After the first doctor´s appointment and various tests, the results show low hemoglobin and ferritin (iron stores) levels. The doctor suggests consuming additional iron in order to experience a carefree pregnancy and birth. Pharmacy shelves are full of different iron supplements. How to make the right decision – based on price, ingredients, iron salt? Syrup or pills?
Iron deficiency anemia is very common during pregnancy. Anemia during pregnancy can be diagnosed with hemoglobin values below 110 g/l during the first and third trimesters and below 105 g/l during the second trimester. Low hemoglobin levels (85–105 g/l) are linked to low birth weight and premature birth. Mother´s pre-pregnancy iron stores are used by the body´s accelerated hematopoiesis process and to ensure the normal growth of the fetus. Repetitive bleeding during pregnancy, multiple and successive pregnancies, mother´s acute and chronic illnesses (e.g. ulcerative intestinal inflammation, stomach and duodenum ulcer disease, repeated urinary tract infection etc.), iron absorption disorder, intestinal parasites, drugs for reducing gastric acidity and insufficient nutrition all increase the risk of iron deficiency anemia .
The body uses iron to produce hemoglobin found in red blood cells. Hemoglobin helps to transport oxygen to different tissues and organs. During a normal pregnancy, a woman´s body has about 1250 ml of extra blood. The weight of red blood cells increases by about 250 ml to satisfy the demand for extra oxygen. Because of that, levels of hemoglobin and iron stores decrease during pregnancy. Midwives and gynecologists regularly analyze pregnant women´s blood to check for any changes during pregnancy. Pregnant women are checked for anemia during the first trimester of pregnancy (or after the first appointment) and tests are repeated during week 28 to leave enough time for treatment.
The body needs around 1300-1400 mg of iron due to pregnancy. It regulates the additional iron demand during pregnancy in two ways: by increasing iron absorption from food and by using body´s iron stores. The need for iron is the following:
|COMPONENTS NEEDING IRON||AMOUNT OF IRON IN MILLIGRAMS (MG)|
|Additional red blood cells||570|
|Iron loss via skin, feces and urine||270|
|Iron needed by the fetus||200-370|
|Placenta and umbilical cord||35-100|
|Bleeding after pregnancy 500 ml||250|
|Breastfeeding 6 months||150|
|Amenorrhea 15 months, storage||250|
|Total iron need
The World Health Organization (WHO) advises consuming 30-60 mg of iron daily for women without diagnosed anemia and 120 mg for women with low already diagnosed anemia. It is advised to start using iron supplement from the beginning of pregnancy [4,5].
Based on nutrition science it is safer to consume 50-100 mg of iron per day starting from week 20 to prevent iron deficiency. The body loses blood during pregnancy depleting hemoglobin, and bleeding after birth can mean blood loss of about half a liter. Therefore, it is in the interest of pregnant women to consume additional iron starting from week 20. The need for iron increases at the end of the pregnancy . By week 20, a lot of women have very low iron stores, i.e. ferritin level, so here it is more wise to listen to the guidelines of WHO and starting with iron supplementation 30 or 60 mg per day depending on current iron stores, i.e. ferritin level.
Pregnant women often suffer from constipation due to slower metabolism. Metabolism slows down during pregnancy to ensure that the fetus gets all the necessary minerals and vitamins needed for normal growth. Before purchasing iron food supplements, take a look at the ingredients, the most important thing is to find out which iron salt has been used in the product.
Different iron salts are absorbed differently by the body. The lower the absorption of the iron salt, the more foreign matter is stored in the body, causing nausea, constipation, metal flavored “burps” etc. Very often iron salts with low bioavailability, i.e. with low absorption, are used in food supplements and OTC drugs. For instance, the absorption of iron sulphate and fumarate is about 27–28%, the absorption of iron gluconate is around 32%. Pregnant women often use supplements with iron sulphate and the daily dosage is around 100–300 mg because of the low absorption of iron sulphate. The daily dosage of bisglycinate should be at least two times smaller due to high bioavailability.
PREVENTING AND TREATING IRON DEFICIENCY WITH NÔGEL
- specialized in iron supplements
- co-operation with Estonian universities, doctors, midwives and chemists
- highly bioavailable (90%) stomach-friendly iron bisglycinate
- usually does not cause side effects (constipation, nausea)
- absorbs at least twice more effectively than widely-used iron sulphate and fumarate 
- optimized vitamin C content to reduce oxidative stress with natural organic acerola
- content of vitamins and minerals is always checked
- safe iron salt – usage has been accepted in infant and toddler food by the European Union´s regulations 
- natural ingredients – safe for you and your baby
- for every product sold we donate 5 cents to local charity 🙂
In addition to the iron salts in the supplements, it is worth paying attention to the bulking agents used in pills and also to the form of vitamin C, is it natural or synthetic? A lot of food supplements contain other vitamins and/or minerals in addition to iron. You should first find out what does your body actually need before consuming any other minerals and vitamins along with iron just in case.
 Tartu University Hospital Women´s Clinic – Iron deficiency anemia
 Milman N, et al. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med. 2014 Mar;42(2):197-206. doi: 10.1515/jpm-2013-0153.
 Regulation (EU) No 609/2013 of the European Parliament and of the Council of 12 June 2013. Commission Delegated Regulation (EU) 2017/1091 of 10 April 2017
 A.Aro, M.Mutanen, M.Uusitupa. Ravitsemustiede (Nutrition Science), 4th-7th volume, 2017