Iron Deficiency Anaemia (IDA) in Pregnancy 

The total iron requirement in pregnancy is 1200 mg. Iron is needed for expansion of the maternal red cell mass, foetal growth, placental growth, and blood loss at delivery.

Daily iron requirement

• Pathophysiology (iron math)
  • About 10-15 mg of iron can be found in a well balanced diet.
  • 1-2mg is absorbed and is sufficient to meet an unpregnant body’s requirements.
  • However, as mentioned above the second half of pregnancy needs more iron.
  • The body’s iron stores are about 200-300mg in a female spread among hemoglobin (67%), reticulo-endothelial system (25%) and the rest can be found in myoglobin and in enzyme systems.
  • A rapidly growing fetus requires about 350mg with 250mg of iron being lost in the process of delivery. The expanded RBC mass requires about 450mg. In total a pregnant woman requires an extra 1000mg.
  • The body’s iron stores cannot meet this figure and gets depleted predisposing pregnant women to iron deficiency.
• Signs and symptoms
  • Fatigue and inability to participate in physically taxing activities that they could perform with ease before
  • Headaches that occur daily
  • Cold intolerance
  • Palpitations
  • Dyspnea
  • Leg cramps on activity
  • Restless leg syndrome
    • low levels of iron = low dopamine levels
  • Increased number of infections
  • Pica in extreme cases
  • Pallor of the mucous membranes
  • Tachycardia
  • Koilonychia
  • Glossitis with atrophy of lingual papillae
  • Angular stomatitis
• Treatment
  • Oral iron (ferrous sulphate)
    • 60 – 120 mg per day until Hb ≥ 11 g/dL
    • The expected increase in haemoglobin is 1g/dL/week after iron therapy
    • Continued prophylactic dose for 3 months or until 6 weeks postpartum, whichever is longer
    • Iron is taken with an empty stomach
    • Supplemental ascorbic acid or citrus juice can be given to increase iron absorption.
  • Parenteral iron (iron sucrose, ferric carboxymaltose, or ferric derisomaltose) for:
    • Moderate-severe anaemia
    • Oral iron intolerance
    • Malabsorption
    • Late pregnancy
    • Failure to respond to iron
  • Blood transfusion for:
    • Severe anaemia
    • Anaemia near term
    • Acute haemorrhage
    • Symptomatic anaemia
    • Cardiac failure
    • Haemodynamic instability
  • Erythropoetin
    • Usually administered in conjunction with IV iron
    • Not normally done, but it may be used in cases where a fast increase in hemoglobin is needed such as in the third trimester

Treatment according to severity