After the first doctor´s appointment and various tests, the results show low hemoglobin and ferritin (iron stores) levels. The doctor suggests consuming additional iron in order to experience a carefree pregnancy and birth. Pharmacy shelves are full of different supplements. How to make the right decision – based on price, ingredients, iron salt? Syrup or pills?
Iron deficiency anemia is very common during pregnancy. Anemia during pregnancy can be diagnosed with hemoglobin values below 110 g/l during the first and third trimesters and below 105 g/l during the second trimester. Low hemoglobin levels (85–105 g/l) are linked to low birth weight and premature birth. Mother´s pre-pregnancy iron stores are used by the body´s accelerated hematopoiesis process and to ensure the normal growth of the fetus. Repetitive bleeding during pregnancy, multiple and successive pregnancies, mother´s acute and chronic illnesses (e.g. ulcerative intestinal inflammation, stomach and duodenum ulcer disease, repeated urinary tract infection etc.), iron absorption disorder, intestinal parasites, drugs for reducing gastric acidity and insufficient nutrition all increase the risk of iron deficiency anemia .
The body uses iron to produce hemoglobin found in red blood cells. Hemoglobin helps to transport oxygen to different tissues and organs. During a normal pregnancy, a woman´s body has about 1250 ml of extra blood. The weight of red blood cells increases by about 250 ml to satisfy the demand for extra oxygen. Because of that, levels of hemoglobin and iron stores decrease during pregnancy. Midwives and gynecologists regularly analyze pregnant women´s blood to check for any changes during pregnancy. Pregnant women are checked for anemia during the first trimester of pregnancy (or after the first appointment) and tests are repeated during week 28 to leave enough time for treatment.
The body needs around 1300-1400 mg of iron due to pregnancy. It regulates the additional iron demand during pregnancy in two ways: by increasing iron absorption from food and by using body´s iron stores. The need for iron is the following:
|COMPONENTS NEEDING IRON||AMOUNT OF IRON IN MILLIGRAMS (MG)|
|Additional red blood cells||570|
|Iron loss via skin, feces and urine||270|
|Iron needed by the fetus||200-370|
|Placenta and umbilical cord||35-100|
|Bleeding after pregnancy 500 ml||250|
|Breastfeeding 6 months||150|
|Amenorrhea 15 months, storage||250|
|Total iron need
The World Health Organization (WHO) advises consuming 30-60 mg of iron food supplements per day for women with sufficient iron stores and 120-240 mg for women with low iron stores [4,5]. Iron food supplements are normally consumed after hemoglobin and/or ferritin, i.e. iron stores, have decreased. This is mainly due to the fact that iron (especially iron salts with low bioavailability like iron sulphate, fumarate and gluconate) causes gastrointestinal side effects.
It is safer to consume 60-120 mg of iron per day starting from week 20 to prevent iron deficiency. The body loses blood during pregnancy depleting hemoglobin, and bleeding after birth can mean blood loss of about half a liter. Therefore, it is in the interest of pregnant women to consume additional iron starting from week 20. The need for iron increases at the end of the pregnancy .
Pregnant women often suffer from constipation due to slower metabolism. Metabolism slows down during pregnancy to ensure that the fetus gets all the necessary minerals and vitamins needed for normal growth. Before purchasing iron food supplements, take a look at the ingredients, the most important thing is to find out which iron salt has been used in the product. Different iron salts are absorbed differently by the body. The lower the absorption of the iron salt, the more foreign matter is stored in the body, causing nausea, constipation, metal flavored “burps” etc. Very often iron salts with low bioavailability, i.e. with low absorption, are used in food supplements and OTC drugs. For instance, the absorption of iron sulphate and fumarate is about 27–28%, the absorption of iron gluconate is around 32%. Pregnant women often use supplements with iron sulphate and the daily dosage is around 100–300 mg because of the low absorption of iron sulphate. The daily dosage of bisglycinate should be at least two times smaller due to high bioavailability.
This is why we have chosen iron bisglycinate for Nôgel´s iron food supplements, because of its high bioavailability, which is up to 90%. In addition, it has been found in scientific research that iron bisglycinate is absorbed at least two times better than iron sulphate or fumarate . Thanks to high bioavailability, iron bisglycinate does not usually cause gastrointestinal side effects and is, therefore, the best tolerated iron salt. It is a safe iron salt and its usage has been accepted even in infant and toddler food by the European Union´s regulations .
Maximum of 60‒120 mg of elemental iron in bisglycinate form is sufficient to treat iron deficiency anemia, whereas the dosage should be 200‒300 mg of elemental iron per day with iron sulphate.
Read more about iron bisglycinate and absorption HERE.
In addition to the iron salts in the supplements, it is worth paying attention to the bulking agents used in pills and also to the form of vitamin C, is it natural or synthetic? A lot of food supplements contain other vitamins and/or minerals in addition to iron. You should first find out what does your body actually need before consuming any other minerals and vitamins along with iron just in case.
Nôgel´s iron food supplements consist of four carefully selected ingredients in addition to iron bisglycinate:
- Organic Acerola cherry (natural vitamin C)
- Estonian nettle
- Organic Korean chlorella aka algae
- Carnauba wax
Iron syrup for children consists of three natural ingredients in addition to iron bisglycinate: organic orange juice concentrate for natural vitamin C, organic pear juice concentrate and nettle tea, which we prepare ourselves, from Estonian high-quality and pure nettle.
Nôgel´s iron food supplements are great for pregnant and breastfeeding women. Iron syrup for children is suitable for babies starting from 6 months. No animal ingredients have been used, so the products are also suitable for vegans. Nôgel is also involved in charity work – for every 30 mg iron jar purchased, a tree is planted in Estonia in co-operation with the Estonian State Forest Management Center (RMK). For every other product purchased, we donate 5 cents to local children´s charity foundation. The content of iron and vitamin C in the supplement have been checked in laboratory.
 Tartu University Hospital Women´s Clinic – Iron deficiency anemia
 Milman N, et al. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med. 2014 Mar;42(2):197-206. doi: 10.1515/jpm-2013-0153
 Regulation (EU) No 609/2013 of the European Parliament and of the Council of 12 June 2013. Commission Delegated Regulation (EU) 2017/1091 of 10 April 2017
 A.Aro, M.Mutanen, M.Uusitupa. Nutrition science. 4th-7th volume, 2017
 World Healt Organization (WHO).Daily iron and folic acid supplementation in pregnant women. 2012/2019.