Should You Take an Iron Supplement if You’re TTC or Pregnant?

For a long time, taking iron in pregnancy was an automatic “yes!” There was no question, women should all take a prenatal with iron or take a separate iron supplement. Research shows that about 2.6% of pregnant women have iron deficiency anemia and about 16.3% are iron deficient.

The general recommendations for iron are 15-18mg per day for women (depending on age) and 27mg per day for pregnancy. To get that from your diet you could eat:

Breakfast:

• 2 pieces of whole grain bread (2 mg)
• 2 eggs ( 2 mg)

Lunch:

• 1/2 cup canned white beans (4mg)
• 6 oz ground beef (4.5 mg)
• 1/2 cup boiled broccoli (1 mg)

Dinner:

• 6 oz chicken (2 mg)
• 1/2 cup boiled spinach (3mg)
• 1/2 cup white rice (1mg)

Snack:

• 2 oz dark chocolate (2mg)
• 1/4 cup raisins (1mg)

For a total of 22.5 mg of iron in a day. All in a days effort! Some days you may get more and some days you will get less. The important thing is that you are getting enough over time.

So does everyone truly need the extra iron? Are we covering bases that aren’t even on the field? Let’s talk about who needs it, who doesn’t, and what to look for.

Two sides to every story?

On the one hand, some will say that because iron needs increase in pregnancy, there should be no question about supplementation.

Others will say that we need to be mindful of taking too much because it can impact how our bodies use other nutrients and supplements.

Like most situations in nutrition, there is nuance, and both sides make valid points. So let’s dig into it.

Why Iron Matters:

It’s necessary to keep in mind that our bodies need iron. Iron is an essential mineral that is required to make red blood cells in the body. Specifically in pregnancy, it’s necessary to help carry oxygen to baby and develop vital organs.

Deficiency is not something that we want to be chasing, so keeping track of iron levels before you get pregnant can be incredibly helpful.

Key Factors to Keep in Mind:

1. Many nutrients in our body work together

• Iron and Vitamin A are both essential for iron metabolism in the body. This means you need to be eating adequate amounts of both. This is also a situation where animal-based sources tend to have a stronger impact vs plant-based sources.

2. Heme Iron vs. Non-Heme Iron

• Heme iron is iron that is bound to a protein called heme and is found in animal-based sources such as red meat. This form is much better absorbed and utilized.
• Non-heme iron is unbound iron that is found in plant-based sources such as beans. When you eat non-heme iron with a source of vitamin C (such as bell peppers, citrus, or berries), it can improve your body’s ability to absorb and utilize that iron.

3. Certain nutrients can impair iron absorption

• Tannins in coffee and tea: make sure to take your prenatal separate from your morning coffee.
• Calcium: this means no taking your iron supplement with calcium fortified orange juice! This is also the reason that many prenatals are low in calcium.
• Phytates: found in legumes, whole grains, nuts and seeds. Don’t worry, you can still (and should!) eat these foods. It just means that if you are iron deficient, it can be helpful to be mindful of when you eat certain foods.

4. Additional factors

• Iron absorption actually increases during the later stages of pregnancy. In fact, in the general public, iron absorption increases if the needs are higher and decreases if the needs are lower.
• Stomach acid impacts your body’s ability to absorb iron; as a result, taking antacids regularly can negatively impact iron levels.
• Increased blood volume in pregnancy can make it look like hemoglobin is low, even if iron levels are adequate. This is important to consider when looking at iron levels.

5. Different Forms of Iron

These different forms can impact both absorption and tolerance.

• Ferrous Salts: Common types are ferrous sulfate, ferrous fumarate, and ferrous gluconate..
  • Ferrous sulfate is commonly used and has more iron in it than ferrous gluconate.
• Iron chelates: Common type is iron bisglycinate.
  • These can be better absorbed and sometimes better tolerate.
• Carbonyl Iron:
  • Elemental iron and can be better tolerated due to being more slowly absorbed.

Who Should Consider Taking an Iron Supplement

1. If you have low iron levels or low iron stores. I always encourage clients who are TTC or pregnant to get a full iron panel and review those results with a dietitian or your doctor. This means looking at:
   • Serum Iron
   • Total Iron Binding Capacity (TIBC)
   • Ferritin
   • Transferrin Saturation
2. If you don’t eat many high heme-iron foods including, but not limited to:
   • Oysters
   • Mussels
   • Red meat
   • Sardines
   • Turkey
   • Shrimp, crabs, clams
3. If you are carrying more than one baby or currently have/have a history of heavy menstrual bleeding as this can put you at higher risk for anemia.
4. If you are an endurance athlete, particularly a distance runner as this can put you at higher risk for deficiency.
5. You have a history of GI conditions or weight loss surgery.

Who Should Consider Not Taking an Iron Supplement

1. If you have healthy iron levels and eat adequate amounts of iron from heme-iron sources. It is important to check iron levels throughout pregnancy as they can change. Often levels will be checked in the first and third trimester, but you can request them anytime!
2. If you have a condition called Hemochromatosis, which is when your body already has excess stores of iron.

The Bottom Line

Iron toxicity and overload can be a serious concern, which is why understanding your levels and taking appropriate supplementation is so important.

Adequate iron is a balancing act that can be done well. If you aren’t sure what is best for you, consider working with a dietitian!