, RNA, and proteins
• Electron transport
• Cell proliferation and differentiation
• Regulation of gene expression
• Myelin formation (insulates axons)  Brain
• Makes up part of some enzymes

Why should pregnant women
especially be concerned?
• Positive energy balance
• Building not breaking down – RBC, plasma, placenta, fetus

• Iron stores can run low – the body requires more iron than it usually does
• First trimester: daily needs go down because the woman is no longer
menstruating  saving about 0.56 mg of iron per day.
• Second trimester blood volume increases by 45% with an increase in
plasma volume of 50%; red cell mass is raised by 35%
• Third trimester: the fetal demands are at its peak  gains most of its
• On average a daily dose of 4–6 mg of iron is required in the second and
third trimesters of pregnancy. But in general for the whole pregnancy 2–
2.8 mg of iron per day.
• Consumption  between 20 and 48 mg of dietary iron
• Risks! –two pregnancies back to back, having more than one child,
having a heavy menstrual flow prior to pregnancy, vomiting, low iron

Symptoms of IDA
• Fatigue and a feeling of weakness
• Grumpiness
• Poor concentration
• Pale skin
• Headaches
• Brittle nails – spoon nails
• Palpitations
• Shortness of breath
• A blue tint to the whites of eyes
• A sore tongue
• Possible characteristics of RBC:
microcytic, hypochromic. 40% normocytic

Dangers for the baby
• Low iron in the mother will affect iron stores in fetus. Important because a
healthy newborn will have iron stores saved for 6 months  gut immature.
Can’t regulate iron absorption.
• Studies suggest that babies with anemic mothers are more likely to be anemic later in life
even with adequate nutrition

• When IDA is detected early in pregnancy there is greater than 2X increase in
the risk of preterm delivery and low birth weight
• 3rd trimester IDA associated with inadequate weight gain for gestation
• Hypoxia from IDA  increase CRH  stress hormone cortisol  preterm delivery

• Tests done in infants and toddlers  low iron: Cognitive issues – learning,
memory, IQ, language ability, fine-motor skills, concentration, coordination,
behavior (irritability, attention deficit hyperactivity disorder (ADHD))
*neurological damage cannot be completely reversed  through tests can see
improvement 
supplements – motor skills testing
• Tests: mother and strangers face recognition/memory greater attentional
response/adding to memory 9 vs 12 months

• Iron deficiency at birth can have long term affects  5 year olds scored lower
on things such as language and motor skills
• The neonatal period (0-24 months of age), is the time where iron deficiency
has the most irreversible damage.

Is Ida common or
• An estimated 1 billion people worldwide have IDA
• About 50,000/year die during pregnancy or childbirth
due to IDA
• At this moment over 40 million pregnant women suffer
from iron deficiency
• Iron deficiency is the most common and overlooked
nutrient deficiency worldwide. Especially so in pregnant
women and children within developing countries
• “Prevalence of iron deficiency and IDA is increased 2fold or more for those women who are minorities, below
the poverty level or with < 12 y of education.”

Prevention of ida
• For pregnant women a daily dose of somewhere between 2–6 mg – depending
on trimester. Require between 20 and 48 mg of dietary iron
• Iron supplements
• Shots are shown to be equally as effective. Pills are easier and cheaper

• daily instead vs intermittent supplementation.
• Some believe daily to be more effective
• Other researchers think both unsuccessful. Intermittent supplementation during
adolescent years. Less oxidative stress and less gastrointestinal problems (nausea,
vomiting, diarrhea, and constipation.)
• High iron has been associated with maternal complications such as gestational diabetes

• Diet!
• Foods rich in iron: liver, chicken, lentils, beans, fish, peanut butter, soybeans,
oatmeal, pumpkin seeds, dried apricots, sundried tomatoes, parsley, kale.
• *Note: vitamin C helps with iron absorption for non-heme iron
• Foods fortified with iron

The end


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