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Women’s Health Division References; Ministry of Health, (2008). Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women – a Background Paper. Pairman,S, Pincombe,J, Thorogood,C & Tracey,S. 2nd Ed. (2010). Midwifery. Preparation for practice. www.emmasdiary.co.nz Community Midwifery Guidelines CMDHB Aug. 2012 Department: Women’s Health Approved by: Director of Midwifery Document Owner: M. Pickmere (Midwife); Clinical Midwife Educator Update: July 2013 ID: A189027 Review: July 2015 Iron and Anaemia in Pregnancy Information for Pregnant Women and Whaanau Anaemia in Pregnancy Anaemia (low iron) is when there are less of the oxygen carrying cells in the blood, which may be due to a variety of causes. Blood tests are checked at your first appointment and when you are 26-28 weeks and 36 weeks pregnant. Lack of Iron Lack of iron (deficiency) anaemia is the most common type of anaemia in women of childbearing age. The body uses iron to make red blood cells. Causes include heavy periods, a poor diet, smoking and a short gap between pregnancies. Effects of anaemia for the mother • Feeling tired • Breathless on exercising • Infections • Feeling the cold • Difficulty concentrating • Increased risk of haemorrhage (very heavy bleeding) after the birth • Strain on your heart, especially immediately after birth Effects of anaemia on baby • Growth can be slower so baby is lighter than average at birth • Small placenta • Lower amounts of oxygen getting to the baby • Premature (before 37 weeks) birth Food sources of Iron • Red meat, fish and poultry –more easily absorbed than iron found in plant based foods. • Tofu, wholegrain bread, cereals, egg yolk, legumes. • Dried fruit, vegetables, nuts and seeds – all contain iron. Vitamin C helps with the absorption of iron; • Mandarins, oranges, tamarillos and lemons. • Fruit juice, kiwi fruit and feijoas. • Cauliflower, broccoli, green capsicum and tomatoes. The above must be eaten with meals to assist the absorption of iron. Avoid: • Drinking milk, tea or coffee within two hours of meal times or when taking iron supplements (tablets, syrup or water). These can block the body’s absorption (soaking up) of the iron. • Medicines taken to relieve indigestion can also block the effect of iron. Medications for high blood pressure and thyroid deficiency have a reduced effect if taken within two hours of taking iron. Timing of your drugs is important please discuss with your midwife or doctor what is suitable for you. If possible, iron should be taken with a large glass of water, half an hour before food. If this causes a gastric upset can be taken with food. The colour of your bowel motions and urine can darken when taking iron. Lack of Folic Acid Also called folic acid deficiency anaemia. Low levels of Folic Acid are linked to defects (or abnormalities) in the brain or the spine (e.g. spina bifida). To prevent these defects, folic acid should be taken just before becoming pregnant and during the first 3 months of pregnancy. Alcohol can lower folic acid levels. Women who are taking certain anti-epileptic medications, couples with spina bifida or a history of having babies with spina bifida should take folic acid three months before pregnancy at the higher dose of 5mg daily and throughout the pregnancy. Lack of Vitamin B12 Vitamin B12 levels fall in pregnancy, but are unlikely to cause problems for most women as the body draws upon its own stores. • Low vitamin B12 creates tingling in the hands or feet so it is important you report this to your midwife or doctor. • Vitamin B12 can be replaced by a course of injections. Vitamin B12 deficiency (lack of) can lead to nerve damage. • Women following a vegetarian or, in particular, a vegan diet should have their B12 levels monitored during pregnancy and also during breastfeeding. • Women who have gastric bypass surgery are also likely to need to have Vit B12 levels monitored during pregnancy and breastfeeding. Dairy products contain B12 Following the guidelines in this pamphlet may prevent you needing supplements however, your midwife or doctor will inform you if your blood results show anaemia. Most supplements are in tablet form although some are in a liquid. Iron injections or an infusion (a drip) may be needed to treat severe (really bad) anaemia.