How to Increase Iron During Pregnancy: The Hidden Reasons Your Iron Levels Stay Low

When you were pregnant, did you envision hearing your baby’s heart beat for the first time, experiencing their little kicks while lying in bed, or watching them grow bigger and bigger? Did you ever imagine that instead, you’d feel completely drained all the time, find it hard to catch your breath going up just a few flights of stairs, or wonder where your energy went each day despite getting a good nights’ rest?

I’ve heard this question more times than I can count from my clients: “How do increase iron during pregnancy?” It comes at me daily through emails, different social media posts, and chats with my community members who want to know how to treat their own iron deficiency.

Many of you read this because you’ve either had a result come back showing low iron, experienced some of the below symptoms (or both) without having much else wrong in terms of health, or found out over the years that you’ve been suffering from an underlying issue called low iron.

What I hope you take away from reading this post today is that while there are indeed physical changes that happen in your body when you get pregnant—some amazing ones!—it doesn’t mean you have to suffer from chronic exhaustion if it’s affecting your quality of life.

But there’s more going on with increasing iron during pregnancy than just adding some spinach to your plate or taking a supplement! There are multiple physiological processes required for increasing absorption, transportation, storage, and utilization of iron from your diets. And those processes are changing drastically because of pregnancy!

Hormones change dramatically. So does the amount of blood in the body. Nutritional requirements shift as your growing baby develops. Morning sickness, food aversions, your digestion and your meal timing are all things to think about when it comes to getting enough iron every day.

Iron is really important, for women and one of the main things it does is help our bodies make iron, which is a big part of hemoglobin. Hemoglobin is a protein that is found in our blood cells and it helps transport oxygen to all the different parts of our body like our organs and muscles and tissues.

When you are pregnant your blood volume gets a lot bigger. This is because your body needs to make sure that you and your baby are getting enough oxygen and nutrients. But without enough iron, it’s harder for us to get our oxygen transported efficiently, chances will good our little ones won’t have all the resources they need to grow, develop their brains, and form healthy red blood cells either.

But only supplements sometimes cannot be able to restore it alone. It could be due to things like unknowingly consuming other foods/drinks that decrease iron absorption alongside iron supplements, or having pre-existing low iron stores (“low ferritin”) prior to becoming pregnant, and making it more challenging during each trimester to adequately supply those growing needs.

Why Iron Becomes So Important During Pregnancy

During pregnancy, your body goes through numerous changes – from pumping out more blood with every beat of the heart, developing a placenta, to starting to create tiny organs, muscles, nerves and much more. It all takes extra oxygen that you need to provide regularly as you grow.

Iron makes sure that your body can produce enough hemoglobin (a protein found in red blood cells) needed to carry oxygen around your entire body including to your precious baby inside of you! As your blood volume increases by about 30-50% across pregnancy, 1 the amount of iron you'll need also skyrockets compared to what your body was using pre-pregnancy.

If your iron levels weren't already on board pre-conception, this could get tricky quickly! That's why it's super important that our health care pros track our iron stats while pregnant. Iron also supports several important functions, including: Helping your body make healthy red blood cells. Supporting your baby’s brain and nervous system development.

Without adequate iron, your body can slowly draw down on their stored iron (ferritin). 2 This will start to manifest with symptoms well before your hemoglobin gets to dangerously low levels. Serum ferritin test is first test to check your blood iron stores, because it shows early iron deficiency anemia.

Why Some Women Still Have Low Iron Despite Taking Supplements

What’s more frustrating still is if you start to see absolutely no improvements on this journey despite diligently taking all these pills each day as recommended by your doctor. The truth? For most pregnant women with low iron, the reason why they aren’t able to get their iron up quickly has nothing to do with them taking their supplements at all.

Instead, it means either their bodies are failing to absorb what they need from these pills or there may simply be higher requirements for iron than what those pills provide. Some common reasons include:

• Taking iron with tea, coffee or calcium rich food missing doses due to side effects such as nausea & constipation starting pregnancy with low ferritin (Low iron stores)
• Multiple pregnancies with little time to rebuild their stores of iron completely between them and twin pregnancies 3
• Having heavy bleeding from your period prior to becoming pregnant
• Certain digestive problems can make it harder for your body to absorb iron.
• Iron requirements that cannot be met by diet alone.

It's important to understand these hidden factors as part of understanding how to increase iron during pregnancy.

Could You Have Low Ferritin Even If Your Hemoglobin Is Normal?

The short answer is ‘yes’. Many people (and certainly I didn’t know this before) are surprised by this. Remember, Ferritin is the storage unit for Iron – think of it as your bodies “Iron Savings Account”, and Hemoglobin represents how much iron is actively in use at any point in time, as we’re using it to make red blood cells.

This means that your ferritin levels can get very low well before your hemoglobin levels drop into the abnormal range, leaving you feeling symptoms of iron depletion but with all of your usual routine Hb blood tests coming back “normal”.

They will also prescribe these tests depending on other findings. So for instance, they might order extra blood workup to help confirm an iron deficiency diagnosis — particularly if symptoms persist despite treatment.

Here are some of those conditions that could lead to recommending further testing, including:

• Starting pregnancy with low iron stores
• Having heavy menstrual bleeding prior to getting pregnant
• Closely spaced pregnancies
• A vegetarian/vegan diet with no special iron planning
• Digestive problems that interfere with nutrient absorption
• Identify if you had a history of iron deficiency or iron deficiency anemia previously.

Understand the difference between ferritin & hemoglobin to know why are you still looking up 'how to increase iron during pregnancy' even after starting iron supplements? Learn to identify low iron stores early on to create nutrition & medical strategies timely without progressing further into more serious cases of iron-deficiency.

How to Increase Iron During Pregnancy: 9 Nutrition Tips

Are you wondering how to get more iron while pregnant? It’s not just about ‘eating more iron.’ For your body to utilize the iron you consume, it also requires certain combinations of other nutrients, eating patterns, and (sometimes) supplementation for proper absorption & utilization.

Here are some evidence based nutrition strategies that will boost your Iron levels all through your pregnancy!

1. Include an Iron-Rich Food at Every Main Meal

If you are looking at consuming a larger volume of iron over time rather than just once per meal, then including foods rich in iron all through the day will provide more chances for absorption. But did you know that your body absorbs iron found in animal foods more efficiently than in most plant foods? 4

If you’re having trouble maintaining enough iron for health, even if you think you’re eating “healthy,” this may be why. Including lean animal based iron sources into your diet as recommended by your healthcare provider can support healthy iron levels while pregnant. Many women are surprised to find out about the differences between iron found in animals vs plants.

Examples include:

Animal sources (heme iron – more easily absorbed):

• Lean beef
• Lamb
• Chicken
• Turkey
• Fish (choose pregnancy-safe options)
• Eggs

Plant sources (non-heme iron):

• Lentils
• Chickpeas
• Kidney beans
• Black beans
• Soybeans
• Tofu
• Pumpkin seeds
• Sesame seeds
• Spinach
• Kale
• Fortified breakfast cereals
• Oats
• Quinoa

In general, eating a wide variety of foods (rather than focusing solely on one “superfood”) will provide more benefits. I also write a detailed list of vegetarian high iron foods list for women that is budget friendly and easy to meet the needs of women who are suffering from iron-deficiency anemia from a long time. You can access it now for free if you want this!

2. Pair Iron With Vitamin C to Improve Absorption

One of the most basic ways to improve one's nutritional intake is to combine iron and vitamin C-containing foods together. This will allow you to turn plant-based iron into a more easily digestible form. Allow more absorption and in result reducen deficiency.
Some examples of such a combination would be:

• Lentil curry with added tomatoes.
• Chickpea salad with squeezed lemon juice.
• It’s important to eat breakfast cereals fortified with nutrients. This would be a good way to ensure sufficient vitamin C when consuming these cereals with kiwis.
• Put some fresh bell peppers on top of your bean chili in order to boost your vitamin C content.

3. Don't Let Tea or Coffee Cancel Out Your Healthy Meal

However, many women might not be aware of this fact as they aren’t informed about these “polyphenols” found in tea & coffee that lower iron absorption when consumed along with meals. 5

Instead of stopping consumption entirely, you can still have some tea or coffee but 1-2 hours prior to having iron rich meal/supplements (at least) will enable better iron absorption.

4. Be Mindful of Calcium Around Iron Supplements

Calcium is an important nutrient throughout pregnancy, though taking large doses of calcium together with iron supplements can limit their absorption. Speak to your healthcare provider or pharmacist about how to best take calcium and iron supplements if you’ve been prescribed either of these nutrients. Avoid taking all of these at once.

Spacing out your supplements by a few hours might allow your body to absorb the iron better. Many people find that pairing their iron with water (or even a vitamin C rich drink) and calcium throughout the rest of the day works well for them. Always stick to what’s best for you – never mix iron supplements with dairy products. Take 2 hours gap as possible. 6

5. Don't Rely on Spinach Alone

Yes — spinach does contain iron and other nutrients that make it healthy for you to eat. But it also has some natural compounds called polyphenols and calcium which can reduce the amount of iron that gets absorbed into your body from this leafy green, not oxalates which mainly called culprit by many is just a myth. 7

Incorporate various forms of dietary iron such as those found within legumes, lean meats, fortified cereals, tofu and even seeds into your diet instead of just spinning around and only focusing solely upon its consumption.

Typically speaking when we diversify our eating habits we’re often able to enjoy greater health advantages compared against if we’d chosen focus specifically about one singular item!

6. Eat Enough Protein Every Day

It also plays an important role by supporting your body’s need for healthy blood cell production during pregnancy. This protein requirement increases as you go through each stage of pregnancy to compensate for heightened nutritional needs. Good protein choices include:

• Eggs
• Lean poultry
• Fish
• Greek yoghurt
• Lentils
• Beans
• Tofu
• Cottage cheese
• Nuts and seeds

When you combine this with Iron rich foods to make balanced meal for yourself and baby’s health. It helps you even more. I also write a detailed guide on 12 High-Protein Vegetarian Recipes that are quick, easy to make, very low on budget, and the big news, you can make it using everyday ingredients without using any protein powder. Check out these now from here to make at home with less effort!

7. Choose Whole Foods More Often Than Ultra-Processed Foods

Ultra-processed foods might offer you energy, but not enough nutrients that you are needed.
By constructing your meals using fruits, vegetables, whole grains, beans, dairy (if appropriate) and quality protein, you will find it much easier to get sufficient iron and other nutrients in your pregnancy.

8. Be Mindful of Antacids

There is a possibility that antacids, along with some other medications which decrease acid levels in your stomach, can interfere with iron absorption in your body. It is important to discuss this thing as well. As a nutritionist we see, our clients with gut issues most commonly go through this problems.

If you have to use antacids during your pregnancy, discuss with your doctor or pharmacist the time at which it should be taken. Usually, there is a possibility that leaving a two-hour gap between taking iron supplement and antacid will improve your iron absorption. 8

9. Treat Morning Sickness

The impact of morning sickness is not alike for all women. While some individuals suffer from slight nausea, there are those who are unable to take their meals for weeks and months. Nausea in pregnancy can affect women, preventing them from taking iron rich foods.

In fact, many women might be unwilling to take the foods because of how they smell or taste. The truth is that this contributes further to the problem that women have to take adequate amount of iron for their pregnancy. Iron is important for pregnant women, but nausea will prevent them from taking iron rich meals.

In case nausea interferes with proper nourishment and/or intake of prescribed medication, do not stop treatment without the approval of your doctor. Your healthcare professional might advise you on how to change the schedule of supplements or use something else. Keep in mind that the goal of nutrition during pregnancy is not about following it to perfection each day.

A Gentle Reminder

Picture two women who are taking the same iron supplement daily. One takes it with tea and misses breakfast as she is in hurry to reach her workplace. The other takes it with water, and has her breakfast including fortified cereal, berries and vitamin C.

While the two women are consuming the same supplement, the amount of iron that their bodies absorb may differ drastically. Small things in life sometimes make all the difference.

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