5.6.4 Iron
The requirement for iron increases during pregnancy, especially during the second half, when
the volumes of blood and erythrocytes increase and the fetus and placenta require more iron.
Furthermore, absorption of iron increases considerably during pregnancy, as there is no loss of
blood through menstruation. It is important to ensure that the intake of iron from food is
sufficient during pregnancy. The capacity for iron absorption depends significantly on the type
of food, other foods eaten at the same time and physiological requirements. Haem iron is the
form that is best absorbed, and lean red meat and fish should be eaten regularly. Although
foods of plant origin, including wholegrain products and vegetables, also contain large
quantities of iron, its bioavailability is much lower. Vitamin C significantly increases the uptake
of iron (from e.g. citrus fruit juice), while fermented and non-‐fermented tea, coffee, wholegrain
products and products rich in calcium decrease uptake. Therefore, it is important to avoid eating
iron-‐containing food at the same time as food that delays iron absorption; a 2-‐h interval should
be observed. Plasma ferritin levels should be normal before conception and during pregnancy.
Iron-‐containing supplements should be used if the iron reserves are insufficient, which may
result in reduced haemoglobin production; anaemia, in turn, is associated with lower immunity
and higher risks for infectious diseases, less productivity, cognitive disorders and emotional
stress in the postnatal period, higher risks for maternal mortality, premature delivery and low
birth weight, as well as placental abruption and blood loss after delivery.
The fetus is relatively
well protected against iron deficiency due to transporter proteins in the placenta. Nevertheless,
maternal iron deficiency is associated with a greater frequency of iron deficit anaemia in the
newborn by the age of 3 months, with delayed psychomotor and/or mental development. This
may have a negative effect on social and emotional behaviour and possibly be linked with
disease later in life.
Preventive use of iron supplements is not advised in every pregnancy, as excessive iron can
have negative consequences. Supplements should be taken only if indicated.
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