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Post-Partum Anemia: Can Prenatal Supplements Prevent It?
by Stacelynn Caughlan Cl.N, CH

The postpartum period is challenging enough for most new moms. Recovering from the birth, learning to parent, and taking care of herself requires a lot of energy. Having anemia in the postpartum can make the process much more difficult. Anemia results when hemoglobin levels are low. Hemoglobin is an oxygen-carrying constituent built into the red blood cells. Since the red blood cells are responsible for delivering oxygen to other cells in the body, any problems with the oxygen delivery system (which happens with anemia) will result in the body struggling to work properly.

Iron is a key component of hemoglobin, therefore if the body is low in iron it will affect the body's oxygen delivery system often causing symptoms such as shortness of breath and fatigue - two of the classic signs of anemia.

Numerous studies have shown that prenatal iron supplementation results in higher maternal hemoglobin concentrations for up to two months postpartum and higher serum ferritin (iron) concentrations for as long as 6 months postpartum. Ferritin levels reflect how much iron is stored in the body whereas the hemoglobin levels indicate how much has actually been used in the red blood cells. In my opinion, the advantages to having optimal stores during pregnancy largely outweigh the minimal disadvantages of supplementation. But there is a lot of uncertainty about what is meant by 'optimal stores'.

Controversy abounds in the routine iron supplementation of all pregnant women. During pregnancy blood volume increases. However, since the plasma volume increases (water component of blood) more than the red blood cell volume, there is a dilution of hemoglobin. Therefore when a blood sample is taken, a natural decrease in hemoglobin and hematocrit values is seen during pregnancy. Some caregivers may interpret this as the body crying out for more hemoglobin, others suggest we should just leave it as is.

When observing a pregnant woman’s hemoglobin values, could we be comparing them to artificial standards? ‘Normal’ hemoglobin values used during pregnancy were determined by establishing the highest possible value that could be achieved through iron supplementation, not diet. It was discovered that supplemental iron cannot increase hemoglobin levels beyond the optimal amount needed for oxygen delivery, and supposedly that was the ideal amount for all women. Unfortunately, the quantity of iron needed to reach that prescribed 'normal' prenatal hemoglobin value far exceeds what a woman can consume in her diet. This has, therefore, led to the concern about the actual necessity of the recommended iron levels.

During pregnancy, iron absorption is particularly efficient. This is fortunate as a pregnant woman's needs for iron do increase, perhaps even double, whereas her caloric needs do not increase by that much (on average 300 additional calories). It is often suggested that a woman would need to consume more than 3000 calories a day to obtain the required iron. This is why supplements have become so popular.

The bioavailability of the iron supplements used is an important consideration. Common supplements derived from ferrous sulfate are not well tolerated by most women and cause gas, bloating, and constipation. Because such small amounts are absorbed (sometimes as little as 5%), large doses are necessary.

Iron supplements that are commonly referred to as ‘natural’ iron supplements are usually derived from fruit juices and plant extracts. They predominantly contain ferrous gluconate which is supposedly well utilized by the body. Therefore lower doses are appropriate and effective. They also contain many B vitamins and vitamin C. Repeatedly I have seen these supplements alone dramatically raise hemoglobin values in addition to revitalize an anemic mother. The same results can be obtained using the less expensive ferrous sulfate, but with many side-effects and over a slightly longer period of time. Floridix Liquid Iron is the most popular and is extremely well tolerated.

Iron is not the only ally in maintaining healthy hemoglobin values. This is most obvious in women who experience anemia and who are not responsive to iron supplementation alone. Folic acid, B12 and protein all play a role in the structure of hemoglobin. Vitamins A and C also contribute to the absorption and utilization of dietary iron.

Blood loss is another cause of anemia. Significant blood loss after the birth, the most extreme being a postpartum hemorrhage, can greatly increase the risk of developing postpartum anemia. Ample stores of hemoglobin and iron prior to the birth may decrease the severity of the anemia and hasten recovery. Vitamin K is a known blood-clotting agent that is produced in a healthy intestine and it is found readily in foods such as leafy green vegetables. It is not available as an over-the-counter supplement in Canada (it is available in the US) but is a naturally occurring constituent of common supplements such as alfalfa. Some individuals may not produce enough of their own vitamin K (such is the case after antibiotic use) or they may have a greater biological need for it. Alfalfa tablets taken in the last month of pregnancy may reduce the risk of postpartum hemorrhage. This maybe particularly worthwhile for the mother who had significant blood loss in a previous birth: however, some caution is warranted if she is susceptible to hemorrhoids or varicose veins.

In my practice I like to emphasize the importance of a nutrient-rich diet. But I also encourage pregnant women to consider supplementing with iron because I have seen such positive effects over the years. Whether or not supplementing every pregnant woman with large doses of iron is prudent is still debatable. What is known is that some supplementation may contribute to healthier moms, healthier births, and healthier babies.

Vitamin K
Floridix Liquid Iron
Stacelynn Caughlan is a Clinical Nutritionist and Certified Herbalist who specializes in Prenatal and Pediatric Health.

Disclaimer: The information provided on is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek professional medical advice from your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.


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