10 Steps to Improve Iron Levels for Fertility & Pregnancy
By Chloe Dymond Young - BANT Registered Nutritional Therapist, IBCLC and ex-Midwife (17 years).
Optimising Iron Through Diet: Improving Fertility and Pregnancy Health:
During my career as a Midwife in a busy London hospital, one the most common pregnancy complaints I came across on a daily basis was low iron and anaemia. It caused pregnant women a whole host of symptoms including:
Fatigue & low energy
Pale skin & lips
Breathlessness & palpitations
Brain fog & poor focus
Hair loss & weak nails
Restless leg syndrome
Dizziness
Sore tongue & mouth ulcers
Feeling low & irritable
and strange cravings for things like coal & clay
It wasn’t just the symptoms, low iron also increased the need for iron infusions and in some cases blood transfusions. The caveat? Iron supplements are not always successful at increasing iron levels and frequently caused side effects like nausea, cramps, constipation or black stools, leaving many women struggling to take them consistently. More gentle versions of iron are available and this should always be discussed with your health advisor if you’re symptomatic. Beyond this, anaemia can impact a baby’s growth, birth outcomes, and even how well a mother recovers after birth. That’s why I’m so passionate about helping women optimise their iron stores before they get pregnant. Read on for the full lowdown.
The Importance of Iron
Iron is a vital nutrient for women planning pregnancy. Getting your iron levels spot on before conception can;
Improve your chance of fertility.
Boost health, energy and vitality during pregnancy
and support your baby’s development and growth.
Did you know - iron deficiency is one of the most common nutritional deficiencies among women worldwide. During this post I’m going to explain some of the reasons why, along with my ‘top ten tips’ so you have the knowledge to optimise your iron intake preconception and throughout pregnancy.
Why Does Iron Matter Before Pregnancy?
Iron plays a pivotal role in forming haemoglobin, the protein in red blood cells that carries oxygen throughout the body. For women, especially those preparing for pregnancy, maintaining sufficient iron levels is essential to support the increase in blood volume throughout pregnancy, as well as providing for her growing baby.
Research shows that women with low iron stores before pregnancy are at higher risk of iron deficiency anaemia during pregnancy, which is associated with;
Fatigue,
Increased susceptibility to infections,
Preterm delivery,
and low birth weight babies
(1. World Health Organization, 2021).
The Physiological Changes During Pregnancy that Impact Iron…
From early pregnancy, a woman’s blood volume increases by approximately 40-50%, creating a greater demand for iron. The foetus also requires iron for growth and brain development. Consequently, iron requirements can almost double by the third trimester of pregnancy.
If iron stores are low before conception, the body struggles to meet these demands, leading to depletion of maternal iron and potential anaemia.
What Causes Iron Levels to Be Low?
Iron is essential for overall health, but low levels are especially common in women. This is partly due to monthly blood loss from menstruation. While the body recycles iron efficiently, ongoing losses can eventually outweigh what’s absorbed or reused. And it’s not just about diet, several other factors can contribute to low iron, including:
Chronic inflammation (which raises hepcidin and blocks absorption)
Food intolerances or restrictive diets
Medications like antacids or proton pump inhibitors
Poor gut health (e.g. low stomach acid, IBS, coeliac disease)
Heavy menstrual bleeding
Pregnancy and breastfeeding (higher iron demands)
Genetic variations affecting absorption or transport
10 Tips to Optimise Iron Before Pregnancy:
1. Understand the Two Types of Dietary Iron
Heme Iron: Found in animal products like red meat, poultry, and fish. It is absorbed efficiently (about 15-35%) and less influenced by other dietary factors.
Non-Heme Iron: Found in plant-based foods such as legumes, spinach, lentils, nuts, and seeds. Its absorption rate is lower (2-20%) and more sensitive to inhibitors and enhancers in the diet.
Women following plant-based diets can still meet their iron needs but may require more attention to absorption enhancers and inhibitors.
2. Boost Iron Absorption with Key Nutrients
Vitamin C (Ascorbic Acid): Research consistently shows that vitamin C significantly enhances non-heme iron absorption by converting it into a more absorbable form. Including foods rich in vitamin C such as citrus fruits, strawberries, bell peppers, and broccoli alongside iron-rich meals is a simple, effective strategy.
Vitamin A: Vitamin A supports iron metabolism and helps mobilise iron from stores. Beta-carotene rich foods like carrots, sweet potatoes, and leafy greens support iron status indirectly.
Copper: Copper is necessary for iron transport and incorporation into haemoglobin. Foods rich in copper include shellfish, nuts, seeds, and whole grains.
Probiotics: Emerging research suggests that a healthy gut microbiome may improve mineral absorption, including iron. Probiotic-rich foods like yogurt, kefir, and fermented vegetables may support better iron status, although more research is needed in this area.
3. Limit Iron Absorption Inhibitors
Certain substances and lifestyle habits can reduce iron absorption:
Tea and Coffee: Polyphenols in these beverages bind iron and significantly decrease its absorption when consumed with meals. It’s best to consume tea and coffee between meals rather than during.
Calcium: Calcium competes with iron for absorption. High-calcium foods, such as dairy or supplements taken at the same time as iron-rich meals can reduce iron uptake.
Inflammation: Chronic inflammation, often linked to obesity, infection, or stress, raises hepcidin levels, a hormone that blocks iron absorption. Managing inflammation through diet, lifestyle, and addressing underlying health conditions can improve iron status.
4. Special Considerations for Plant-Based Diets
Plant-based eaters can maintain healthy iron levels by:
Consuming higher amounts of iron-rich plant foods.
Pairing iron sources with vitamin C-rich foods every meal.
Avoiding simultaneous intake of inhibitors like tea, coffee, and calcium supplements with iron-containing meals.
Considering cooking methods such as soaking, fermenting, or sprouting legumes and grains, which reduce phytates that inhibit iron absorption.
5. Genetic Variants and Predispositions Affecting Iron Levels
Iron metabolism is tightly regulated, but genetic factors can influence individual iron status, sometimes leading to too little or too much iron.
HFE Gene Mutations: The most well-known genetic variant related to iron overload is mutations in the HFE gene, which cause hereditary hemochromatosis - a condition where iron absorption is excessively high. Although hemochromatosis is rare in women of reproductive age due to menstrual iron losses, awareness is important, especially if there is a family history.
TMPRSS6 and TFR2 Variants: Other genetic polymorphisms affect iron regulation by altering hepcidin expression or iron transport proteins, influencing susceptibility to iron deficiency or overload.
Understanding genetic predispositions can help personalise iron management strategies, particularly for women with unexplained iron imbalance.
6. Other Reasons for Anaemia Symptoms: B12 and Folate Deficiencies.
If you’ve tested iron levels and they’re normal, but you’re experiencing symptoms of anaemia, it could be that you have low folate or vitamin B12. Both are additionally involved in the formation of red blood cells and can cause anaemia when depleted. Checking these nutrient levels alongside iron can help identify insufficiencies and optimise levels to boost fertility and prepare for a healthy pregnancy.
7. The Risks of Too Much Iron: Why Balance Is Key
While iron deficiency is common, excess iron can be harmful and is increasingly recognised as a risk factor for oxidative stress and chronic disease.
Oxidative Damage: Excess iron catalyses the formation of free radicals, damaging cells and tissues, potentially increasing inflammation.
Gestational Risks: High iron stores before pregnancy have been linked in some studies to gestational diabetes, preeclampsia, and low birth weight. Over-supplementation without testing can contribute to excess iron.
This highlights the importance of testing iron status before supplementing, rather than taking iron supplements indiscriminately.
8. Know Your Iron-Rich Foods:
Heme Iron (best absorbed):
Red meat (beef, lamb), Chicken (especially thighs and liver), Turkey, Liver (chicken or beef - very high in iron!), Sardines, Mackerel, Oysters and clams, Eggs (especially yolks).
Non-Heme Iron (plant-based):
Lentils and chickpeas, Tofu and tempeh, Pumpkin seeds and sunflower seeds, Quinoa and buckwheat, Spinach and kale, Dried apricots, Prunes and raisins, Blackstrap molasses, Oats, Dark chocolate (70%+ cacao).
Tip: Pair plant-based iron foods with vitamin C-rich foods (like citrus, bell peppers, or tomatoes) to boost absorption.
Finally……
9. Bring it all together:
Optimising iron through diet before pregnancy sets the foundation for a healthier pregnancy journey. Focus on a balanced, nutrient-dense diet that includes both heme and non-heme iron sources, along with vitamins C, A, copper, and potentially probiotics to enhance absorption. Be mindful of factors that inhibit iron uptake like tea, coffee, calcium, and inflammation.
10. Test iron levels and optimise diet or supplement if necessary:
If you suspect low iron or have risk factors such as heavy menstrual bleeding, vegetarian/vegan diets, or previous pregnancies with anaemia, consult your health care provider. They should test your iron levels and advise on supplementation if it’s deemed necessary, alongside dietary strategies.
How Can I Help You?
If you’d like help and guidance with blood tests or optimising iron, folate and B12 through diet and supplements, I have a Women and Baby Clinic - you can book an appointment through my services page.
For more in depth support I also offer trimester specific programmes and DNA testing packages. BOOK A FREE 15 DISCOVERY CALL via the links on my website if you’d like to chat and find out more.
COMING SOON - my fertility meal planner and guide, to help you maximise every meal for optimal fertility and preparation for a healthy pregnancy.
1) World Health Organization (2021): https://www.who.int/health-topics/anaemia#tab=tab_1
