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Iron Deficiency, Fertility, and Pregnancy

Iron levels are obviously important in pregnancy and in pre-conception because a big part of creating a a healthy baby, is being able to create a lot of new iron-rich red blood cells to feed that baby. Iron levels can have a big affect on pregnancy, complications for mama, complications for baby, and even complications for the baby past the neonatal period. So let’s talk about it.

Symptoms of Iron Deficiency

  • Fatigue
  • Ice craving (Pica)
  • Restless legs syndrome
  • Headache
  • Exercise intolerance
  • Exertional dyspnea (shortness of breath)
  • Weakness

Essentially, this feels like you’ve been flattened and just can’t regain your energy or strength.

Risks of Iron Deficiency in Pregnancy

 Just feeling horribly fatigued in pregnancy and not enjoying the pregnancy itself is enough reason to correct an iron deficiency, however there are other more severe pregnancy risks for mother and baby.

  • Placental abruption – this is when the placenta begins to detach from the uterine wall before the baby is due for delivery. It is an emergency situation.
  • Severe postpartum hemorrhage and increased risk for maternal transfusion
  • Maternal shock
  • Maternal intensive care unit (ICU) admission

There are iron deficiency and pregnancy risks for the baby as well:

  • Preterm birth – this happens when the baby is delivered early, and comes with a spectrum of risks for the baby.
  • Neonates born to anemic mothers had higher rates of fetal distress
  • Higher rates of admission to the neonatal intensive care unit.
  • Low birth weight
  • Small for gestational age 

There are also risks for the children of mothers with iron deficiency anemia during pregnancy after the neonatal period. These include:

  • Increased risk of autism spectrum disorder, or ASD
  • Increased risk of attention deficit hyperactivity disorder, or ADHD
  • Increased risk of intellectual disabilities

It is important to remember that iron deficiency is not necessarily considered causative for these issues, and all of these are complex syndromes with many different factors contributing to each one, but iron deficiency in the mother during pregnancy is known to increase the risk of these conditions for the child.

The Importance of Ferritin Testing for Iron Deficiency in Pregnancy

Generally, when we’re measuring iron levels we look at the red blood cells and whether or not they’re within normal limits and we also look at long term iron storage in the form of ferritin. It is obvious to tell when people are outside of this range, but there are a lot of questions about whether the normal range for ferritin is actually the best measure of iron status for women. 

Currently, the normal range for ferritin goes from roughly 15 to roughly 315, depending on your lab. As you can tell, that is an extremely broad range and the iron profile of a woman with a ferritin of 15 is going to be very different from that of a woman with a ferritin of 300. Also, researchers have pointed out that data from women during pregnancy and children is especially lacking and also that most of the research in this area was conducted 30+ years ago. 30 years in research terms is much like 30 years in technology terms – our data and information is changing and growing so quickly, that this is beyond obsolete.

Because of these issues, it is important to look at both red blood cell iron levels, which every doctor will do, and also ferritin, which you may have to advocate for yourself as a patient. If your ferritin levels are too close to the bottom end of the range, it could be valuable to talk with your doctor about additional iron supplements even if your red blood cell levels are normal.

“Serum ferritin (SF) concentrations are the most commonly deployed indicator for determining ID, and low SF concentrations reflect a state of iron depletion. However, there is considerable variation in SF cutoffs recommended by different expert groups to diagnose ID. Moreover, the cutoffs used in different clinical laboratories are heterogeneous. There are few studies of diagnostic test accuracy to establish the sensitivity and specificity of SF compared with key gold standards (such as absent bone marrow iron stores, increased intestinal iron absorption, and hemoglobin response to SF) among noninflamed, outpatient populations. The limited data available suggest the commonly recommended SF cutoff of <15 μg/L is a specific but not sensitive cutoff, although evidence is limited. Data from women during pregnancy or from young children are especially uncommon. Most data are from studies conducted >30 y ago, do not reflect ethnic or geographic diversity, and were performed in an era for which laboratory methods no longer reflect present practice.”

Daru J, Colman K, Stanworth SJ, De La Salle B, Wood EM, Pasricha SR. Serum ferritin as an indicator of iron status: what do we need to know? Am J Clin Nutr. 2017 Dec;106(Suppl 6):1634S-1639S. doi: 10.3945/ajcn.117.155960. Epub 2017 Oct 25. PMID: 29070560; PMCID: PMC5701723.
Iron deficiency and pregnancy risks, iron deficiency and fertility, iron deficiency and infertility,

The Best Way To Correct Iron Deficiency in Pregnancy

Iron deficiency in pregnancy can be extremely difficult to correct because the deficiency is happening at a time when iron need is exceptionally high and so any iron that is being supplemented is going directly to building new blood cells with none left over to replenish iron stores.

If you are having symptoms of anemia in pregnancy, often the fastest and most effective way to correct it is to get an iron infusion from your doctor. This will have to be prescribed and unfortunately this is an often underutilized tool, because doctors often encourage women to continue with iron supplements even in pregnancy. In this situation, advocate for yourself, because an iron infusion can relieve your symptoms immediately and save you from months of suffering.

Iron Deficiency in Male Factor Infertility

Interestingly, iron and also copper have a double-edged effect for men, as shown in this study published in Journal of Assisted Reproduction and Genetics.  Either too low or too high levels of these nutrients have been shown to affect sperm parameters. Excess or deficiency of either element may lead to defective spermatogenesis, reduced libido, and oxidative damage to the testicular tissue and spermatozoa, which ultimately leads to fertility impairment.

Iron excess is often overlooked in men, and can be reasonably common especially in men who eat a lot of red meat. Unfortunately, the symptoms of excessive iron are somewhat vague and easy to misinterpret as something else. They include erectile dysfunction, low sex drive, fatigue, weakness, joint pain, abdominal pain, and ultimately heart failure. A great way for men to keep their iron levels in a good range is to donate blood periodically, which can help to regulate iron levels in a safe way.

The Bottom Line for Iron Deficiency and Pregnancy Risks

It is important to look at every detail with fertility because of the limited time window, and that includes iron levels, even if those are considered clinically normal, but perhaps not optimal. Your doctor will test your red blood cell iron levels, called your hemoglobin, and your red blood cell iron concentration, called hematocrit. Make sure they also run a simple ferritin test to evaluate your long-term iron storage, because that will impact your pregnancy as well.

Can MTHFR gene mutation increase the risk of miscarriage?

There is some evidence to suggest that MTHFR gene mutations may increase the risk of recurrent miscarriage. The MTHFR gene provides instructions for making an enzyme called methylenetetrahydrofolate reductase, which is involved in the activation of folate (vitamin B9). Mutations in the MTHFR gene can affect the activity of this enzyme, leading to decreased levels of active folate and an increased risk of high homocysteine levels in the blood.

Elevated homocysteine levels have been associated with an increased risk of miscarriage and also an increased risk of blood clots, including micro clotting, which can lead to complications during pregnancy such as miscarriage. However, the relationship between MTHFR gene mutations and miscarriage is still not fully understood and more research is needed to determine the extent of the association.

While MTHFR gene mutations may increase the risk of miscarriage, they are not the only factor that can contribute to pregnancy loss. Other factors such as chromosomal abnormalities, hormonal imbalances, and autoimmune disorders can also play a role in miscarriage.

What is the relationship between MTHFR gene mutation and preeclampsia?

The MTHFR gene mutation has been linked to an increased risk of developing preeclampsia during pregnancy. Preeclampsia is a serious pregnancy complication characterized by high blood pressure and damage to organs such as the kidneys and liver.

Studies have shown that women with MTHFR gene mutations may have lower levels of folate in their blood, which can contribute to the development of preeclampsia. Folate is important for healthy fetal development and for maintaining a healthy pregnancy.

Additionally, the MTHFR gene mutation may lead to increased levels of homocysteine, an amino acid that has been associated with inflammation and blood vessel damage. This can further contribute to the development of preeclampsia.

Not all women with MTHFR gene mutations will develop preeclampsia, and other factors such as maternal age, obesity, and underlying medical conditions can also increase the risk of developing this complication. However, identifying and managing MTHFR gene mutations in pregnant women may be an important step in reducing the risk of preeclampsia and other pregnancy complications.

If you are concerned about preeclampsia or other pregnancy complications with MTHFR consider consulting Dr. Amy or taking the Healthy Foundation Pregnancy Preparation course.

Can MTHFR gene mutation increase the risk of preeclampsia?

Yes, MTHFR gene mutation can increase the risk of developing preeclampsia during pregnancy. Preeclampsia is a serious pregnancy complication characterized by high blood pressure and damage to organs such as the kidneys and liver.

Research has shown that women with MTHFR gene mutations may have lower levels of active folate in their blood, which can contribute to the development of preeclampsia. Folate is important for healthy fetal development and for maintaining a healthy pregnancy.In addition to affecting folate levels, the MTHFR gene mutation can also lead to increased levels of homocysteine, an amino acid that has been associated with inflammation and blood vessel damage. This can further contribute to the development of preeclampsia.

Not all women with MTHFR gene mutations will develop preeclampsia, and other factors such as maternal age, obesity, and underlying medical conditions can also increase the risk of developing this complication. However, identifying and managing MTHFR gene mutations in pregnant women may be an important step in reducing the risk of preeclampsia and other pregnancy complications.

If you are concerned about preeclampsia or other pregnancy complications with MTHFR consider consulting Dr. Amy or taking the Good Start Pregnancy Preparation course.

How does MTHFR gene mutation affect the body’s ability to process homocysteine?

The MTHFR gene mutation can affect the body’s ability to recycle homocysteine, an amino acid that is produced when the body breaks down proteins.

The MTHFR gene provides instructions for making an enzyme called methylenetetrahydrofolate reductase (MTHFR), which is involved in converting homocysteine into another amino acid called methionine. Methionine is then used to produce important molecules such as proteins and neurotransmitters.

However, certain mutations in the MTHFR gene can lead to reduced activity of the MTHFR enzyme, which can result in increased levels of homocysteine in the blood. Elevated homocysteine levels have been associated with an increased risk of cardiovascular disease, stroke, and other health problems.

The MTHFR gene mutation can also impact the body’s ability to activate folate, a B-vitamin that is essential for healthy fetal development and for maintaining a healthy pregnancy. Reduced folate levels can further contribute to elevated homocysteine levels.

It’s important to note that not all MTHFR gene mutations have the same effects on enzyme activity or homocysteine levels, and the impact of these mutations can vary depending on the specific mutation and individual factors. However, identifying and managing MTHFR gene mutations may be important in reducing the risk of health complications associated with elevated homocysteine levels.

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MTHFR is a common genetic mutation that can contribute to anxiety, depression, fatigue, chronic pain, infertility, and more serious conditions like breast implant illness, heart attack, stroke, chronic fatigue syndrome, and some types of cancer. If you know or suspect you have an MTHFR variant, schedule a free 15-minute meet-and-greet appointment with MTHFR expert Dr. Amy today.

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Amy Neuzil
Amy Neuzil

Dr. Amy Neuzil, N.D. is a leading expert in MTHFR and epigenetics, and she is passionate about helping people achieve optimal health and wellness for their genetic picture. She has helped thousands of people overcome health challenges using a simple, step-by-step approach that starts with where they are today. Dr. Neuzil's unique approach to wellness has helped countless people improve their energy levels, lose weight, and feel better mentally and emotionally. If you're looking for a way to feel your best, Dr. Amy Neuzil can help. Contact her today to learn more about how she can help you achieve optimal health and wellness.

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