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Are you iron deficient when pregnant?

Are you iron deficient when pregnant?

Are you iron deficient when pregnant?

Are you aware of the potential hazard of developing iron deficiency or anemia during pregnancy? It's quite alarming that around 52% of expectant women receive a diagnosis of this deficiency. Often, they have limited comprehension of the changes occurring in their bodies, leading to a sense of confoundment. Consequently, these women tend to entrust their health management completely into the hands of their healthcare practitioner because they don’t have a firm grasp on the underlying factors leading to this nutritional insufficiency.

In such instances, it's essential to establish a dialogue about this common health issue. It's a known fact that pregnancy incurs myriad changes in a woman's body. Sufficient knowledge about these changes, particularly about nutritional deficiencies like this, can instill a sense of security and control. Understanding bodily functions and needs can lead not only to a healthier pregnancy but also to a more informed approach to health in general. Therefore, it is crucial to address this knowledge gap to empower expectant mothers about the iron's role and its implications on a healthy pregnancy.


Blood Composition and Iron in Pregnancy

Throughout pregnancy, the human body goes to extraordinary lengths to nurture the new life growing within. One of the phenomenal changes it undergoes includes producing approximately 40-50% more blood to support this development. This increased blood volume leads to a relative dilution effect, often causing seemingly lower readings of hematocrit (HCT) and hemoglobin (HGB) levels. HCT measures the proportion of red blood cells, responsible for oxygen transport, in your blood. Simultaneously, HGB represents the amount of hemoglobin - the protein within red blood cells that delivers oxygen to the body's organs and tissues, and carries carbon dioxide back to the lungs.

When the readings of these vital markers drop, healthcare professionals may leap to the conclusion that the expectant mother requires additional intake of this mineral or even a blood transfusion in some cases. However, this is an oversimplification as various factors can influence these markers. These include diet, lifestyle, innate nutrient absorption capabilities, and overall health status.

Moreover, there are hypotheses suggesting that an increase in blood volume can be associated with pregnancy complications, predominantly during the second and third trimesters. They argue it may indicate a higher concentration of blood rather than dilution, posing potential risks, as it could signify insufficient blood supply to the fetus. Hence, understanding these complexities can lead to more personalized and holistic healthcare approaches for expectant mothers.


The Misunderstood Marker – Ferritin

It's widely observed that many healthcare professionals rely on ferritin levels, a protein that stores iron, to diagnose this mineral's deficiency. However, this isn't necessarily an accurate reflection of iron deficiency. Low ferritin doesn't directly imply a shortage of iron but is indicative of the body's struggle to utilize this mineral stored within tissues, such as the liver - the organ responsible for the majority of our iron storage and recycling.

Deficiencies in nutrients like retinol (vitamin A), copper, zinc, and B vitamins can also contribute to low ferritin levels. Additional factors causing low ferritin can include stress, malabsorption, and gut-related issues.

Interestingly, despite presenting low ferritin levels, some individuals may actually have an excess of this mineral. In such instances, supplying more iron could worsen their conditions. Therefore, it is vital to interpret ferritin levels judiciously to avoid potential misdiagnoses of iron deficiency and the associated complications.


Delving Deeper – Iron Recycling System (RES)

In an earlier article titled "Are You Truly Iron Deficient?", we delved into why ferritin might not be the most reliable marker for diagnosing this deficiency, and here's a brief recap of our findings:

Our bodies are equipped with a remarkable ability to recycle this mineral daily. The excess iron that is not utilized or excreted through sweat, bleeding, or oxygenation is reused by our body in an intricate process known as the Iron Recycling System or the Reticuloendothelial System (RES). The RES encompasses our red blood cells, small intestine, liver, spleen, and bone marrow. The liver plays a pivotal part in this system, serving as the primary organ for the disposal of red blood cells while simultaneously recycling iron. This activity also relies on the bone marrow, which facilitates the creation of monocytes that devour defective blood cells. These monocytes then morph into macrophages, which recycle the iron.

This recycling is necessary because our bodies lack a physiological mechanism to actively discard iron. We lose a marginal amount of iron—around 1-2 mg per day—through our gastrointestinal system, sweating, and cell shedding. However, this calculation doesn't factor in the iron loss through menstruation for women. Interestingly, it's noteworthy that women have a higher capacity to absorb iron compared to men, likely to compensate for this additional loss. Our Reticuloendothelial System (RES) is designed to recycle as much as 24mg of iron per day, which in turn implies our bodies only require an additional 1mg of iron to compensate for daily losses. This additional iron is easily obtainable from a balanced diet. Mirroring this, the total iron necessary to maintain red blood cell production amounts to 25mg—hence the simple equation: 24mg (recycled) + 1mg (additional) = 25mg. This requirement consistently aligns with the natural biological processes of our bodies.


Issues with Iron Deficiency Diagnosis

There remains a persistent issue of women predominantly being diagnosed with iron deficiency. So, what's the underlying problem? Firstly, many individuals are consuming diets abundant in iron-fortified foods. Excess consumption of these foods can potentially overburden the Reticuloendothelial System (RES).

Secondly, healthcare providers may not be conducting comprehensive blood tests. To accurately diagnose iron deficiency, it's vital to assess levels of both hemoglobin and ferritin in conjunction with ceruloplasmin, copper, and the total iron-binding capacity. However, many medical practitioners rely solely on ferritin tests, which is a flawed approach. This is mainly because our iron stores are distributed as follows: approximately 70% in our hemoglobin, 10% in our myoglobin, and the rest within our RES. Since ferritin is regarded as an intracellular protein, assessing it alone doesn't provide an all-encompassing perspective. Finally, many people lack sufficient levels of crucial iron co-factors like retinol, magnesium, and copper. Ensuring these complementary nutrients are included in one's diet can effectively regulate iron levels.


The Complex Nature of Iron

Evidently, iron relies heavily on various supporting nutrients, and simply increasing iron intake won't necessarily address the root of the problem. There are numerous preliminary processes occurring within our bodies that directly impact how iron is utilized. Importantly, the proper distribution of iron in and out of tissues relies on specific proteins that help the body use it effectively. When iron isn't adequately escorted by proteins, the body perceives a stress response and begins to hoard iron within the tissues as a protective measure.

This is predominantly because unescorted iron can trigger inflammation and promote the growth of harmful pathogens such as parasites or bacterial infections. As this inflammatory response escalates, so does the storage of iron. Our bodies consequently produce a protein called hepcidin that prevents further influx of iron into our hepatic system. This perpetuates the cycle of iron storage within the tissues and hinders its utilization in our Reticuloendothelial System (RES). Moreover, a study here suggests that without a comprehensive assessment of iron values, iron supplementation may potentially increase the risk of developing gestational diabetes. Hence, a thorough understanding of the body's iron utilization and balanced nutrient intake is paramount to achieving optimal health outcomes.



In conclusion, iron is a remarkably intricate mineral that interacts closely with other essential nutrients, including B vitamins, retinol, copper, magnesium, and even zinc. It can be significantly influenced by heavy metals within the body. To obtain a holistic understanding of one's iron status, we strongly advocate for consulting with a medical practitioner and undertaking a Hair Tissue Mineral Analysis (HTMA) in conjunction with a comprehensive Full Monty Iron Panel.

Are you considering undergoing an HTMA? Click here to schedule one with us—we're here to assist you on your health journey!

Barbara Madimenos
Hair Tissue Mineral Analysis Practitioner
Functional Diagnostic Nutrition Practitioner
Integrative Health Coach

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