The article contained herein is provided as a service to the community by the Malaysian Pharmaceutical Society. It is intended for general guidance only, and not as a substitute for appropriate attention from a qualified healthcare professional. The reader is advised at all times to seek the help of the appropriate healthcare professionals on any matter if in doubt.
What is iron and why is it essential to me as a pregnant woman?
Iron is a type of mineral and an essential nutrient of our body. Iron forms part of haemoglobin, a substance in our red blood cells which carries oxygen from lungs to all the other living tissues in the body. In fact, abundance of iron in blood is a reason why our blood is red in colour. Pregnant women require approximately double the amount of iron than non-pregnant women to support the needs of the growing foetus and placenta in the womb.1
How much iron do I need to consume daily?
A daily intake of 27mg elemental iron is recommended for pregnant female compared to 15 – 18mg for non-pregnant female.1-2 This can be obtained from various iron-rich food sources such as liver, beef, turkey, soybeans and lentils.1 In cases where daily diet does not provide sufficient iron, iron-supplements can be given.
What could happen if I do not get enough iron?
Without sufficient iron, our body cannot produce enough haemoglobin to carry oxygen, resulting in iron-deficiency anaemia. Symptoms of iron-deficiency anaemia include but not exclusive of extreme fatigue, pale skin, cold hands and feet, dizziness and shortness of breath.1,3 Pregnant women without iron deficiency anaemia are associated with higher incidence of premature delivery, low birth weight and increased maternal mortality.4
How common is iron-deficiency anaemia among pregnant female?
A study conducted in Malaysia in 2007 shows that overall, anaemia happens in about 35% pregnancies, majority of them being mild anaemia.5 Some experts believe that the prevalence could reach 50% or higher.6
How do I know if I am having iron-deficiency anaemia? Are there any other causes of anaemia in pregnant female?
Due to the high prevalence of anaemia during pregnancy, doctors will normally carry out blood test during check-up to assess if you are having any anaemia. Not all anaemia cases are caused by iron deficiency. Other causes include thalassaemia, renal failure, vitamin B12 or folate deficiency and liver disease. Additional test would need to be done to ascertain the underlying cause.6
How is iron-deficiency anaemia treated?
Most pregnant women are routinely prescribed iron supplements by doctors during check-up to prevent iron-deficiency anaemia. Folate, Vitamin B Complex (especially B12) and Vitamin C (ascorbic acid) are recommended to be given together with iron supplements. Vitamin C can enhance iron absorption whereas folate and Vitamin B12 are also needed by our body to make new red blood cells. Dose of iron supplements might differ depending on severity of iron deficiency.1,6
Is iron supplement suitable for all pregnant women with anaemia?
No. There are certain conditions under which iron supplements are not recommended. These include patients having anaemia not associated with iron-deficiency, diverticular disease, repeated blood transfusions, ulcerative colitis, etc.6 Do consult your doctor or pharmacist before you purchase iron supplements for consumption.
Can iron supplement cause any problem?
Yes, it can. Common side effects of iron supplements are constipation, nausea, vomiting, diarrhoea, and stomach discomfort, depending on individual tolerability. Your stool will also likely to appear dark-in colour due to iron staining. These side effects are generally harmless and in some cases will subside after a while. Do inform your doctor or pharmacist if your symptoms persist and become intolerable. They can check whether you are taking your supplements appropriately, advise you on dose adjustments or offer another type of iron supplement to substitute your current one.
How should I store my iron supplements?
Similar to most other medications, iron supplements should be stored in a cool, dry place and away from direct light and heat. If you have any children at home, make sure the iron supplements are kept out of their reach. Accidental consumption of iron supplements can lead to iron toxicity in children. Remember to check the expiry dates of your iron supplements in your shelves before you consume them.
Do I still need to take iron supplements after delivery?
It depends on your iron level post-delivery. Most doctors would normally recommend continuous consumption of iron supplements several months post-delivery to replenish the iron store in your body.6
Ask the Pharmacist
This week, we interviewed Mr Jeff Kong, a registered pharmacist running a community pharmacy in Kajang. In his daily practice, he encounters many pregnant ladies who visit his pharmacy for iron supplements. In this Q&A section, he has graciously offered his professional advice on iron supplementation for pregnant ladies based on his experience.
Q: I have seen iron supplements in the forms of tablet, capsule, liquid and soft gel. Is there any difference between them?
Jeff: There is little difference between different forms of iron supplements other than their appearances and their iron content. I normally advise my clients to choose based on personal preference. Some clients do not like swallowing big tablets or softgels, so they might prefer liquid or tablets of smaller sizes. On the other hand, certain tablets and liquid have strong smells which could aggravate morning sickness in some pregnant ladies. In this case, a coated and smaller tablet would be more appropriate. Always engage your doctor or pharmacist to choose an iron supplement that matches your need and your level of tolerability.
Q: What about the different brands of iron supplements available in the market? How to I choose between them?
Jeff: Different brands of iron supplements might contain different iron salts (iron sulphate, iron fumarate, iron glucanoate, etc). They also come in different forms and different iron content. As long as you are consuming the right amount of iron based on your body requirement, there is little reason for you to be choosy. Some iron supplements are combined with other vitamins and minerals into fixed-dose tablets for convenient consumptions. Your budget also plays a role because the price difference between the brands can be quite huge. Again, the same advice, discuss with your doctor or pharmacist to see which iron supplement suits you best.
Q: I have been taking multivitamin tablets daily, which already contains iron. Why does the doctor still ask me to take iron supplements?
Jeff: The multivitamins that you are taking are called prenatal vitamins. While they do contain iron, the amount of elemental iron can range from 5mg to as high as 30mg per tablet, depending on the brand. If you develop iron-deficiency anaemia while taking the multivitamin, it is likely that your multivitamin is not giving you sufficient iron to meet your need and hence, doctor top up with additional iron supplements. Under close supervision by doctor, one can consume up to a total of 180mg elemental iron per day.6
Q: Why can’t I just take more multivitamin tablets to make up the amount of iron required by my body?
Jeff: No, you should never take more prenatal vitamins than your doctor’s recommendation. This is because some vitamins in the tablet are not supposed to be consumed in large amount. For example, excessive consumption of Vitamin A (more than 10,000IU a day) would be harmful to foetus.
Q: What are the proper ways to take my iron supplements?
Jeff: Take iron supplements on a full stomach to prevent stomach discomfort. Drink plenty of water, do some light exercise and consume more fibre to prevent constipation. Do not take tea and coffee 1 hour before and 2 hours after consuming iron supplements as they can reduce iron absorption. For those taking more than 1 tablet of iron supplements a day, they should take them in 2 or 3 equally spaced doses because absorption of iron decreases with increasing doses.1,2,6
Q: Can I take iron supplements with my other medications? I am taking antacids for heartburn and an antibiotic for my urinary tract infections.
Jeff: Try not to take iron supplements with antacids and antibiotics as these medications affect the absorption of each other in our body. Taking them together will cause a loss of effectiveness.
Q: Any other advice you would give to pregnant women on iron supplements or those experiencing iron deficiency?
Jeff: Pregnant women must always remember the importance of proper diet. Green leafy vegetables and lean red meat are fantastic dietary source of iron. Generally, while meat contains lower amount of iron per gram compared to vegetables, iron from meat sources are more easily absorbed and utilised by our body. Nevertheless, the message to all pregnant women is do not just depend on iron supplements alone.
1. Office of Dietary Supplements, National Institute of Health. Dietary Supplement Fact Sheet: Iron. http://ods.od.nih.gov/factsheets/iron
2. Drug Information Handbook 18th Edition.
3. Mayo Clinic. Iron Deficiency Anemia. http://www.mayoclinic.com/health/iron-deficiency-anemia/DS00323/DSECTION=symptoms
4. Allen L.H. Anemia and iron deficiency: effects on pregnancy outcome. The American Journal of Clinical Nutrition 2000; 71(suppl): 1280S – 4S.
5. Jamaiyah H., Anita D., Lim T.O., et al. on behalf of Malaysian Anemia Study Group. Anemia in pregnancy in Malaysia: a cross-sectional survey. Asia Pac J Clin Nutr 2007;16 (3):527-536.
6. Guidelines on Anaemia in Pregnancy and Postpartum.