Is too much iron dangerous during pregnancy?

I am 22 weeks pregnant and taking an iron supplement because I'm borderline anemic. My doctor never told me how much to take. Is there a risk of taking too much?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

There are toxic levels of iron, but usually these levels would be hard for an adult to consume in a supplement.

The body can only absorb so much iron, but 18 milligrams of "elemental iron" is the recommendation. This can be taken in through a variety of sources: in a diet that is the best absorbed and tolerated or, if you are low and need supplements, in the form of ferrous fumurate, ferrous gluconate or ferrous sulfate. Ferrous sulfate is well absorbed, but sometimes poorly tolerated, causing cramping in the stomach and intestines. Ferrous gluconate is better tolerated but not quite as well absorbed. Ferrous fumurate is fine but is expensive. Dosages are usually about 300 milligrams two to three times a day.

Your best source of iron is meat, especially red meat or liver. Turkey, chicken and fish are not as high but do contain iron. Egg yolks, green leafy vegetables, dark-red kidney beans, chickpeas and dried fruits are good sources, as are dried fruits. Fortified cereals such as Total or Product 19 should be eaten once or twice daily. Vitamin C can help absorption of iron.

If your supplement provides more than 18 milligrams of elemental iron, it is money down the drain. I would ask your provider how much iron he or she would recommend. This might depend upon how low it is and upon your history.

If you are nearing 26 to 30 weeks, this is a time of major iron depletion, as the blood volume increases faster than red-cell volume. True iron deficiency can be detected by tests such as serum ferritin levels, a peripheral smear or red-cell indices. If your hemoglobin is 10 or lower, such tests may be requested.

If you are of Mediterranean or Black-African descent, you should have a test for sickle cell trait and/or anemia. If you get ample dietary iron, this iron deficiency should be corrected by your 36th week.

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