Things a new mom might want to know

Part one: iron deficiency anemia (IDA)

When one reaches certain age, babies and baby-related content floods one’s input channels and slowly but surely most of the women one knows transition into motherhood. And if growing the baby and waiting for it to be born makes many anxious and frightened, it is nowhere near to the whole new world of the “after the birth”. There are a lot of scary tales on the labor itself and it is still considered in some cultures to be a right of passage into the womanhood (“oh, you had a c-section? well, you had it easy!” etc.). Interestingly, a lot attention is focused on the process that takes a woman around 20 hours with her firstborn, instead of on what happens post-partum. And oh, boy, there are many changes just in mother’s body. Most of pre-birth prep though is understandably focused on the newborn as it will help to get through first months, to survive herself and to keep the baby alive, because as soon as the infant is abroad, there won’t be any time for theory. So I proposing a few posts on what might come a bit later, when the most grueling part is over, the child is doing well and eating more and more regular human food and a mother finally has enough time and attention span to notice that something might be not quite right within herself.

This is optimistically meant to be series of posts on what to look out for, what might be going on and what it might mean. It is not a guideline on self-treatment, however, and if you are not well, I implore you to go and see the doctor. Better safe, than sorry.

When one’s body cannot make enough red blood cells or said cells do not function well one can develop anemia. There is a bunch of potential causes, but we are talking here of the most common one — lack of iron. Which in its turn might be due to:

• increased loss — menstrual and other gynecologic losses, frank or occult gastrointestinal bleeding, or excessive red blood cells destruction
• increased demand — which might come on top of menstrual losses during and after pregnancy
• decreased supply — dietary deficiency with unbalanced or sub optimal vegan or vegetarian diet, “tea and toast” diet, conditions and diseases leading to decrease in absorbing ability of the gut, etc.

IDA is affecting about a quarter of Earth’s population and it is the most common type of anemia in North America.

A note on iron metabolism and consumption:

• in general, no matter how much iron is consumed with food, the body is able to take in only 5–10 % of it or about 0.5 — 2 mg per day in context of North American diet, at the same time the recommended amount of iron varies between 0.26 mg in newborns to 27 mg in pregnant women; so for the absorbed amount to be sufficient we need to consume more, (NB! for the scale 1 teaspoon of water weighs around 5 grams = 5000 milligrams, iron and other minerals and vitamins are considered micro nutrients, after all)
• degree of the uptake is positively impacted by co-ingestion of vitamin C, citric acid and negatively by dietary calcium, soy protein, phytates (found in oats and some other grains), and polyphenols (found in tea, coffee)
• iron metabolism is tightly controlled so that none of the already acquired iron goes to waste, but women of childbearing age are at risk of negative iron balance by default as they are loosing some on monthly basis
• there are two types of iron in diet — heme (from animal products, such as meat, poultry, fatty fish, eggs ) and non-heme (from white beans, spinach, lentils, nuts, some dry fruit, iron-fortified cereal and breads); iron from non-heme sources is harder to absorb, so the amount of the product needed to reach the optimal iron intake is almost twice as much as from animal products
• also, when a person already has anemia just eating more red meat won’t cut it
• contrary to a common belief eating food of red color, such as pomegranate for instance, would not impact one’s iron levels in any way as not everything that is red has to do with iron

Now to the symptoms of anemia:

• less specific ones are fatigue, headache, light-headedness, decrease exercise tolerance, shortness of breath, palpitations (feeling of fluttering, fast-beating or pounding heart), dizziness, syncope (fainting), tinnitus (ringing or buzzing in ears without any external source of sound), skin and mucous membrane pallor (particularly the conjunctivas and the mucous lining of the underside of the tongue), hair becoming brittle and being lost in increased volumes
• slightly more specific ones — pica (craving non-food substances i.e. chalk, ice, soil), koilonychia (nails develop a concave, spoon-like curvature), restless leg syndrome

I’d like to make a particular emphasis on increased hair loss. In order to support and encourage growth of a fetus mother’s organism ramps up production of hormones and growth factors. Which is why some women note increase in hair quality and volume, as certain ingredients of the growth cocktail wake up, as it were, the hair that before the pregnancy were in a sleeping state. Naturally, when the baby is abroad the need for boosters declines sharply and their lack lets those awoken hair follicles to fall into slumber again, leading to normal increase in hair loss. It might look quite disturbing with them coming out in fistfuls even, at which point new mothers are often advised by well-wishers that this should be remedied by latest and coolest in the way of vitamins, supplements or special diets with adding whatever is in vogue by ways of fads. Don’t get me wrong, changes in hair and nail quality might be due to lack of vitamins, but in the developed world anemia is by far more likely candidate. Unfortunately, the relatedness of hair and nail changes to the body’s iron storage is less known than that of vitamins. So if the hair loss goes on and on stretching into months and comes in a combination with some other signs and symptoms from the list above, it would be wise to check on the iron.

Let’s look at what to look, if your physician or a nurse practitioner wouldn’t volunteer such info themselves.

1. First and most commonly checked indicator would be hemoglobin (Hb). Hemoglobin is in fact the molecule that is delivering oxygen to tissues and cells of our bodies and picking up carbon dioxide to be thrown out by way of breathing out. Suspicious hemoglobin level for an adult male is <130 g/L and for an adult woman is <120 g/L.

Although hemoglobin is a useful, it is not an early indicator. Also of note is that for the person to develop visible paleness of mucous membranes hemoglobin has to drop to at least 90 g/L, and for the skin it is even lower — 75 g/L.

2. Another indicator of some specificity can be found on the complete blood count (CBC), it’s called mean corpuscular volume (MCV). It is looking at mean volume of red blood cells and it is helpful early on in clarifying at what type of anemia we might be looking. MCV of less than 80 is telling us that cells on average are on the smaller side indicating microcytic anemia, one of which is caused by deficit of iron. With IDA, MCV might be decreasing before the hemoglobin catches on, and we might also find that erythrocytes are sub normally pigmented (hypochromic).

3. The third panel of indicators is finally looking at iron. There are several, the most important for iron stores being ferritin. Ferritin is also one of the substances that gets elevated in the acute phase of inflammation. It being lower than 100 mcg/L necessitates assessment of other iron indices (total iron binding capacity [TIBC], serum iron, saturation), and it being less than 45 mcg/L is indicating IDA.

Treatment of IDA should address the underlying cause of the deficit (if any, as women of childbearing age are at higher risk developing IDA just because they are menstruating), supplement for the lost storage and monitor for response (hemoglobin normalizes by 10g/L per week if no blood loss). NB: if a post-menopausal woman or a man is found to have IDA, it warrants gastrointestinal workup.

If after chugging through this text you recognize some of the described, see your physician to make sure and get help.