Iron in pregnancy

Iron is one of the nutrients your body needs a lot more of in pregnancy, and running low on it is one of the most common issues that comes up at antenatal appointments. Your body is making a big increase in blood volume to support your growing baby and placenta, and iron is essential for that — so demand goes up, and many people need a little help to keep up.

When iron gets too low, you can develop iron-deficiency anaemia. The signs overlap with normal pregnancy tiredness, which is why it’s easy to miss: feeling unusually exhausted, pale, breathless, dizzy or light-headed, having a racing heart, or getting frequent headaches. That’s exactly why your routine antenatal blood tests check your iron levels — usually early in pregnancy and again later on — so it can be picked up and treated even before you feel the effects.

Getting iron from food. There are two kinds of dietary iron. Haem iron, from animal sources like red meat, chicken and fish, is the most easily absorbed. Non-haem iron, from plant sources like legumes (lentils, chickpeas, beans), tofu, wholegrains, leafy green vegetables, nuts, seeds and iron-fortified cereals, is absorbed less easily — but you can boost how much you absorb with a couple of simple tricks:

• Pair non-haem iron with vitamin C — a squeeze of lemon, some capsicum or tomato, or a piece of fruit with the meal.
• Avoid tea and coffee with meals, as they reduce iron absorption; have them between meals instead.

If you’re vegetarian or vegan, it’s very doable to get enough iron, but worth being deliberate about — combining a variety of the plant sources above, using the vitamin C trick, and keeping an eye on your levels with your care team.

Supplements. If your blood test shows your iron is low, your GP or midwife will usually recommend an iron supplement — this isn’t given to everyone as standard, but only if you need it. Iron supplements can cause constipation (and sometimes nausea or dark stools), which is common and manageable: keep up your fibre and fluids, stay active, and if it’s a problem, ask about a different formulation or dose, or taking it every second day, which suits some people better. Take it with vitamin C (like orange juice) and away from tea, coffee and calcium (including dairy and antacids) for best absorption. Don’t take high-dose iron on your own without advice, as too much isn’t good either.

Why it matters: keeping your iron up helps you feel better through pregnancy, supports your baby, and leaves you in better shape for the birth (where some blood loss is normal) and the demanding newborn weeks. Low iron is also a common cause of that “flattened by fatigue” feeling, so it’s genuinely worth sorting.

Some people are more likely to run low on iron: if you’re expecting twins or more, if your pregnancies are close together, if you began pregnancy with low iron stores, if you had heavy periods beforehand, if you follow a vegetarian or vegan diet, or if morning sickness has made eating hard. If any of these are you, it’s worth being a bit more proactive about iron-rich foods and keeping an eye on your levels — and mentioning it to your care team.

Occasionally, when iron is very low, or tablets aren’t tolerated or aren’t working fast enough, your doctor may recommend an iron infusion (iron given through a drip), which tops your levels up more quickly — your team will advise if that’s appropriate. It’s worth treating low iron properly, because significant anaemia can leave you exhausted, less able to cope with the normal blood loss at birth, and is linked with some risks for your baby — so it’s genuinely one of the more useful things to stay on top of.

The takeaway: eat iron-rich foods with a hit of vitamin C, keep tea and coffee away from meals, and let your routine blood tests do the monitoring — and if you’re advised to take a supplement, stick with it and manage any constipation with the usual measures. If you’re ever worried about your energy levels, mention it, and ask whether your iron’s been checked.