A Saskatchewan physician is shedding light on a commonly unrecognized problem: iron deficiency in pregnancy.
Dr. Christine Lett is one of the authors of a research study that looked at the incidence of iron deficiency and anemia during pregnancy and postpartum, and the impact of iron supplementation on pre-delivery and postpartum anemia in iron-deficient patients.
“I started looking into this after I learned that iron deficiency is the most common micronutrient deficiency and that the majority of people with iron deficiency are reproductive- aged-women and children,” explains Dr. Lett.
The study’s results astounded the researchers, Lett says.
Using an electronic medical record database, they conducted a review 280 patients between November 2016 and November 2017, looking at their complete blood count (CBC) and iron levels taken during the second trimester diabetes screening. What they found was that between the 24th and 28th week of pregnancy, 87 per cent of their sample was iron deficient. They also found that during this time, only eight per cent of their sample were anemic (a low hemoglobin level), but this number climbed to 44 per cent postpartum.
“Seventy-four per cent of those iron-deficient patients received antepartum oral iron supplementation, which increased pre-delivery hemoglobin levels, but this did not impact the incidence of postpartum anemia,” says Lett.
Hemoglobin is a protein in red blood cells which contains iron, which is what transports oxygen in the bloodstream.
“What we found was that iron deficiency in pregnancy was very common in our sample, but that wouldn’t have been recognized by checking the hemoglobin levels alone, which is what we typically do when we just order a CBC . This would only have been found by checking iron levels.”
The findings changed the way she thinks about iron levels in her patients.
“After we did this study, I recognized that I was waiting for patients to become anemic before identifying iron deficiency. So I changed the way I thought about iron, and now I'm motivated to make sure women's iron stores are replete prior to pregnancy so that they don't become anemic during pregnancy or postpartum,” she explains.
It’s important for everyone, especially pregnant women, to have a healthy iron level. Low iron can lead to feelings of fatigue, weakness, anxiety, difficulty concentrating, headaches and dizziness, dry and damaged hair and skin, and low levels during pregnancy can put the baby at risk of premature delivery and low birth weight.
Daraleigh O’Watch is one patient who benefitted from receiving iron to treat anemia during her last pregnancy and postpartum. After her first iron infusion, which is how her doctor recommended she receive iron, she said she woke up with more energy than she had had in years.
Daraleigh O'Watch and her daughter.
“I cleaned my house, played with my kids and still had energy to do more! I couldn’t believe what a difference it made,” O’Watch says.
She continued receiving iron infusions throughout her pregnancy, and after she gave birth before leaving the hospital.
Over the course of her treatment, “the anxiety that had become ‘normal’ for me was completely gone,” she says. “I did not have another anxiety attack. It was the best pregnancy of them all. I had so much energy. I felt like finally my family had their mom back.”
O’Watch says she had the best recovery of any of her pregnancies after she delivered her daughter. She was out of the hospital quickly, her baby wasn’t jaundiced as her others had been, her milk came in quickly, her daughter grew well, and she didn’t get the postpartum blues as she had with her other children.
“Before this pregnancy, I was concerned that I was depressed,” she says. “Now I realize the symptoms I had been feeling prior to pregnancy were all because my iron was so low.”
Lett has now developed a screening and treatment algorithm for iron deficiency in pregnancy that is available on
saskblood.ca for widespread use.
Lett encourages all women to advocate for iron level testing, not just a hemoglobin level. The first line of treatment for iron deficiency is oral iron. If patients can’t tolerate oral iron because of the effect it has on their digestive system, or if it has no effect on their iron levels after a few weeks, IV iron is recommended.
More information can be found here. Lett’s algorithm is available here.