Managing Iron Deficiency Anemia Before, During, and After Pregnancy

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Whether you’re trying to get pregnant, are pregnant, or are in the postpartum period, your iron level is something your doctor will monitor, especially if you’re at risk of developing iron deficiency anemia, the most common type of anemia.

What Is Iron Deficiency Anemia?

Iron deficiency anemia is a medical condition caused by low levels of iron in your body. Anemia happens when your body does not make enough healthy red blood cells. It can also occur if these blood cells do not work correctly.

Symptoms of Iron Deficiency Anemia

When your iron levels are low, it’s not uncommon to experience a variety of signs and symptoms including, but not limited to:

  • Fatigue
  • Cold hands and feet
  • Dizziness
  • Weakness
  • Chest pain
  • Brittle nails pale skin
  • Irregular heartbeat
  • Headaches
  • Low body temperature
  • Shortness of breath

You may experience one or more of these symptoms if your body is not making enough hemoglobin to carry oxygen to all parts of your body. 

In general, a low intake of iron is usually the cause of iron-deficiency anemia. This can happen as a result of not getting enough iron in your diet or through supplements, from blood loss, and certain health conditions like celiac or Crohn’s disease that make it difficult for your body to absorb iron from food.

Additionally, this condition affects more women than men and tends to be at its highest for women who are of childbearing age or pregnant.

How Does Pregnancy Affect Iron Deficiency Anemia?

Pregnancy requires a lot of iron for normal development and growth, particularly in the second half of pregnancy.

According to Dr. Matthew Cantor, OB/GYN at NewYork-Presbyterian Hudson Valley Hospital, iron-deficiency anemia develops in pregnancy for two reasons:

  1. The blood volume expands considerably, and this dilutes iron levels.
  2. Women who start out with iron deficiency anemia before pregnancy usually become more deficient and require closer monitoring by their doctor.

Why Is Iron So Important During Pregnancy?

Getting adequate iron in your diet or through supplements is essential during pregnancy. Not only does your body need to make extra blood to help provide the placenta with all the nutrients it needs to grow—which requires iron to do so — it also needs iron to help prevent health conditions that can negatively impact you and your child.

The American College of Obstetricians and Gynecologists (ACOG) recommendations state that pregnant women need double the amount of iron that a nonpregnant woman needs in order to supply oxygen to the fetus.

According to Dr. Cantor, iron is so important during pregnancy for the following reasons:

  • Improving anemia before delivery of the baby is very important to compensate for the expected blood loss during a normal delivery.
  • Anemia prior to delivery is a risk factor for needing a blood transfusion.
  • Furthermore, there’s an association between anemia and low birth weight, preterm birth, pre-eclampsia, and overall maternal and perinatal mortality. Both preterm birth and low birth weight can increase the risk that your baby will have developmental problems at birth and during childhood.
  • Breastfeeding may be more difficult with anemia, and there's also an association with postpartum depression.

Managing Iron Deficiency Anemia Before Pregnancy

If anemia is diagnosed before pregnancy, Dr. Cantor says it's important to find out the type of anemia. “Your physician can run tests to look for causes like vitamin B12 or folate deficiencies, and red blood cell mutations like sickle cell or thalassemia,” he explains.

Heavy menstrual bleeding can cause iron deficiency anemia in reproductive-age women who are not pregnant. The treatment for anemia before pregnancy is the same as in pregnancy, with diet and oral iron supplements. Women with heavy menstrual bleeding should discuss treatment options with their physician.

Managing Iron Deficiency Anemia During Pregnancy

Most doctors screen for anemia at the beginning of pregnancy and then again in the second and third trimesters.

While many doctors encourage patients to eat a diet rich in plant sources of iron such as green leafy vegetables, shellfish, legumes, seeds, and quinoa, iron in this form is not absorbed as well as iron from animal sources such as meats, poultry, and fish.

To help improve absorption, the ACOG recommends eating iron-rich foods with vitamin-c high foods like citrus fruits. 

Because of this, Dr. Cantor says it’s essential to start with prenatal vitamins taken daily or every other day. Most prenatal vitamins contain 27 milligrams of iron, which is the recommended amount during pregnancy.

If iron deficiency anemia is present during the second-trimester screening, your doctor will likely give you an iron supplement. If this happens, Dr. Cantor says oral iron is better absorbed on an every-other-day basis, taken on an empty stomach with an acidic juice like orange or grapefruit. During the third trimester screening, if the anemia worsens or doesn't improve, then Dr. Cantor says many doctors will consider IV administration of iron. 

It's important to remember that while the most common form of anemia in pregnancy is iron deficiency, Dr. Cantor says there are other causes, and those should be considered in cases not responsive to oral supplementation and before starting IV iron to confirm you are getting the correct treatment.

Iron Deficiency Anemia During the Postpartum Period

After childbirth and during the first few weeks and months of the postpartum period, many women will see an improvement in the symptoms related to iron deficiency anemia. Dr. Cantor says iron deficiency anemia often decreases after delivery because menstrual bleeding is suppressed by breastfeeding. 

That said, some women may still experience iron deficiency anemia after childbirth. This is typically caused by an inadequate iron intake during pregnancy and blood loss during delivery. Postpartum anemia can increase symptoms related to anxiety, stress, and depression. It can also decrease the mother-infant attachment.

Because of the continued risks in the postpartum period, new moms need to be screened, especially if they had excessive blood loss during delivery or had anemia during pregnancy. Severe anemia after delivery can sometimes require IV iron or a blood transfusion.

"It's still important to supplement with oral iron to maximize a new mother's energy, support breastfeeding, and reduce the risk for postpartum depression," says Dr. Cantor.

A Word From Verywell

Doing what’s best for your health and the health of your baby often requires eating the right food and taking supplements recommended by your doctor. If you’re at risk for iron deficiency anemia, your doctor will walk you through all the steps to manage this condition both during pregnancy and in the postpartum period.

5 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Office of Women’s Heath. Iron-deficiency anemia.

  2. National Heart, Lung, and Blood Institute. Iron-Deficiency Anemia.

  3. Api O. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. Turk J Obstet Gynecol. 2015 Sep; 12(3): 173–181. doi:10.4274/tjod.01700.

  4. National Institutes of Health. Iron.

  5. USDA ChooseMy Plate. Why take a prenatal supplement?

By Sara Lindberg
Sara Lindberg, M.Ed., is a freelance writer focusing on health, fitness, nutrition, parenting, and mental health.