NEW RESEARCH HAS found that 4 out of 5 women are low in iron in the final three months of their pregnancy. The research was undertaken by the Irish Centre for Maternal and Child Health and the School of Food and Nutritional Sciences at University College Cork (UCC).
Lecturer in Nutrition at UCC and study lead, Dr Elaine McCarthy said this finding was surprising in a healthy low risk population. Practical advice to prevent iron deficiency recommended by the study includes increased intake of fortified breakfast cereals combined with fruit juice to enhance iron absorption, followed by iron supplements if a diagnosis of iron deficiency has been given.
To the latter-day advice of consuming liver is not recommended and Guinness “perhaps not”, said Dr McCarthy on Morning Ireland.
We certainly wouldn’t recommend liver anymore because it has other nutrients that are a little bit at high risk and Guinness perhaps not.
‘Most people know that animal-based products like meat and poultry have a lot of iron in them. But other foods that are not animal based like your fortified breakfast cereals or green leafy vegetables or dried fruit. All of those have iron in them.
‘But the top tip around iron is how we eat that. For example, if we have foods like vitamin C. If I have my fortified breakfast cereal in the morning it would be better for me to have that with a glass of orange juice rather than a cup of tea because there is something in the tea that actually can inhibit the absorption of iron in the body whereas the orange juice has vitamin C which enhances the absorption of iron in the body. So that’s an important tip.’
While this was a good-natured morning discussion referencing outdated advice and looking at the study, breakfast cereals and stout cannot be the best advice for women in a country with some of the highest levels of obesity and alcohol consumption during pregnancy. Advice on prevention of iron deficiency needs to be balanced against other significant risks including consumption of ultra-processed foods and alcohol on health outcomes for both mother and baby.
Obesity is a major risk factor for a range of complications from gestational diabetes to premature birth. In a recent UCD audit of births at the Coombe Hospital, it was established that women with obesity are up to three times more likely to have a premature child during their first pregnancy. In Ireland, the rate of obesity in mothers during their first 12 weeks of pregnancy is between 19% and 25%.
Professor Michael Turner, UCD School of Medicine, has spent much of his career dealing with health problems that arise in pregnancy.
‘One in six women presenting to the Coombe is obese. The evidence suggests that maternal obesity is increasing.
‘We found that maternal obesity is associated with an increase in pregnancy complications such as gestational diabetes, preeclampsia, hypertension and thromboembolism- pulmonary embolism is one of the most common direct causes of maternal death in Ireland’, Professor Turner said.
There is also evidence of harm from alcohol right from the very start in the womb. According to research in Lancet Global Health, almost two out of three (60.4%) of Irish women continue to drink when they are expecting a baby — six times the global average of one in ten.
Alcohol is a teratogen with the ability to cause birth defects in the developing foetus. It is no surprise therefore that Ireland has the third highest rate of foetal alcohol spectrum disorder (FASD) in the world at about 6,000 cases per year.
FASD embraces a range of lifelong physical and neurological conditions affecting children born to mothers who drink during pregnancy that include behavioural problems, difficulties regulating emotions and impulse control as well as learning difficulties and impaired cognition.
Why do iron deficiency and iron deficiency anaemia occur during pregnancy? The body uses iron to make haemoglobin. Haemoglobin is a protein in the red blood cells that carries oxygen to tissues. During pregnancy, blood volume increases and so does the amount of iron needed. The body uses iron to make more blood to supply oxygen to the baby. If there is insufficient iron during pregnancy as was shown to be the case in four out of five women in this study, iron deficiency anaemia can develop.
Severe iron deficiency anaemia during pregnancy increases the risk of premature birth (when delivery occurs before 37 complete weeks of pregnancy). It is also associated with having a low birth weight baby and post-partum depression.
Risk factors for iron deficiency anaemia during pregnancy include: having two closely spaced pregnancies, pregnancy with more than one baby, morning sickness, heavy periods before pregnancy and of course diet with insufficient iron-rich foods.
Symptoms included fatigue, weakness, dizziness, headache, pallor or shortness of breath and pica – craving to eat things that are not food. Signs include a rapid heartbeat or low blood pressure or difficulty concentrating.
If you feel these symptoms during pregnancy, your doctor can run a blood test and advise on whether you need iron supplements.
Key to prevention is a healthy diet in the months leading up to and during pregnancy to ensure that both mother and baby get all the nutrients they need.
In terms of iron, the HSE recommend eating foods rich in iron at least twice a day while pregnant. Haem iron is a type of iron that is more easily absorbed by the body. Haem iron is in red meats, like beef, lamb, mutton and pork. Non-haem iron is less well absorbed by the body and is found in eggs, green leafy vegetables and pulses such as dried beans and peas. It is also found in fortified breakfast cereals, but this must be balanced against the level of ultra-processing that includes additives and added sugar along with the removal of nutrients like fibre and protein.
Vitamin C helps the body absorb iron. Eating foods rich in vitamin C such as oranges, kiwis, strawberries and red peppers helps in the absorption of non-haem sources of iron.
Tea and coffee contain tannins that can also impact the amount of iron your body absorbs. The HSE recommend avoiding drinking tea and coffee with meals for this reason.
But iron is not the only important nutrient for pregnant women.
The HSE recommend about an extra 250 calories during the second trimester and up to 500 calories during the third trimester as well as a supplement of folic acid with 400 micrograms of folic acid each day throughout your pregnancy. If you have certain medical conditions, you may need to take more.
Green leafy vegetables and milk are good sources of folic acid. Fortified breakfast cereals also contain folic acid but again this must be balanced against intake of ultra-processed foods high in sugar, salt and additives.
Calcium is important during pregnancy for healthy bones and managing blood pressure and three servings of milk, cheese or yoghurt a day is recommended. Two portions of oily fish (salmon, herring, trout, mackerel, or sardines) will boost both omega-3 and vitamin D levels.
Good nutrition in the months leading up to and during pregnancy is absolutely essential to give mother and baby every chance of a healthy pregnancy and a healthy baby – iron is just one part of that.
It is hard to beat the pragmatism and wisdom of Michael Pollan in ‘In Defense of Food’, published almost two decades ago in 2008.
‘Eat food’, (as opposed to ultra-processed junk), ’not too much, mostly plants’.
Following this advice means that iron and most other essential nutrients during pregnancy will normally look after themselves.
Dr Catherine Conlon is a public health doctor in Cork and former director of human health and nutrition, safefood.
To embed this post, copy the code below on your site
have your say