Iron deficiency can occur during pregnancy, leading to anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells. and other pregnancy complications, and low iron levels during pregnancy are unrelated to a diagnosis of hemolytic disease of the fetus and newborn (HDFN).
Up to 52% of pregnant women in developing countries don’t get enough iron. Oral iron supplements, or in cases of severe anemia, iron transfusions may be recommended to boost iron levels, supporting hemoglobin levels that carry oxygen to the organs. Iron is also important for the growth of the fetus.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (RhRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells.) factor (Rh-positiveRh-Positive A blood type trait that means your red blood cells have the Rh(D) antigen. or Rh-negativeRh-Negative A blood type trait that means your red blood cells lack the Rh(D) antigen.) during pregnancy.
Treating iron deficiency in pregnancy
A pregnant woman’s iron levels can fall as a result of the blood volume increasing, and due to not consuming enough iron, vitamin B12 and folic acid. If left untreated, low iron can become anemia, which in turn can progress to severe anemia. This places the baby in danger of complications such as prematurity, miscarriage, low birth weight and fetal death.
Learn more about HDFN treatment and care
Symptoms of iron deficiency during pregnancy
Low iron levels leading to mild anemia may cause the following symptoms:
- Fatigue
- Feeling cold in hands and feet
- Shortness of breath
- Dizziness
- Palpitations
- Headache
- Poor concentration
Increasing iron levels during pregnancy
A prenatal blood test will check your iron levels, assessing your red blood cells, stored iron levels and B12 and B9 levels. If you are low in iron, daily iron, vitamin B12 and folic acid supplements will be recommended. You can also make changes to your diet to include iron-rich foods such as, spinach, kale, broccoli, lean red meat, eggs, poultry, fish, brown rice, nuts, seeds, strawberries, watermelon and dried fruit.
If mild to moderate anemia progresses to severe anemia, you may require iron transfusions. Intravenous iron infusions are safe during pregnancy and are used to raise iron levels quickly.
Iron and HDFN pregnancies
In pregnancies at risk of HDFN, an iron transfusion carries the risk of red blood cell alloimmunizationAlloimmunization When a person’s immune system develops antibodies against foreign antigens from the same species—such as when an Rh-negative mother’s body forms antibodies against her baby’s Rh-positive red blood cells., leading to the mother developing antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. that attack the fetus’s red blood cells. Anemia during pregnancy generally affects the mother and is treated with iron supplements or iron transfusions that boost the mother’s iron levels.
However, in pregnancies affected by HDFN, the fetus can suffer from anemia or severe anemia, with potentially life-threatening complications. In HDFN, an iron transfusion is not the solution for treating fetal anemia. Instead, intrauterine transfusions (IUTIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN.) supply the fetus with new red blood cells to combat anemia in utero.
In fact, too much iron can be dangerous for the baby, with some newborns affected by HDFN suffering from iron overload as a result of intrauterine blood transfusions.
