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Pregnant. Taking gentlesorb iron, now constipated. Should I increase medicine dose? Risks if I become anemic?

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Hi, I am 31 weeks pregnant and my iron has been quite low in the last month. My ferritin has been 11 ug/l and the reference range is 11 - 145. My hemoglobin is not that bad - last test showed 121 g/l and the range is 115 - 165 g/l. My hematocrit is a little below range - 0.368 L/L while the range is 0.37-0.47 L/L. Finally my RDW is slightly above range - 14.6% while the range is 11 - 14.5%. All my other results from the CBC were ok. My MCV was 94.2 FL and the range is 80-97. I recently increased my daily iron supplement intake to 54mg gentlesorb iron from chelate. This is the only iron I can take - the one from ferrous sulfate gives me incredible constipation and is impossible to take. But this iron is ok to take. Even with the increase my ferritin did not change - still 11 and my RDW is now a bit out of range. I know I am still borderline but am worried I might become anemic soon. Is it safe to increase my daily iron intake to 54+18=72mg iron from chelate? My pills are 18mg each so I cannot increase it by less. I also wanted to say I take my iron with orange juice since I read that it's better absorbed with vitamin C. Also, I take it at least 2 away from my calcium and magnesium prenatal vitamins. So is 72mg daily a safe dose to take for the next 2 months until the end of my pregnancy?

Also, how often is safe to have blood tests? Lately they did my glucose test and some thyroid tests, so in the last 2 months I had a blood test every 2 weeks where they took around 3 vials of blood on average. I know taking blood can increase the iron deficiency. So is it safe to take blood every 2 weeks or should it be less?

What are the risks if I become anemic and it goes undiagnosed for awhile? I only have 2 months to go in my pregnancy...

Finally, is iron from chelate a type of iron that is harder to absorb? It says Gentlesorb and is made to not cause constipation. Unfortunately I cannot take another type of iron but just wondering...


Posted Fri, 19 Apr 2013 in Pregnancy
Answered by Dr. Timothy Raichle 3 hours later
Hello, I would be happy to help you with your question. First, tell me, besides anemia and hypothyroidism:

1. Are there any other problems in the current pregnancy?
2. Is this your first pregnancy?

Please answer and I will get back to you with a great answer!
Above answer was peer-reviewed by
Follow-up: Pregnant. Taking gentlesorb iron, now constipated. Should I increase medicine dose? Risks if I become anemic? 3 minutes later
Hi Dr. Raichle, we have spoken a lot so far...I have asked you questions on C-section, glucose test, the epirethinal membrane, my skin condition...I had some contractions and cramps earlier in pregnancy in month six and early month 7 and that is why I am on bedrest till the end of the pregnancy. But my question this time was on iron - this iron just does not seem to want to go up, thus I had all the questions above...thanks
Answered by Dr. Timothy Raichle 22 minutes later
Just to review:

1. Ferritin = your bodies stores of iron
2. Hemoglobin / hematocrit = the most useful numbers
3. RDW = take for the next 2 months?
2. How often is safe to have blood tests?
3. What are the risks if I become anemic?
4. Is iron from chelate a type of iron that is harder to absorb?

First of all, based on the numbers that we pay the most attention to, hemoglobin and hematocrit (H/H), you are actually doing just fine. With pregnancy, there is an increase in total blood volume, and your production of red blood cells simply does not keep up with this volume increase. So it is unusual if a pregnant women at 31 weeks is NOT slightly anemic. Based on your H/H you are actually falling into the normal range for a pregnant patient. Your body is attempting to increase production of red blood cells (increased RDW), but it will likely never be normal. Total ferritin stores, also, will likely never be normal. If you take iron that your body cannot handle or utilize, it can be harmful. So in answer to your questions in order:

1. I would probably recommend that you stay at your current dose of iron given that the primary numbers of concern (H/H) are pretty normal for pregnancy
2. You can have blood drawn relatively frequently during pregnancy without much harm. Every two weeks is certainly harmless. But in your case, I would probably not check it again until 36 weeks and when you presented in labor
3. Given your numbers at this point, it is unlikely that you will become dangerously anemic by the end of the pregnancy. The danger of anemia in pregnancy has to do with the increased risk for transfusion at the time of delivery if there is extra bleeding.
4. Sellers of 'iron chelate' claim that the iron is absorbed better, but this is a controversy, and some would suggest that they are making a claim that is not substantiated just to sell their product. I have read that it is not any better than Iron sulfate. Any iron, regardless of the delivery method of delivery, is better than none!

I would suggest to you the following:
1. Do not fixate on the subtle nuances of the numbers - focus on the H/H because these are the numbers that they will be paying attention to at the time of delivery. In your case, these numbers are not that bad
2. Consider trying to supplement your iron through diet / foods that are XXXXXXX in iron instead of taking more iron chelate.

I hope that this helps and good luck! It is not easy to see your previous questions, so I am sorry that I did not recognize your name immediately.

Above answer was peer-reviewed by
Follow-up: Pregnant. Taking gentlesorb iron, now constipated. Should I increase medicine dose? Risks if I become anemic? 19 minutes later
Thank you so much doctor Raichle, I was not sure if this is a question for a hematologist but I am glad you answered. I understand maybe the system does not make it clear what the previous questions were.
Ok, I will not increase my dose of iron then. What happens if you take too much iron - you said it could be harmful. How much is too much? I hope what I am taking right now is safe. But it sounds like 72mg might be too much, and hopefully the 54mg now is safe. What if I was to take 72mg every other day, i.e. 54mg one day and 72mg the other? But it seems like the best thing for now is to not increase the dose which is what I would do. By the way I forgot to say my grandma is anemic, but maybe that has no relevance.
I just felt recently (i.e. in the last week), that I was often out of breath even when sitting down or lying down (i.e. not just when walking). What would help me is eat a big portion of beef and open the window for some fresh cold air. So I thought maybe that has to do with my borderline low iron reserves. I guess my reserves are fine now but I was not sure as my baby grows in the next 9 weeks, if my iron would decrease further due to the additional blood I need to make for the baby as he grows. And if I don't test the iron through a blood test, I guess I would not know what is happening to it. So if I don't have a blood test in the next month, how would I know if my H/H decreased a lot? At which point should I be concerned i.e. what other symptoms should occur that should be a cause of concern? I heard the "out of breath" problem could be normal problem of pregnancy since I am 8 months now...thanks!
Answered by Dr. Timothy Raichle 1 hour later
If you take too much iron it can end up deposited in organs such as the heart. The dose you are taking is appropriate and is not harmful. As I said, the best way to actually get iron is with foods XXXXXXX in iron (a list can easily be obtained online). The every other day dosing is okay as well.

If you are having episodes of shortness of breath, while this might be nothing, it should be addressed with your OB/GYN provider. It is normal for pregnant women to feel like they cannot catch their breath, but this is different than actual shortness of breath.

There is little concern about the growth of your baby over the next 9 weeks, assuming that growth has been fine up until now, and based on your current lab values. The labs should be checked no more than every two weeks. You do not need a hematologist to answer this question - it is an OB question, and based on those numbers that you gave me, you are not high risk because of this.

It sounds like you are well infomed, healthy and making good decisions. If you are eating a healthy diet, taking your vitamin + iron supplements as described, there is no reason to expect a problem. Based on your concern about the blood levels, though, a repeat blood count at most every two weeks is reasonable, but more ideally at 36 weeks and then again when you present in labor.

Good luck!
Above answer was peer-reviewed by
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