She had been warned that fatigue would increase as her pregnancy progressed. But she felt more exhausted and tired than usual. M, 30, a first-time mum was at 28 weeks of pregnancy. Her short evening walk after dinner left her breathless with her heart pumping rapidly. She also felt a little dizzy. Her husband was very concerned and brought her for a consultation.
She looked pale and her resting heart rate was slightly elevated at 100 beats per minute. Ultrasound examination of her foetus was normal. Blood tests, however, showed that she was anemic with a low iron reserve. M was suffering from iron-deficiency anemia, a common condition during pregnancy.
Iron-deficiency anemia occurs when the body lacks enough iron to produce hemoglobin, a substance in red blood cells that helps carry oxygen. As pregnancy progresses, the foetus requires more nutrients, including iron, to help develop its red blood cells and support its growth. Unfortunately, M’s iron stores were too low to meet these needs. With her iron levels depleted, she could not provide enough oxygen to her own tissues. This explained her pale appearance, breathlessness and fatigue.
Prevalence of Iron-deficiency in Singapore
Local studies have found that anaemia is seen in one in five women of reproductive age and about three-quarters of pregnant mums suffer from iron deficiency.
Importance of iron during pregnancy
Iron is crucial during pregnancy for the following reasons, as it supports both the health of the mother and the developing baby:
1. Formation of Hemoglobin
Iron is essential for making hemoglobin, the protein in red blood cells that carries oxygen to tissues. During pregnancy, a woman’s blood volume increases, requiring more hemoglobin to support both the mother and the growing baby.
2. Prevention of Anemia
Severe anemia during pregnancy is associated with preterm delivery, low birth weight, and increased risk of maternal death.
3. Fetal Development
Iron is important for the baby’s brain development. It supports the growth of the fetal brain and nervous system, and a deficiency in iron can lead to cognitive and developmental issues later in life.
4. Immune Function
Iron also plays a role in the immune system. Adequate iron levels help maintain the mother's immune function, which is critical during pregnancy when her immune system is slightly suppressed to accommodate the growing fetus.
5. Placental and Fetal Growth
Iron contributes to the proper formation of the placenta and supports the growth of the fetus. Low iron levels can impair placental function, which can affect the delivery of nutrients and oxygen to the baby.
6. Increased Energy Levels
Adequate iron intake helps pregnant women maintain energy levels by supporting their body's ability to carry oxygen efficiently to muscles and tissues.
7. Compensating for Blood Loss During Delivery
Labor and delivery can result in significant blood loss, which depletes the body’s iron stores. Iron helps in the replenishment of hemoglobin levels and healing after childbirth. Iron helps prevent postpartum fatigue and weakness.
8. Supporting Milk Production
Iron is essential for the production of breast milk. Adequate iron levels ensure that the baby receives iron through breast milk, supporting its growth and development.
Recommended Iron Dosage During Pregnancy:
27 mg per day is the recommended daily intake of iron for pregnant women.
Diagnosis of iron-deficiency anemia
Common symptoms of iron deficiency anemia, which include:
Fatigue or weakness
Dizziness or lightheadedness
Shortness of breath
Pale skin, especially noticeable in the face or hands
Rapid or irregular heartbeat
Cold hands and feet
Headaches
Brittle nails or hair loss
Laboratory Tests include:
Full Blood Count
Serum Ferritin: This test measures the amount of stored iron in the body. A low ferritin level (less than 30 ng/mL) is a strong indicator of iron deficiency.
Serum Iron: Low levels suggest iron deficiency.
When Should Blood Tests Be done?
Pregnant women should be routinely screened for anemia during the first prenatal visit and again in the second or third trimester.
Women with risk factors for anemia such as poor eating habits, frequent pregnancies, or heavy menstrual periods before pregnancy, may require more frequent testing.
M was much relieved when I reassured her that with adequate and early intervention, her condition would improve. The treatment plan involved changes in her diet and the addition of iron supplements. M began eating more iron-rich foods. She also took iron pills diligently.
By the time she was near her due date, her iron levels and haemoglobin had risen. She eventually gave birth to a healthy baby boy.
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