Iron requirements during pregnancy

Iron (Fe) requirements increase dramatically during pregnancy due to the rapid expansion of blood volume, tissue accretion, and potential for blood loss during delivery (Table 22.3). Although some of the increased blood volume is available to the mother after delivery, iron requirements still increase severalfold during pregnancy. For a normal pregnancy, it has been estimated that women need at least 6 mg of Fe/day compared with only 1.3 mg of Fe/day when they are not pregnant. This sixfold increase is very difficult to meet from diet alone, especially in settings where diets are poor in quantity and quality. In many developing countries, women enter pregnancy with depleted iron stores and/or iron-deficiency anemia, and this increases both their risk of becoming anemic during pregnancy and the adverse consequences related to iron deficiency and anemia. It should be noted however that hemoglobin drops during mid-pregnancy even among well-nourished women with adequate iron stores as a result of plasma volume expansion (Fig. 22.3). Although WHO recommends a single indicator, i.e., hemoglobin

< 11 g/dl, trimester specific cutoff values have been used in developed countries such as the United States. The cut-off value for anemia during mid pregnancy is hemoglobin

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