Absorption of non-haem iron from food during normal pregnancy

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Abstract
Objective: To determine whether the increased iron demands of pregnancy could be met by increased absorption from dietary sources. Design and setting: Longitudinal prospective study in the research unit of a maternity hospital. Subjects: 12 normal pregnant women. Interventions—At 12, 24, and 36 weeks' gestation (within one week) and 16-24 weeks after delivery women ate a breakfast of meat, bread, and orange juice (3.2 mg iron), extrinsically labelled with the stable isotope iron-54 (2.8 mg); the stable isotope iron-57 (200 µg) was given intravenously. Main outcome measures: Serum samples were taken for 10 hours after administration of the isotopes; ratios of the isotopes were measured by inductively coupled plasma mass spectrometry, and the absorption of oral iron was calculated. Results: The geometric mean (95% confidence interval) absorption of iron at 12, 24, and 36 weeks' gestation was 7% (5% to 11%), 36% (28% to 47%), and 66% (57% to 76%) respectively. At 16-24 weeks after delivery the absorption was 11% (6% to 21%). The mean increase in absorption at 36 weeks (compared with that at 12 weeks) was 9.1 times (6.0 to 13.7). One pregnant woman developed iron deficiency anaemia but was otherwise indistinguishable from the others. Conclusions: An increase in the absorption of iron from food is a physiological consequence of normal pregnancy, not the result of developing anaemia during pregnancy, and such an increase is large enough to meet the increased requirements of pregnancy provided that the dietary intake is adequate.