Categories: Frequently Asked Questions Vitamins and Supplements For Parents Pregnancy

Iron is probably the only nutrient that it is impossible to get enough of with a very good diet during pregnancy; therefore, some kind of supplement may be necessary.

Are you anemic? That is, do you have iron-deficiency anemia, a specific type of anemia that results from low iron stores? Do you have difficulty tolerating iron supplements (stomach distress, constipation, etc?) Iron is probably the only nutrient that it is impossible to get enough of with a very good diet during pregnancy; therefore, some kind of supplement may be necessary. (Folic acid supplements should also be taken prior to and during pregnancy to minimize the risk of neural tube defects.) The amount of iron in the standard prenatal vitamin is enough for most women who eat a healthy diet. Additional iron can be gotten with iron-rich nutrients: red meat, dark green leafy vegetables (especially kale, collards, mustard greens, chard), and dried fruits (prunes, raisins, figs). Cast iron skillets are good for adding iron to your diet; as you cook in them, a tiny amount of the iron leaches off into the food.

For some women, this is still not enough iron. The most common, and the cheapest, iron supplement is iron (or ferrous) sulfate, available over the counter and cheaply at the pharmacy or grocery. One or two tablets a day, taken with citrus juice or with water, will improve the blood count over several months. However, these tablets can be harsh on the stomach and cause constipation, or make existing constipation worse.

For women who need additional iron and cannot tolerate iron sulfate tablets, there are several alternatives. Iron gluconate is easier on the stomach, and there are some time-released versions. These are more expensive, of course, than iron sulfate tablets. Finally, there is Floradix, a liquid herbal supplement from Germany which seems to work for women who cannot tolerate the other options and can't get their iron stores up with food. It seems to work very well. I sell it on my website, www.midwifeinfo.com. Taking Floradix twice a day should build your iron stores at about the same rate that iron tablets would, with no gastric side effects. Floradix contains less iron than these supplements, but it is 25% absorbed compared to 2-10% for the tablets. It also contains B vitamins and vitamin C which enhance absorption, herbal extracts to increase digestion, and fruit juices to ensure proper stomach acidity. A 20mL dose of Floradix will deliver15 mg of iron; taking it twice a day should definitely improve your iron stores.

There is current controversy about what constitutes a "normal" blood count or hematocrit during pregnancy. Certainly, it is lower than a woman's normal non-pregnant hematocrit, about 37-40%. During early pregnancy, the blood is diluted with additional fluid, and so the red blood cells, which carry the iron, constitute a smaller fraction of the whole blood. As the bone marrow is triggered to make more red blood cells, they catch up, add more red blood cells to the diluted fluid, and the hematocrit rises again later in pregnancy. What we used to think of as "anemia" during pregnancy may actually be a normal physiological process. Thinner blood may cross the placenta and get to the baby more easily. We may be making things worse, not better, by trying to get women's hematocrits back up to the normal non-pregnant values. However, there is a low that is too low, and that is probably under 30% for many women. If the hematocrit is too low, women will have symptoms: fatigue, rapid heart beat, dizziness. Therefore, almost all midwives and physicians will want to treat those women with extra iron.

There is an almost universal propensity to treat low hematocrits with iron during pregnancy among obstetricians and most midwives. However, according to "Guidelines for Effective Care in Pregnancy and Childbirth, "the available data from controlled trials provide clear evidence that normal (for non-pregnant women) values can be restored by this supplementation, but there is no evidence that it has any effect, beneficial or harmful, on clinical outcomes for mother or baby." You can find a reference for this at http://www.update-software.com/ccweb/cochrane/revabstr/ab000117.htm. (NS, 11/30/01)