Iron deficiency is the most common nutritional deficiency during pregnancy, with up to 30% of expectant mothers developing iron-deficiency anaemia by the third trimester. This guide explores why iron is crucial during pregnancy and the best food sources to help you maintain optimal levels for both you and your baby.

Why Iron Matters During Pregnancy

During pregnancy, your blood volume increases by approximately 50%, requiring significantly more iron to produce the additional red blood cells needed to supply oxygen to both you and your developing baby. Iron also plays several other crucial roles:

• Supports the development of the placenta and the growth of the fetus
• Helps prevent premature birth and low birth weight
• Essential for the baby's brain development and cognitive function
• Contributes to your immune system function, helping you fight infections
• Helps prevent fatigue, which is already a common pregnancy symptom

The NHS and Royal College of Obstetricians and Gynaecologists recommend 27mg of iron per day during pregnancy (an 80% increase from the pre-pregnancy recommendation of 14.8mg). Meeting these increased requirements through diet alone can be challenging, particularly if you experience food aversions or morning sickness.

Being aware of the symptoms of iron deficiency can help you seek treatment early. Common signs include unusual fatigue, pale skin, dizziness, shortness of breath, difficulty concentrating, and cold hands and feet. Many of these symptoms overlap with normal pregnancy experiences, so regular blood tests are the most reliable way to monitor your iron status.

Best Food Sources of Iron

There are two types of dietary iron: heme iron from animal sources and non-heme iron from plant sources. Heme iron is more easily absorbed by the body (15-35% absorption rate) compared to non-heme iron (2-10% absorption rate).

Top animal sources (heme iron):

• Lean red meat: 3.5mg per 100g serving of lean beef
• Liver: 6.0mg per 100g (check with your healthcare provider as liver is high in vitamin A)
• Poultry: 1.3mg per 100g serving of chicken
• Sardines: 2.9mg per 100g
• Eggs: 1.2mg per two large eggs

Top plant sources (non-heme iron):

• Legumes: Lentils (3.3mg per 100g), chickpeas (2.9mg per 100g), kidney beans (2.2mg per 100g)
• Dark leafy greens: Spinach (2.7mg per 100g), kale (1.5mg per 100g)
• Fortified cereals: Various brands (check labels, typically 4-8mg per serving)
• Tofu: 2.7mg per 100g serving
• Dried fruits: Apricots (2.7mg per 100g), prunes (0.9mg per 100g)
• Seeds and nuts: Pumpkin seeds (3.3mg per 30g), cashews, pistachios
• Whole grains: Quinoa (1.5mg per 100g cooked), fortified breads

Maximizing Iron Absorption

The way you combine foods can significantly affect how much iron your body absorbs. Here are evidence-based strategies to maximize absorption:

• Pair with vitamin C: Combining iron-rich foods with vitamin C can increase absorption by up to 3-4 times. Try having a glass of orange juice with your breakfast cereal, adding bell peppers to bean dishes, or including strawberries in a spinach salad.
• Cook in cast iron cookware: Using cast iron pans, especially for acidic foods like tomato sauce, can increase the iron content of your meals.
• Timing matters: Avoid consuming calcium-rich foods or beverages (milk, cheese, yogurt) at the same time as iron-rich meals, as calcium can temporarily inhibit iron absorption. Space them about 2 hours apart.
• Watch tea and coffee intake: The tannins in tea and coffee can reduce iron absorption by up to 50%. Try to avoid these beverages an hour before and after iron-rich meals.
• Consider food preparation: Soaking legumes, grains, and seeds reduces their phytate content, which can inhibit iron absorption.

Here are some practical meal ideas to boost your daily iron intake:

• Breakfast: Fortified cereal with strawberries and a glass of orange juice
• Lunch: Lentil soup with a side of vitamin C-rich fruit or a spinach salad with lemon dressing
• Dinner: Lean beef stir-fry with broccoli and bell peppers or tofu and spinach curry with tomatoes
• Snacks: Hummus with red bell pepper slices, dried apricots with pumpkin seeds

Supplements and Monitoring

If your blood tests reveal low iron levels, your healthcare provider may recommend supplements. Here's what you need to know:

• Take iron supplements as directed, typically between meals for optimal absorption
• Vitamin C can help absorption (take with a glass of orange juice)
• Common side effects include constipation, nausea, and dark stools
• Never self-prescribe iron supplements as excess iron can be harmful

Throughout your pregnancy, your healthcare provider will monitor your iron status with hemoglobin tests at your booking appointment (around 8-12 weeks) and again at 28 weeks, with additional testing if you have symptoms of anemia or risk factors. The NHS defines anemia in pregnancy as hemoglobin below 110g/L in the first trimester, or below 105g/L in the second and third trimesters.

Special Dietary Considerations

If you follow a vegetarian or vegan diet, or have other dietary restrictions, you may need to pay extra attention to your iron intake:

• For vegetarians: Include plenty of eggs, legumes, fortified foods, and dark leafy greens
• For vegans: Focus on legumes, tofu, fortified plant milks, whole grains, seeds, and dried fruits
• For those with celiac disease: Many fortified gluten-free products contain less iron than their wheat-based counterparts, so careful planning and possibly supplementation are important
• If you have inflammatory bowel disease: Iron absorption may be impaired, and you may need specific guidance from both your obstetrician and gastroenterologist