Preconception care involves making sure you have adequate supply of all the nutrients essential to the health of the sperm and ova (egg) and to fetal development. Preconception also involves making sure your body is ready for the pregnancy ahead. These are not just important for the health of you during pregnancy, but also important for the health of your baby and their future health.

Iron is one of the most common deficiencies in women and is overlooked in terms of prevention. This is highlighted by the fact that the percentage of women planning pregnancy with intakes below dietary recommendations was 74%.

The classic sign of low iron is fatigue and low energy, which in our busy lives this is often dismissed as the new norm. Waking up unrefreshed or feeling exhausted at 3pm is not seen as out of the ordinary – but it really should be.

Other signs of low iron include shortness of breath, poor immune system, hair loss, tinnitus, poor circulation and even menstrual abnormalities, such as heavy bleeding, infertility and even miscarriages .

How can iron have such far reaching effects?

The main reason is that iron is needed to help carry oxygen around the body to various tissues and organs. If there isn’t enough oxygen to these tissues they simply cannot function as they should- this includes your brain, lungs and ovaries.

How can you assess your iron levels?

The best way to assess your iron levels is through blood tests (iron studies). Here you want to look at Ferritin, which refers to your stored iron and is most reflective of your iron status. As a Naturopath I want optimal iron levels, which for a menstruating female is between 80-100. In Australia, the reference range for “healthy” is usually between 30-200. Now, this is important to know (and to ask your doctor for) because as you can see the range is quite large and sadly many doctors only discuss iron levels if the pathology lab flags it to them. This therefore means many women who have say 35 or 32 do not get flagged as needing to improve their iron. BUT, it is quite easy for these women to fall below 30 when they are at such low levels and not know. It may be months or years before they have another blood test.

A particular concern is for the women who have these lower levels of Iron and fall pregnant. This is because the recommended intake for iron increases from 18mg a day to 27mg a day. So, for these women who were struggling to even get adequate iron at 18mg a day will find it nearly impossible to have 27mg a day.

Wow. Why does my iron requirements almost double?

During pregnancy your blood volume increases significantly because you now have to supply oxygen to your growing placenta and of course your growing baby. Then, during your last trimester your baby will be given first preference to your dietary iron. This happens because your baby needs to have adequate iron levels for their first 6 months of life until solids are introduced. Iron levels reduce in breastmilk over time and are not enough to support the growth demands of a baby.

Then lastly, you need higher levels of iron to compensate for the blood loss that will happen during labour. As after this your body will be working hard to re-build your blood levels and therefore needs a healthy store of iron too.

So, what can go wrong if I don’t have adequate iron before falling pregnant?

1. You may not fall pregnant: Women with inadequate iron stores are more likely to suffer from anovulation, meaning they fail to ovulate.

2. You can increase your risk of miscarriage and pre-eclampsia: Low iron compromises fetal and placental growth as well as neural tube closure.

3. You can increase the risk of pre-term labour, which can increase health complications for your baby.

4. There can be consequences to your baby’s blood, brain, eye, bone health and growth rate

5. Increased susceptibility to your immune function and therefore increased risk of serious infections (as your immune system is also compromised when pregnant)

6. Long term health effects to your baby: Epidemiology studies have found that iron deficiency during pregnancy is associated with developmental difficulties in their offspring involving cognitive, social-emotional, and adaptive functions.

These sounds really scary and they are. But, the great thing is these can ALL be easily avoided by simply checking your iron and staying on top of keeping it within the healthy range of 80-100. You want to have this checked ideally 6-12months BEFORE falling pregnant because it takes time to build up iron. And you want to do this slowly through diet and supplementation.

Take home messages

1. Low iron can have serious effects on your fertility, pregnancy health and baby’s health

2. Have your iron assessed at least 6-12months before thinking about falling pregnant – as it takes time to build up your stores.

3. Ask to see what your ferritin is at. Don’t just accept it as being “okay”. Even better, ask for a copy so you can also monitor your iron status.

4. Consult a Naturopath or Nutritionist who specialises in preconception care to help you build up your iron levels gradually – and also assess other possible nutrients to focus on.

About Kirsty Richardson – BHSc - Naturopathy

Kirsty is a clinical Naturopath (Naturally Interested Naturopathy) who graduated from Southern School of Natural Therapies in 2018. She became passionate about women’s health and preconception awareness after having a baby herself. She found that preconception was not something mentioned or talked about with health professionals – which was surprising considering it is the ultimate in prevention. Research now shows that preconception care plays a large role in setting up the foundations for a healthy pregnancy, healthy labour and most importantly, a healthy baby from birth into adulthood. Iron is just one topic within Kirsty’s online workshop ‘Preconception Health- A naturopaths Perspective’.

www.naturallyinterested.com.au

REFERENCES

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Breymann, C., Honegger, C., Hösli, I. et al. Diagnosis and treatment of iron-deficiency anaemia in pregnancy and postpartum. Arch Gynecol Obstet 296, 1229–1234 (2017). https://doi.org/10.1007/s00404-017-4526-2

Caut, C, Leach, M, Steel, A. Dietary guideline adherence during preconception and pregnancy: A systematic review. Matern Child Nutr. 2020; 16:e12916. https://doi.org/10.1111/mcn.12916

De Weerd, S., Steegers, E. A., Heinen, M. M., van den Eertwegh, S., Vehof, R. M., & Steegers-Theunissen, R. P. (2003). Preconception nutritional intake and lifestyle factors: first results of an explorative study. European journal of obstetrics, gynecology, and reproductive biology, 111(2), 167–172. https://doi.org/10.1016/s0301-2115(03)00290-2

Khaskheli, M. N., Baloch, S., Sheeba, A., Baloch, S., & Khaskheli, F. K. (2016). Iron deficiency anaemia is still a major killer of pregnant women. Pakistan journal of medical sciences, 32(3), 630–634. https://doi.org/10.12669/pjms.323.9557

Lucía Iglesias, Josefa Canals & Victoria Arija (2018) Effects of prenatal iron status on child neurodevelopment and behavior: A systematic review, Critical Reviews in Food Science and Nutrition, 58:10, 1604-1614, DOI: 10.1080/10408398.2016.1274285

Ribot B, Aranda N, Viteri F, Hernández-Martínez C, Canals J, Arija V. Depleted iron stores without anaemia early in pregnancy carries increased risk of lower birthweight even when supplemented daily with moderate iron. Hum Reprod. 2012;27(5):1260–1266