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DESCRIPTION
Anemia is defined as an inadequate level of hemoglobin during pregnancy. Hemoglobin is the protein inside red blood cells that carries oxygen to body tissues. Common anemias in pregnancy include iron deficiency anemia (75 to 85% of cases) and folic acid deficiency. In addition, glucose-6-phosphate dehydrogenase (G6PD) deficiency, thalassemia and sickle cell anemia have genetic implications and should receive special evaluation.
There are several types of anemias that may occur in pregnancy. These include:
- Anemia of pregnancy - In pregnancy, a woman's blood volume increases by as much as 50 percent. This causes the concentration of red blood cells in her body to become diluted. This is sometimes called anemia of pregnancy and is not considered abnormal unless the levels fall too low.
- Iron deficiency anemia - During pregnancy, the fetus uses the mother's red blood cells for growth and development, especially in the last three months of pregnancy. If a mother has excess red blood cells stored in her bone marrow before she becomes pregnant, she can use those stores during pregnancy to help meet her baby's needs. Women who do not have adequate iron stores can develop iron deficiency anemia. This is the most common type of anemia in pregnancy. It is the lack of iron in the blood, which is necessary to make hemoglobin - the part of blood that distributes oxygen from the lungs to tissues in the body. Good nutrition before becoming pregnant is important to help build up these stores and prevent iron deficiency anemia.
- Vitamin B12 deficiency - Vitamin B12 is important in forming red blood cells and in protein synthesis. Women who are vegans (who eat no animal products) are most likely to develop vitamin B12 deficiency. Including animal foods in the diet such as milk, meats, eggs, and poultry can prevent vitamin B12 deficiency. Strict vegans usually need supplemental vitamin B12 by injection during pregnancy.
- Blood loss - Blood loss at delivery and postpartum (after delivery) can also cause anemia. The average blood loss with a vaginal birth is about 500 milliliters, and about 1,000 milliliters with a cesarean delivery. Adequate iron stores can help a woman replace lost red blood cells.
- Folate deficiency - Folate, also called folic acid, is a B-vitamin that works with iron to help with cell growth. Folate deficiency in pregnancy is often associated with iron deficiency since both folic acid and iron are found in the same types of foods. Research shows that folic acid may help reduce the risk of having a baby with certain birth defects of the brain and spinal cord (neural tube defects) if taken before conception and in early pregnancy.
FREQUENT SIGNS & SYMPTOMS
These are symptoms of many forms of anemia:
Sometimes no symptoms are apparent or may vary from woman to woman.
Breathlessness. Labored breathing, particularly with exercise.
Tiredness, weakness, dizziness and/or fainting. These occur because organs are not getting enough oxygen from your red blood cells.
Paleness. Pale skin, lips, nails, palms, or underside of eyelids.
Leg cramps.
Insomnia.
Infrequent Symptoms:
Palpations or an abnormal awareness of the heartbeat. Rapid heartbeat (tachycardia).
Jaundiced (yellowish) skin.
Inflamed, sore tongue.
Nausea. Abdominal pain.
Headache. Forgetfulness, difficulty in concentrating.
Jaundice.
These are symptoms of specific forms of anemia:
Anemia caused by iron deficiency:
- Hunger for strange substances such as paper, ice, or dirt (a condition called pica).
- Upward curvature of the nails referred to as koilonychias.
- Soreness of the mouth with cracks at the corners.
Anemia caused by vitamin B-12 deficiency:
- A tingling, "pins and needles" sensation in the hands or feet.
- Loss of sense of touch.
- A wobbly gait and difficulty walking.
- Clumsiness and stiffness of the arms and legs.
- Dementia
- Hallucinations, paranoia and schizophrenia.
Anemia caused by chronic lead poisoning:
- A blue-black line on the gums referred to as a lead line.
- Abdominal pain
- Constipation
- Vomiting
Anemia caused by chronic red blood cell destruction:
- Jaundice (yellow skin and eyes)
- Brown or red urine
- Leg ulcers
- Failure to thrive in infancy
- Symptoms of gallstones
Sickle cell anemia:
- Fatigue
- Susceptibility to infection
- Delayed growth and development in children
- Episodes of severe pain, especially in the joints, abdomen and limbs.
Anemia caused by sudden red blood cell destruction:
- Abdominal pain
- Brown or red urine
- Jaundice (yellow skin)
- Small bruises under the skin.
- Seizures
- Symptoms of kidney failure.
Your midwife or health care practitioner tests your blood for anemia at your first prenatal appointment. One of these tests (hematocrit) measures the percentage of red blood cells in your plasma. The other (hemoglobin) measures the number of grams of hemoglobin in your blood. It's more common to develop anemia as your pregnancy progresses, however, so you'll have another blood test in your late second trimester or early third trimester. It's normal for your hemoglobin and hematocrit levels to go down somewhat in the second half of pregnancy, when the amount of blood in your body is expanding dramatically and the amount of plasma (the fluid component of blood) increases faster than the number and size of red blood cells — but you don't want them to dip too low.
If you do develop anemia, you might not have any symptoms at all, especially if your condition is mild. Or you might feel tired, weak, and dizzy. (Of course, these are symptoms that many women have anyway during pregnancy, anemic or not.) You might also notice that you're paler (especially in your fingernails, the underside of your eyelids, and your lips) and have a rapid heartbeat, heart palpitations, shortness of breath, or trouble concentrating. Finally, some studies have found a link between severe iron-deficiency anemia and cravings for non-food substances such as ice, paper, or clay (a condition known as pica). If you do have these cravings, don't give in to them, and be sure to tell your midwife or health care provider.
CAUSES
Poor diet with inadequate iron.
Folic-acid deficiency.
Loss of blood from bleeding hemorrhoids or gastrointestinal bleeding.
Even if iron and folic-acid intake are sufficient, a pregnant woman may become anemic because pregnancy alters the digestive process. The unborn child consumes some of the iron or folic acid normally available to the mother's body.
Your iron requirements go up significantly when you're pregnant. Iron is essential for making hemoglobin, the protein in red blood cells that carries oxygen to other cells. During pregnancy, the amount of blood in your body expands until you have almost 50 percent more than usual. And you need more iron to make more hemoglobin for all that additional blood. You also need extra iron for your growing baby and placenta.
Unfortunately, most women start pregnancy without sufficient stores of iron to meet their body's increased demands particularly in the second and third trimesters. If you get to the point that you no longer have enough iron to make the hemoglobin you need, you become anemic.
Your risk is even higher if you have morning sickness severe enough to cause frequent vomiting, if you've had two or more pregnancies close together, if you're pregnant with more than one baby, if you have an iron-poor diet, or if your pre-pregnancy menstrual flow was heavy.
This is why the amount of iron you need shoots up during pregnancy from 18 to 27 milligrams (mg) a day. And because it's hard to get enough iron through diet alone, the Centers for Disease Control recommend that pregnant women take a daily supplement of 30 mg of elemental iron as a preventive dose. Many prenatal supplements contain that amount.
Iron deficiency is the most common cause of anemia, but it's not the only cause. You could also develop anemia by not getting enough folic acid or vitamin B12, by losing a lot of blood, or from certain diseases or inherited blood disorders such as sickle cell disease. The treatment for anemia depends on the cause. Iron supplements are not always the answer.
RISK INCREASES WITH
Poor nutrition, especially multiple vitamin deficiencies.
Women who are unable to eat well because of nausea or vomiting (morning sickness).
Having a multiple pregnancy, such as twins, where iron stores are depleted quicker by your growing babies.
Having two pregnancies relatively close together.
Excess alcohol consumption, leading to poor nutrition.
Medical history of any disorder that reduces absorption of nutrients.
Use of anti-coagulant drugs. Anti-seizure drugs.
Smoking or second hand smoke. Smoking alters the absorption of nutrients and can contribute to anemia.
Previous use of oral contraceptives.
Injury and bleeding problems such as hemorrhoids or gastrointestinal bleeding.
G6PD deficiency is more common in persons of Mediterranean, African American and Sephardic Jewish descent. Sickle cell anemia is found in African Americans and in persons of Italian, Middle Eastern and East Indian descent.
PREVENTIVE MEASURES
If you are a vegetarian (vegan), talk to your midwife, nutritionist, or health care provider about your diet and any possible need for supplements.
Eat foods rich in iron such as beef, whole-grain breads and cereals, eggs and dried fruit. Select iron-fortified cereals and breads.
Eat foods high in folic acid, such as wheat germ, beans, peanut butter, oatmeal, mushrooms, collard greens, broccoli, beef liver and asparagus.
Eating foods high in vitamin C, such as citrus fruits and fresh, raw vegetables makes iron absorption more efficient. Vitamin C makes the stomach more acidic and improves the absorption of iron.
Take prenatal vitamin and mineral supplements if they are prescribed.
Decrease your consumption of caffeinated products and tea. These substances can decrease iron absorption. Other offenders include the preservative EDTA, fiber, large amounts of calcium, and the phytates found in some vegetables.
Carefully follow safety guidelines if your occupation involves work with lead-containing materials such as batteries, petroleum, and paint. Ask your midwife, health care provider or local public-health authorities about lead-testing the pottery you use for food or beverage preparation.
Screening for several anemias, e.g., G6PD deficiency and sickle cell disease in high-risk women, should be considered prior to any attempt to become pregnant.
Protect yourself from injury and bleeding (blood loss).
Take your prenatal vitamin and eat a healthy diet that includes plenty of iron-rich foods. Red meat is your best bet, although poultry (dark meat), other meats, and shellfish are good sources, too. Non-animal iron-rich foods include beans, tofu, raisins, dates, prunes, figs, apricots, potatoes (leave the skins on), broccoli, beets, leafy green vegetables, whole-grain breads, blackstrap molasses, and iron-fortified cereals. Keep in mind that your body absorbs the iron from animal sources (heme iron) much more readily than the iron from non-animal sources (non-heme iron).
One note of caution: Don't turn to liver for your iron needs. Liver is best avoided during pregnancy because it contains unsafe amounts of vitamin A, which can cause birth defects.
Eating or drinking something rich in vitamin C at the same time you take your iron supplement or eat iron-rich plant foods can help your body absorb significantly more of the type of iron found in non-animal sources. Good vitamin C choices include a glass of orange or tomato juice, a handful of strawberries, sweet (bell) peppers, or half a grapefruit. Meat and fish (sources of heme iron, which your body absorbs much more easily) can also improve your absorption of the iron in non-meat foods. For example, putting a bit of beef in a pot of vegetable chili can help you absorb iron from the vegetables.
Calcium interferes with your body's ability to absorb iron. So if you're taking calcium supplements, or an antacid that contains calcium, don't take either one while you're eating iron-rich foods or at the same time as your iron supplement. For the same reason, don't take your supplement with milk, which is rich in calcium. Drink milk between meals, instead. The same goes for tea and coffee, which contain polyphenols that interfere with the absorption of iron from supplements and plant sources.
EXPECTED OUTCOME
Usually curable with iron and folic-acid supplements by mouth or by injection.
Treatment is dependent upon underlying cause of anemia symptoms.
POSSIBLE COMPLICATIONS
Premature Labor.
Intrauterine growth retardation (IUGR).
Dangerous anemia from normal blood loss during labor, requiring blood transfusions.
Increased susceptibility to maternal infection after childbirth.
Your baby does a good job taking care of his iron needs — he'll get his share before you do. If you remain anemic during the first two trimesters, though, you're at a higher risk for having a pre-term delivery or a low-birthweight baby, so it is something to take seriously. And if you're severely deficient, it could affect your baby's iron stores at birth, increasing his risk for anemia later in infancy.
Iron-deficiency anemia affects your health as well. It can sap your energy and make it harder for your body to fight infection. And if you're anemic later in pregnancy, you're more likely to have problems if you lose a lot of blood when you give birth. You may feel dizzy, have a rapid heart rate, or have other symptoms that require you to stay in the hospital an extra day or two. You're also more likely to need a blood transfusion.
TREATMENT
GENERAL MEASURES
To diagnose anemia, your midwife or health care provider will likely take your medical and obstetric history, perform a physical exam, and order laboratory tests. You can help by providing detailed answers about your symptoms, family medical history, diet, medications you take, alcohol intake and tobacco usage, and ethnic background. Your midwife or health care provider will look for symptoms of anemia and other physical clues that might point to a cause.
Diagnosis is determined by laboratory blood studies. One of the most basic tests is a complete blood count (CBC), which determines the number, size, volume, and hemoglobin content of red blood cells. Hemoglobin is the part of blood that distributes oxygen from the lungs to tissues in the body. Hematocrit is the measurement of the percentage of red blood cells found in a specific volume of blood. Cutoff values used to define anemia during each trimester of pregnancy are:
First and third trimester:
Hemoglobin (Hgb) less than 11 gm/L or Hematocrit (Hct) less than 33%.
Second trimester:
Hemoglobin (Hgb> less than 10.5 gm/L or Hematocrit (Hct) less than 32%.
(CDC Study: Chronic Disease Prevention Anemia During Pregnancy in Low Income Women)
MoonDragon's Birthing Guidelines: Anemia
This link provides normal, borderline, and anemia values and management for midwives and their clients.
Treatment depends on the type and severity of anemia. You may have your blood iron level and your serum ferritin level checked as these are indicators of your body's total iron stores. You may have your blood levels of vitamin B12 checked as well as folate. Only in rare cases will your health care provider remove a sample of bone marrow to determine the cause of your anemia. Special blood tests can detect rare causes of anemia, such as an immune attack on your red blood cells, red blood cell fragility, and defects of enzymes, hemoglobin and clotting. If hemolytic anemia is suspected, tests can identify the breakdown products of red blood cells in your blood and urine (bilirubin, uribilirubin).
TREATMENT
Treatment will depend on the underlying cause of your anemia. For most anemias, supplements are prescribed and dietary assessments are made.
Anemia caused by blood loss. If you suddenly lose a large volume of blood, you may be treated with fluids, blood transfusion, oxygen, and possibly iron to help your body build new red blood cells. Chronic blood loss is treated by identifying the source of bleeding, stopping the bleeding, and, if necessary, giving treatment for iron-deficiency anemia.
Anemia caused by decreased red blood cell production. With iron deficiency anemia your midwife or health care provider will probably recommend iron supplements that contain the ferrous form of iron, which your body can absorb easily. Timed-release iron supplements are not a good choice for most people because iron is primarily absorbed in the upper part of the digestive tract.
Vitamin B12 deficiency anemia. If your body stores are depleted of vitamin B12, your health care provider will most likely prescribe vitamin B12 injections and may also recommend high doses of B12 supplements or a B12 nasal spray. There is a good chance that many of the symptoms of deficiency will improve once the body is provided with the needed B12. Most people with vitamin B 12 deficiency have a permanent inability to absorb vitamin B12 and will need injections every one to three months or pills daily for the rest of their lives. Your health care provider or midwife may also recommend that you increase the amount of vitamin B12 in your diet. Good dietary sources of vitamin B12 are meat, liver, and kidney; fish, oyster, and clams; and milk, cheese and eggs.
Folate deficiency anemia. If you have a folate deficiency, your health care provider or midwife will prescribe folate supplements and may recommend you increase the amount of folate in your diet. Good dietary sources of folate include fresh fruits, green leafy vegetables, cruciferous vegetables (cauliflower, broccoli and brussel sprouts), liver and kidney, dairy products, and whole grain cereals. Vegetables should be eaten raw or lightly cooked.
Anemia caused by problems of the bone marrow and stem cells. Anemia that originates in the bone marrow and stem cells tend to be more persistent and difficult to treat. The treatments for hereditary anemias, such as thalassemia, vary widely and depend on the specific condition and the severity of symptoms. Some anemias will not require any treatment while others may require repeated transfusion and other aggressive measures. Although aplastic anemia will occasionally go into spontaneous remission, people with this disorder generally require bone marrow transplantation.
Lead poisoning is treated by discontinuing exposure to lead and administering a drug that binds and draws lead out of the body. This is called "Chelation Therapy".
For people with anemia as a result of chronic disease, the best way to alleviate the anemia is often to treat the underlying condition. Shots of Epogen, a hormone that stimulates the production of red blood cells, may also help in some instances. People who have anemia as a result of kidney failure will require adequate dialysis, take Epogen, and possibly have a kidney transplant.
Anemia caused by increased red blood cell destruction. The treatment of hemolytic anemia will be tailored to the underlying cause. Mild cases of hemolytic anemia may not require any treatment at all. If an offending environmental agent can be identified, a chemical, for example, exposure to this agent should stop immediately. People with hemolytic anemia may need surgery to replace faulty heart valves, remove a tumor, or repair abnormal blood vessels. Supportive treatment, like intravenous fluids and pain medication, will often be administered. Blood transfusion may be necessary in some cases. Steroids can halt the body's immune attack on its own red blood cells. Certain damaging factors can be removed from the blood by a treatment called plasmapheresis. If hemolytic anemia persists despite treatment, your health care provider may recommend splenectomy, surgical removal of the spleen, as a last resort. Most people can lead a normal life without their spleen. Gallbladder surgery may also be required if you have longstanding hemolytic anemia and symptoms of gallstones. Hemolytic anemia that damages the kidneys may make dialysis necessary. In extremely rare cases, bone marrow transplantation may be the only solution for certain types of hemolytic anemia.
For G6PD deficiency, treatment is supportive and educational.
Sickle cell anemia in pregnant women requires careful medical management; usually done by specialists. While there is no cure for sickle cell anemia, drugs can help ease the pain. And a drug called hydroxyurea appears to stimulate the formation of an alternate form of hemoglobin that isn't susceptible to the sickling.
If the tongue is red and sore, rinse with warm salt water 3 or 4 times a day. Use 1 teaspoon salt to 8 ounces warm water.
Brush teeth with a soft toothbrush.
If your test indicates that you're anemic, your midwife or health care practitioner will prescribe an iron supplement of 60 to 120 mg a day or more. To make sure you absorb as much of the iron as possible, take your iron pills on an empty stomach. Wash them down with water or orange juice (the vitamin C helps with absorption) but not with milk (calcium hinders absorption).
Note that these doses refer to the amount of "elemental iron," or pure iron, in a supplement. Some labels list the amount of ferrous sulfate (a kind of iron salt) instead of or in addition to the amount of elemental iron. A supplement that contains 325 mg of ferrous sulfate will give you about 60 mg of elemental iron. Others use ferrous gluconate, 300 mg of which yields about 34 mg of elemental iron.
One more important thing to note: Be vigilant about keeping any pills containing iron in childproof containers and away from children. More kids die from iron overdose each year than from any other kind of accidental drug poisoning. In fact, a single adult dose can poison a small child.
MEDICATION
Iron, folic-acid and other supplements may be prescribed. For better absorption, take iron-supplements 1 hour before eating or between meals. Iron supplements should be taken with a glass of citrus juice, such as orange juice, or a vitamin C supplement to aid in absorption. Iron will turn bowel movements black, and often causes constipation. Iron sometimes may be taken with meals if it has caused an upset stomach. Injections may be required by your health care provider in severe cases of anemia if supplements cannot be taken orally.
High levels of iron in supplements can upset your gastrointestinal tract. Most often, they lead to constipation, which is already a problem for many pregnant women. If you suffer from constipation, try drinking prune juice. It can help you stay regular (and is a good source of iron). You may also have nausea or, more rarely, diarrhea. If you think your supplement is making you feel queasy, try taking it at bedtime.
If side effects continue to plague you, talk to your midwife or health care practitioner. You may be able to avoid stomach problems by starting with less iron and then gradually building up to the dose you need or taking the iron in divided doses through the day. And some women find they have less trouble with the side-effects from iron supplements when they take a time-released formula.
Iron supplements can interact with other medications you may take, so be certain to tell your midwife or health care provider if you are being treated for another condition. Calcium supplements interfere with iron absorption so it is best to take them at different times of the day.
Do not worry if your stools look darker (dark greenish or black in color) when you start taking iron. That's a normal side effect.
Your midwife or health care provider will monitor your red blood cell counts including hematocrit, hemoglobin, and ferritin levels during treatment. If your anemia does not improve with iron supplements, your health care provider will look for some other underlying cause. In rare cases, your health care provider may prescribe iron injections or give you iron intravenously (through a needle in the vein). In extremely rare cases of life-threatening iron-deficiency anemia, treatment may involve a blood transfusion.
ACTIVITY
Rest often until the anemia disappears.
Avoid activity that could result in injury and bleeding problems.
DIET
Eat well and take prescribed supplements. Your midwife or health care provider may recommend that you increase the amount of iron, vitamin B12, and/or folate in your diet. Increase fiber and fluid intake to prevent constipation. Do not take milk with iron supplements as it inhibits absorption of iron, take supplements with citrus juice (orange juice) or water instead. For more in depth information about holistic approaches that involve nutritional therapy and herbal supplements, see the links below:
Good pre-pregnancy nutrition not only helps prevent anemia, but also helps build other nutritional stores in the mother's body. Eating a healthy and balanced diet during pregnancy helps maintain the levels of iron and other important nutrients needed for the health of the mother and growing baby.
Good food sources of iron include the following:
- Meats - beef, pork, lamb, liver, and other organ meats
- Poultry - chicken, duck, turkey, liver (especially dark meat)
- Fish - shellfish, including clams, mussels, oysters, sardines, and anchovies
- Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collard greens
- Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans
- Yeast-leavened whole-wheat bread and rolls, Brewer's yeast (dietary yeast supplement)
- Iron-enriched white bread, pasta, rice, and cereals
The following is a list of foods that are a good source of iron. Always consult your midwife or health care provider regarding the recommended daily iron requirements.
Iron-Rich Foods Quantity Approximate Iron
Content (milligrams)Oysters 3 ounces 13.2 Beef liver 3 ounces 7.5 Prune Juice 1/2 cup 5.2 Clams 2 ounces 4.2 Walnuts 1/2 cup 3.75 Ground beef 3 ounces 3.0 Chickpeas 1/2 cup 3.0 Bran flakes 1/2 cup 2.8 Pork roast 3 ounces 2.7 Cashew nuts 1/2 cup 2.65 Shrimp 3 ounces 2.5 Raisins 1/2 cup 2.55 Sardines 3 ounces 2.5 Spinach 1/2 cup 2.4 Lima beans 1/2 cup 2.3 Kidney beans 1/2 cup 2.2 Turkey, dark meat 3 ounces 2.0 Prunes 1/2 cup 1.9 Roast beef 3 ounces 1.8 Green peas 1/2 cup 1.5 Peanuts 1/2 cup 1.5 Potato 1 1.1 Sweet potato 1/2 cup 1.0 Green beans 1/2 cup 1.0 Egg 1 1.0
Vitamin supplements containing 400 micrograms of folic acid are now recommended for all women of childbearing age and during pregnancy. These supplements are needed because natural food sources of folate are poorly absorbed and much of the vitamin is destroyed in cooking. Making fresh juice (vegetable & fruit) is a good way of consuming heat-sensitive nutrients in foods. See this link for more information about juicing:
Food sources of folate include the following:
- Leafy, dark green vegetables.
- Dried beans and peas.
- Citrus fruits, juices and most berries.
- Fortified breakfast cereals.
- Enriched grain products.
Always consult your midwife or health care provider before taking any nutritional or herbal supplement and beginning any nutritional therapy program. Some supplements should be limited or avoided during pregnancy. Consult your midwife or herbalist about herbal supplements. Your midwife or health care provider are familiar with your particular health issues and are there to assist you in your care.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PRACTITIONER IF...
You have symptoms of anemia during pregnancy such as persistent fatigue, breathlessness, rapid heart rate, pale skin, or any other symptoms of anemia.
You have a poor diet or have concerns about inadequate dietary intake of vitamins and minerals.
You have experienced heavy menstrual bleeding prior to becoming pregnant or symptoms of ulcer, gastritis, hemorrhoids or colorectal cancer.
If you are concerned about environmental exposure to lead.
A hereditary anemia runs in your family and you would like to genetic counseling before having a child.
The following occurs during treatment:
- Diarrhea.
- Nausea.
- Abdominal pain.
- Constipation.
- Bleeding, however slight, from any source.
If you are a woman considering pregnancy, your midwife or health care provider may recommend that you begin taking supplements, especially folate, before conception. These supplements benefit both mother and baby.
NUTRITIONAL SUPPLEMENTS
These listed supplements are suggested for general anemia and some may not be recommended for use during pregnancy or required dosage amounts may be need to be adjusted for your pregnancy condition. Consult with your midwife or health care provider before beginning any nutritional therapy program. Consult with your midwife or herbalist before taking any herbal remedies as some herbs should be avoided during pregnancy. Do not take an iron supplement unless prescribed by your midwife or health care provider. Too much iron can be harmful to you and/or your baby. Follow your recommended nutritional guidelines carefully. If you have any unusual or unexpected side effects from any supplement, discontinue use immediately and consult with your midwife or health care provider about other options that may be available to you. For more information and nutritional recommendations see:
Nutrients Supplement Suggested Dosage Comments Essential Raw liver extract 500 mg twice daily. Contains all the elements needed for red blood cell production. Use liver from organically raised beef. Consider injections (under a health care provider's supervision). Blackstrap molasses Adults: 1 tablespoon twice daily.
Children: 1 teaspoon twice daily.See above under Holistic Recommendations. Folic acid 800 mcg twice daily. Needed for red blood cell formation. Biotin 300 mcg daily. Needed for red blood cell formation. Iron As prescribed by a health care provider. Take with 100 mg vitamin C for better absorption. To restore iron. Use ferrous gluconate form. Caution: Do not take iron unless anemia is diagnosed. Floradix Iron Plus Herbs from Salus Haus 2 teaspoons daily. Contains a readily absorbable form of iron that is nontoxic and from a natural source. Vitamin B12 injections 2 cc once weekly or as prescribed by health care provider. Essential in red blood cell production and to break down and prepare protein for cellular use. Injections (under health care providers supervision) are best. If injections are not available, use lozenge or sublingual form for best absorption. Or vitamin B12 2,000 mcg 3 times daily Essential in red blood cell production and to break down and prepare protein for cellular use. Injections (under health care providers supervision) are best. If injections are not available, use lozenge or sublingual form for best absorption. Vitamin B complex 50 mg 3 times daily. B vitamins work best when taken together. A sublingual form is recommended. Pantothenic acid (vitamin B5 50 mg 3 times daily. Important in red blood cell production. Vitamin B6 (pyridoxine) 100 mg daily. Involved in cellular reproduction. Aids absorption of vitamin B 12. Vitamin C 3,000-10,000 mg daily. Important in iron absorption. Brewer's yeast As directed on label. Rich in basic nutrients and a good source of B vitamins. Copper 2 mg daily. Needed in red blood cell production. Note: If more zinc is used, increase copper proportionately. Zinc 30 mg daily. Do not exceed this amount. Needed to balance with copper. Raw spleen glandular As directed on label. See Glandular Therapy for more information. Vitamin A 10,000 IU daily. Important antioxidant. Plus natural beta-carotene 15,000 IU daily. Important antioxidant. Or carotenoid complex (Betatene) As directed on label. Important antioxidant. Vitamin E 600 IU daily. Take separately from iron supplements. Important for red blood cell survival; prolongs the life span of these cells. Use emulsion form for better assimulation.
ANEMIA SUPPLEMENTS & PRODUCTS
Information for help with anemia, a condition that occurs when either the number of red blood cells or the amount of hemoglobin in the blood is reduced.
Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm - 16 fl. oz.
WaterOz Ionic Iron is a pure liquid Iron supplement. Iron is called the "energy giver." It attracts oxygen and builds blood. Along with manganese and copper it is necessary for healthy blood chemistry and is essential for recovery from illness.Appetite Stimulant Formula Tincture, 100% Organic - 2 fl. oz.
This herbal appetite stimulant has been designed by a Master Herbalist to stimulate the appetite. It combines herbs well known, and recommended by the German Commission E, for improving the appetite and eliminating symptoms of appetite loss.Iron Complex w/ Vitamins & Herbs, Vegetarian Formula, NOW Foods - 250 Tabs
Iron is part of myoglobin, which helps muscle cells store oxygen - iron-deficient people tire easily in part because their bodies are starved for oxygen and without enough iron, ATP (the fuel the body runs on) cannot be properly synthesized so, as a result, some iron-deficient people become fatigued even when their hemoglobin levels are normal.St. John's Wort, Perika, 300mg - 60 Tabs
Nature's Way St. John's Wort is scientifically advanced to maintain a healthy emotional outlook.Folic Acid (Vitamin B-9) 100% Natural, Nature's Way 800mcg - 100 Caps
Folic acid (Vitamin B-9) is necessary precursor for the manufacture of genetic material like RNA and DNA. It also assists in the growth and repair of tissues and in the conversion of fats and amino acids into other useful products in the body.Brewers Yeast, NOW Foods 650mg - 200 Tabs
Brewer's Yeast has been shown to help people having difficulty sleeping, fatigued, and diarrhea caused by Clostridium difficile.Alfalfa Leaves, Nature's Way, 405mg - 100 Caps
Nature's Way Alfalfa Leaves are organically grown by Trout Lake Farm, Washington, and Certified Organically Processed in accordance with Oregon Tilth standards and the California Organic Foods Act of 1990.Bilberry Extract Tincture, 100% Organic - 2 fl. oz.
Helpful with many different diseases of the eyes including vascular retinal disturbances, cataracts, diabetic-induced glaucoma, myopia, and all forms of eye strain.Black Cherry Fruit Extract 750mg NOW Foods - 90 Vcaps
Black Cherry extract or Black Cherry concentrate has been found to prevent attacks of gout. Black, sweet yellow, and red sour cherries have all shown to be effective.Dandelion Root Tincture, 100% Organic - 2 fl. oz.
Dandelion root is a natural diuretic and improves appetite and minor digestive problems. Dandelion leaves are commonly recommended as a food supplement for pregnant and postmenopausal women.Goldenseal Root Tincture (Hydrastis canadensis), 100% Organic - 2 fl. oz.
Uses include Adrenal Glands; Eye Problems; Fainting; Gallbladder; Gallstones; Nephritis; Pancreatic Disorders; Peritonitis; Poison Ivy/Oak; Prostate Problems; Psoriasis; Pyorrhea; Quinsy,;Scarlet Fever; Spinal Meningitis (sometimes referred to simply as Meningitis); Spleen; WoundsPau D Arco (Purple Lapacho), Inner Bark 545mg - 180 Caps
Pau d'arco is a South American herb which helps strengthen and nourish the body's defense system. A healthy immune system is a key in fighting diseases and infections.Red Raspberry Leaves, 480mg - 100 Caps
Red raspberry leaf strengthens the uterus wall and regulates menstrual flow. It nourishes the reproductive organs, especially the uterine muscles, and helps strengthen and prepare the body for childbirth. It is also highly valued for its soothing and astringent properties to the stomach and intestinal tract.Maca (Lepidum meyenii) Tincture, 100% Organic - 2 fl. oz.
Today Maca is used to increase energy and support the immune system. Maca can help a number of conditions from fatigue to frigidity.Instant Energy B-12 (2,000 mcg of B-12 per packet), NOW Foods - 75 Packets
NOW® Vitamin B-12 Instant Energy is the perfect way to keep alert and energized, regardless of the situation. These convenient, fast-acting packets are perfect when traveling or for convenience.Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000mg - 250 Vcaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Meta C Vitamin C Supplement, 1000mg - 100 Tabs
Meta C Vitamin C Supplement is a unique form of vitamin C that is absorbed faster than regular vitamin C and maintains higher serum levels for longer period of time with no intestinal discomfort.Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000mg - 16 fl. oz.
Liquid Vitamin C with Natural Rose Hips & Bioflavonoids is an easy to swallow dietary supplement that exceeds the recommended daily intake of vitamin C.Nettle Tincture, 100% Organic - 2 fl. oz.
Nettle leaf has become a popular treatment of allergies (hay fever) and it can improve goiter, inflammatory conditions, and arthritis.Amalaki (Dhatri), 100% Natural, 450mg - 120 VCaps
Amalaki is an Ayurvedic effective against allergies, anemia, cold & flu, constipation, diabetes, digestive disorders, and liver problems.Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm - 16 fl. oz.
WaterOz Ionic Copper is a pure liquid Copper supplement. Copper influences protein metabolism and general healing, improves vitamin C oxidation and is integral in the formation of RNA.Vitamin B-12 (Cobalamin), 50mcg & B-9 (Folic Acid), 400mcg - 1 fl. oz.
Vitamin B-12 (Cobalamin) helps to maintain a healthy nervous system and helps in the prevention of pernicious anemia.Heart Formula Tincture, 100% Organic - 2 fl. oz.
The Heart Formula can be used for anemia, fatigue and heart problems.Spleen & Pancreas Formula Tincture, 100% Organic - 2 fl. oz.
Use the Spleen & Pancreas Formula to strengthen and nourish the spleen and pancreas naturally.Dong Quai Root Tincture, 100% Organic - 2 fl. oz.
Dong Quai root is often used in the treatment of menstrual cramps, or dysmenorrhea and PMS, hot flashes, and other menopausal symptoms.Once Daily Multi Vitamin & Mineral, All Natural, Lactose Free, w/ Iron - 100 Tabs
Nature's Way Daily Multi Vitamin & Mineral provides many of the essential nutrients that modern diets may lack. They are useful for protection, growth and maintenance of body systems as they age.Alive! Whole Food Energizer Multi Vitamin with Mineral, Nature's Way 18mg of Iron added - 90 Tabs
Alive Whole Food Energizer Multi Vitamin with Mineral with Iron by Nature's Way is absorbed into your blood stream 5 times faster than other leading brands.Ester C with Bioflavonoids, 25% More Free, 500mg / 200mg - 150 Vcaps
Nature's Way Ester C with bioflavonoids is 100% natural calcium ascorbate with biologically active metabolites. These metabolites enhance cellular uptake and retention of Vitamin C. Now get 25% more free.Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000mg - 16 fl. oz.
Liquid Vitamin C with Natural Rose Hips & Bioflavonoids is an easy to swallow dietary supplement that exceeds the recommended daily intake of vitamin C.Barberry Tincture, 100% Organic - 2 fl. oz.
Barberry is used for treating gallbladder disease, heartburn and indigestion and diarrhea. This herb can also be used to treat infections, parasites, psoriasis, and vaginitis.Cocoa Powder - Certified Organic 100% Natural
From holiday desserts and everyday baking, to a steaming cup of hot cocoa on those cold winter days, NOW® Organic Cocoa Powder offers a guilt-free way to satisfy your sweet tooth without the high amounts of sugar, fat and preservatives common to many commercially available mixes.
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