iron levels in pregnancy - advice please!

[wiltshirelass]

can anyone (Mears? Leese?) give me a two minute rundown on the implications of being anaemic in pregancy? I know it makes you feel terribly tired etc etc, but I've just been given a bit of a lecture by someone about my iron levels, who said that if they stayed low I was putting too much strain on my heart and had a higher likelyhood of a big bleed during delivery. Now obviously I'd love them to go up and am drinking fersamal every morning (yeuch) but I really want to understand the implications. Especially about the heart bit. My resting heart rate at the moment is between 105 and 120 which doesn't sound too marvellous to me.
Reassurance/information please?! Thanks!

wiltshirelass - who gave you the lecture? What are your iron levels? Are they being monitored to see if the fersamel is doing any good? You might need a different preparation depending on your levels.
Your heartrate certainly is a bit fast but can be due to anaemia if you are very anaemic. Sometimes women have an increased heart rate (tachycardia) that has nothing to do with anaemia and we refer them to a cardiologist to make sure everything is OK.

If you are very anaemic, Hb below 9g/dl, then your body might not cope so well with blood loss at delivery and you would feel absolutely hellish. Sometimes blood transfusion is needed if you are badly affected by anaemia post delivery.

How are you feeling at the moment.?Are you breathless and tired? Can you function normally or are you debilitated?

Anaemia does mean that your heart has to pump faster to get the oxygen around your body. Oxygen is attached if you like to haemolglobin (Hb). When your Hb is low then there is less available oxygen so the blood needs to be circulated faster.

Obviously if your Hb rises, the heart doesn't need to work so hard. Long standing anaemia over time would have an effect on your heart, but I think it is scaremongering to talk about heart problems with an episode of anaemia in pregnancy.

Need a bit more information to be able to help you more.

it was my mother who gave me the lecture! GP. They were about 9.7 and I'm going for repeat bloods now to see if they have improved.
I've been anaemic on and off since late teens and my mother thinks I have a bit of an iron absorption problem. I do get breathless and I'm perpetually tired. That may also be due to my manic pace of life, work etc etc. What sort of level should I be aiming for to keep everyone happy?

ps very keen to do all I can because I'm planning a home birth, and would hate to haemorrage and make a mess here!

Why are you on Fersamel - do you have difficulty taking ferrous sulphate? Avoid tea and coffee with your meals - take fruit juice instead as that help you absorb the iron.
In pregnancy, a Hb of over 10g/dl is often aimed for, but you will get a different view from Michel Odent. He has published evidence that a lower Hb is the sign of a placenta working well and that professionals get too worked up abour Hb levels. I will try and post a link once I find it.

Can I just commiserate on double whammy of being lectured by GP Mum. V hard to ignore. I let my mother's comments pass over my head, but then she knows bog-all about pregnancy IMHO.

Have found article and am posting relent bit. Couldn't do link to full thing but will try again.

Let us illustrate these interpretations by looking at three main reasons for panicky phone calls after a prenatal visit.

First example: "my haemoglobin is 9: I am anaemic"
When a woman has a haemoglobin concentration in the region of 9.0 or 9.5 at the end of her pregnancy, there are two possibilities. More often than not she will meet a practitioner (doctor or midwife) who is not interested in epidemiological studies and who thinks that iron deficiency in pregnancy can be detected via the haemoglobin concentration. She will be told that she is anaemic and she will be given iron tablets. She will understand that there is something wrong in her body that needs to be corrected.

It can happen, on the other hand, that a pregnant woman with a similar haemoglobin concentration meets a practitioner who is aware of the most significant epidemiological studies and who is interested in placental physiology. This practitioner has digested the huge and authoritative study by a London team about the relation between maternal haemoglobin concentration and birth outcomes (1). Birth outcomes of 153,602 pregnancies were analysed (the haemoglobulin measurement used in the study was the lowest recorded during pregnancy). They found that the highest average birth weight was in the group of women who had a haemoglobin concentration between 8.5 and 9.5. Their main conclusion was that "the magnitude of the fall in haemogloblin concentration is related to birth weight". A similar pattern occurred in all ethnic groups. Furthermore it appeared that when the haemoglobin concentration fails to fall below 10.5, there is an increased risk of low birth weight and preterm delivery. Similar conclusions have been reached by other, yet smaller, epidemiological studies (2,3). This sort of practitioner is also probably aware of the many studies that fail to demonstrate that iron supplementation may improve birth outcomes (4). When such a practitioner suspects anaemia, he or she prescribes specific tests such as erythrocyte protoporphyrin, transferrine saturation or serum ferritin.

The pregnant woman who has access to this evidence-based antenatal advice will be offered reassuring explanations. It will be explained that the blood volume of a pregnant woman is supposed to increase dramatically, and that the haemoglobulin concentration indicates the degree of blood dilution. She will understand that the results of her tests are suggestive of effective placental activity and that her body is responding correctly to the instructions given by the placenta. She will be given good news. The antenatal visit will have had a positive effect on her emotional state and therefore on the growth and development of her baby.

All over the world millions of pregnant women are wrongly told that they are anaemic and are given iron supplements. There is a tendency to overlook the side effects of iron (constipation, diarrhoea, heartburns, etc., plus the fact that iron inhibits the absorption of such an important growth factor as zinc (5).

This misinterpretation of haemoglobin concentration in pregnancy is widespread beyond belief. A Japanese lady spent the first half of her pregnancy in London, before going back to Tokyo. One of her European friends (who had four babies) warned her long in advance that at the end of her pregnancy she will be told that she is anaemic and given iron tablets. Guess the end of the story.

An authoritative British team of epidemiologists published a study about third stage of labour in a prestigious medical journal. In order to concentrate on low risk pregnancies they eliminated all women whose haemoglobin was below 10.(6) Finally, the average concentration in the population they studied was 11.1. Afterwards I was given an opportunity to indicate some of the limitations of this study (7).

A lack of interest in placental physiology is at the root of such misinterpretations. There is a tendency to confuse a transitory physiological response (blood dilution) with a disease (anaemia). Obstetrics is dangerous when it is not evidence-based.

here

And another site that is helpful regarding homebirth and anaemia

this

I am going to have to go and lie down now after all that effort getting links to work

mears, you are marvellous. thank you very much. I will go and peruse.
Ferrous sulphate gives me constipation in about 30 seconds, and seems to make no difference to my levels, I don't think I absorb it. Fumarate seems to work better for me, and actually causes no constipation at all, don't know why that should be...
motherinferior - much as I would love to agree with you it has taken me about 30 years to admit that my mother is actually a really excellent instinctive GP who when she raises a concern is almost always right. Most infuriating!! but I can't ignore her. She has pulled such rabbits out of hats as advising my uncle in 1989 not to give his daughter growth hormone injections because she instinctively felt unhappy with the way they were produced and had been tested (most people who had those injections went on to develop CJD), diagnosed suspected meningitis over the phone for a cousins child when she was 3000 miles away and no rash was apparent - just didn't like the sound of the description of listlessness, and when my father in law was diagnosed with prostate cancer last september, from the sound of test results relayed third hand through me, told me quietly that she felt that he would be too ill to travel in February (we were planning a holiday with inlaws), and would probably not see the birth of his grandchild in august. This is while the oncologist was telling him he would live 5 years. He died in March.
Can't explain it, as she certainly doesn't claim to be an expert in anything in particular, just a good all round GP, but I think she just has a very honed instinct about things.
FYI she also says she has no evidence whatsoever about a link between MMR and autism, but she doesn't have a good feeling about it, and wouldn't give her children MMR today. So I haven't...

Anyway.

mears thanks very much for this, I've had a read of the links and I feel much better about this now.
I'll still continue with the iron (as I'm sure it isn't doing me any harm and because of my general tiredness) but at least I won't be so concerned if my levels don't get to the giddy heights of 1.5 or whatever.
interesting about low levels equalling high birthweight - my last child was 9.5lbs (and I'm 5'5" so that is quite a size) and this one feels like it may be bigger. I'm only 28 weeks so still have some way to go.
anyway very many thanks again

She sounds great, and I was wrong. Take care!

bloody annoying that she is always right, though. mind you I don't take any of her advice about anything non-medical, just to redress the balance!!!!

Don't mean to chip in late in the day but I was badly anaemic in my last pregnancy and this one (and in between - family thing!!) and the only thing I found helpful are the iron in water sachets Spatone no side effects nothing. Take in a glass of Oj first thing and it turned me around in no time!!
Good luck

hey
i had anemia about 4years ago for over a year and a half eventually iron tablets put me back on track but im worried ill get it again during pregnancy
i wondered if anybody had advice on the best food i can eat to try and stop anemia im also a vegetarian so that mite be a cause!!
thanks xxx

Rachael I think if you're eating plenty of beans and pulses for protein you should be getting iron from them. Try to eat iron rich foods* with or just before vitamin c rich foods as it helps absorption of the iron. Blackberries and purple grapes 'build blood' and so help to ward off anaemia. Hope that helps. Keep well.

*leafy green veg, nuts, eggs, lentils, beans, peas, oily fish, dried fruits espec figs, wholegrain cereals and wholemeal bread, black treacle (mmmm... gingerbread !), liquorice and plain chocolate (hurrah !)

This is a BMJ study.... same as Mears refered to?.... basically.... your HB should be around 9.5 at end of pregnancy to be at its best ! It's a common threat that is use to scare woemn off !

BMJ 1995 Feb 25;310(6978):489-91

Relation between maternal haemoglobin concentration and birth weight in different ethnic groups.

Steer P, Alam MA, Wadsworth J, Welch A.

Academic Department of Obstetrics and Gynaecology, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London.

OBJECTIVETo assess the relation of the lowest haemoglobin concentration in pregnancy with birth weight and the rates of low birth weight and preterm delivery in different ethnic groups. DESIGNRetrospective analysis of 153,602 pregnancies with ethnic group and birth weight recorded on a regional pregnancy database during 1988-91. The haemoglobin measurement used was the lowest recorded during pregnancy. SETTINGNorth West Thames region. SUBJECTS115,262 white women, 22,206 Indo-Pakistanis, 4570 Afro-Caribbeans, 2642 mediterraneans, 3905 black Africans, 2351 orientals, and 2666 others. MAIN OUTCOME MEASURESBirth weight and rates of low birth weight (< 2500 g) and preterm delivery (< 37 completed weeks). RESULTSMaximum mean birth weight in white women was achieved with a lowest haemoglobin concentration in pregnancy of 85-95 g/l; the lowest incidence of low birth weight and preterm labour occurred with a lowest haemoglobin of 95-105 g/l. A similar pattern occurred in all ethnic groups. CONCLUSIONS--The magnitude of the fall in haemoglobin concentration in pregnancy is related to birth weight; failure of the haemoglobin concentration to fall below 105 g/l indicates an increased risk of low birth weight and preterm delivery. This phenomenon is seen in all ethnic groups. Some ethnic groups have higher rates of low birth weight and preterm delivery than white women, and they also have higher rates of low haemoglobin concentrations. This increased rate of "anaemia," however, does not account for their higher rates of low birth weight, which occurs at all haemoglobin concentrations.

yup, that's the one - thanks pupuce.
pleased I have an independent midwife attending me otherwise I suspect my community midwives would be using this as an excuse to fob me off from having a homebirth

Can I ask a silly question? How do you know what your iron levels are? Do they only test you if you ask? Just wondered, I'm pregnant but have no idea what mine are.

they test them in your normal antenatal bloods. they normally don't give you details of the level etc unless they are concerned (or some may stick the results in your notes and then you can look at them yourself.

thanks tomps
im esp glad about the chocolate thingy

I seem to remember that chocolate inhibits the absorbtion of something or other... calcium I think it was so you need to make sure you're getting extra calcium to counter balance the chocolate (note that I didn't say "don't eat too much chocolate... there's no such thing )

Apparently SoupDragon, it the caffeine in chocolate that hinders the absorption of calcium. So the moral is if you going to have enough caffeine to effect the absorption of calcium go for the chocolate over the coffee, or even tea.

It's not just down to the amount of iron you take in, it has a lot to do with your absorption rate. I eat hardly any iron-rich foods, because I hate most of them and I thought the mw would tell me to take iron supplements but instead it turns out I've got more than normal, not less so it's alright. It just depends how much your body can take in. Try drinking loads of orange juice to help get it in!!

Just found this and am now paranoid My iron levels are "high". Midwife was pleased, as was I. Is this now bad news???