For many healthcare professionals who work with pregnant women, iron deficiency is one of the most unrecognised yet critical challenges to date. This is predominantly due to inadequate awareness about increased iron requirements, poor nutrition education, and reactive care, leaving many women without adequate iron before and during pregnancy. As a result, iron deficiency and anaemia remain major public health issues among pregnant women in the preconception, pregnancy and postpartum periods.
Close to 90% of women enter pregnancy with low iron stores. Data from the National Family Health Survey-5 (NFHS-5) further underscores this concern, indicating that 52.2% of pregnant women between the ages of 15 and 49 in India are anaemic.
Pregnancy-related exhaustion is frequently dismissed by women because it is “just part of their journey.” As blood volume increases significantly, the iron requirement during pregnancy is high. This forces the fetus to take iron directly from the mother’s reserves.
Even before conception, conditions like heavy menstrual bleeding and inadequate diet can push women towards iron deficiency. Thus, for women with borderline iron stores, this growing demand makes them particularly susceptible to iron depletion during gestation. Moreover, iron supplementation is not important during conception or pregnancy; iron reserves need to be maintained during the postpartum stage as well, to replenish iron lost during childbirth, prevent postpartum anaemia, and combat extreme fatigue. Despite this, the postpartum period appears to be neglected, especially considering that as many as 80% of women in developing countries may exhibit symptoms of postpartum anaemia.
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Iron deficiency remains hidden, as its symptoms are often considered normal. Fatigue, breathlessness, weakness or the inability to concentrate during early motherhood or pregnancy are often not considered to be a warning signal but rather a side effect of becoming a mother.
Standard diagnostic tests, such as a complete blood count (CBC), often detect anaemia only after iron depletion has progressed. Testing of ferritin levels, which is a gold standard in assessing iron reserves, is rarely used. The effects of untreated iron deficiency anaemia can occur in the form of high blood pressure, antepartum haemorrhage, heart failure, susceptibility to infection, protracted postpartum convalescence, and reduced mental and physical capacity to care for the child.
In addition, postpartum anaemia has also been strongly associated with an increased incidence of postnatal depression, a condition that can often be mitigated through the timely use and administration of nutritional supplements.
The potential risks to the fetus or infants include low birth weight, pre-term birth, and adverse impacts on neurodevelopment. Studies indicate that children born to iron-deficient mothers may be born with or develop nerve conduction, sleep disorders, memory loss, motor skills delay, congenital abnormalities, and reduced developmental scores. In severe cases of iron deficiency during crucial periods of neurological development in the fetus, irreversible changes to brain structure could form.
By initiating early interventions, there is an opportunity to impart nutritional knowledge to women. They need to be made aware that nutritional requirements, especially iron requirements, may vary according to different stages of life and increase manifold during pregnancy.
Cognisance about iron-rich foods, such as green leafy vegetables, foods fortified with iron, and moderate quantities of organ meat and eggs, may prove to be beneficial to pregnant women. Vitamin C and iron contain harmonising benefits, as the former aids in the absorption of the latter.
Moreover, addressing other micronutrient deficiencies, especially Vitamin B12, is also vital. Having insufficient folic acid or vitamin B12 during pregnancy can also lead to anaemia and has been connected to unhealthy outcomes such as fatigue, impaired red blood cell formation, and risks to the development of the fetal nervous system.
In most cases, women with depleted or borderline iron levels may require more than dietary adjustments. In such cases, supplementation under the guidance of professionals is necessary. Healthcare professionals can play a role in recommending the right iron supplementation as well as intervening in monitoring progress.
Ensuring adequate iron levels in mothers is crucial for the health of future generations, extending beyond just treating the women themselves. Preventing maternal iron deficiency is vital because it safeguards fetal brain development, reduces the risk of low birth weight and preterm births, and effectively halts the intergenerational cycle of iron deficiency. There is a need to move from treatment to prevention throughout the life cycle of mothers. Maternal nutrition should be considered a basic part of healthcare and not a matter of choice.
Breaking the cycle of maternal iron deficiency begins long before childbirth and extends far beyond it. When mothers are helped to maintain their iron levels, it is beneficial not only to them but to their children, families, and communities.
Dr Suvarna Khadilkar, is Professor and Head, Dept OB&GYN, and Consultant Endocrinologist at Bombay Hospital, Mumbai. She is also the Secretary General-FOGSI (Federation of OB&GYN Societies of India) and Past President-MOGS (Mumbai OB&GYN Society).
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
