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  • Writer's pictureHands and Hearts Birth

Hemoglobin & Pregnancy

Updated: Nov 20, 2022

What is hemoglobin and why do we monitor it in pregnancy?

Heme = iron Globulin = specific

Did you know "anemia" in a well-nourished pregnancy is due to the physiologic dilution of red blood cells as plasma volume increases? It is normal hemodilution for pregnancy.

  • Hemoglobin, or iron, is a complex protein in red blood cells (RBC's) that binds to oxygen in the lungs to carry it throughout the rest of the body. The molecules are measures as grams/per deciliter. An optimal range 12-16 g/dl coming into pregnancy. Below 12 g/dl is iron deficiency while below 10 g/dl is considered iron deficient anemia.

  • The dilution is noticeable around 8 weeks, and will continue until 3-4 weeks postpartum before returning to more "normal" levels. From 8 weeks on it is expected to see a decrease of 2 g/dl by 28-30 weeks. A stable or rising hemoglobin or hematocrit, without supplements, can indicate toxemia onset. Slowly decreasing hemoglobin and a growing/developing baby are markers for a healthy pregnancy. Knowing where you start as early in pregnancy as possible, helps us effectively understand your readings later in pregnancy. Early prenatal care is so important!

  • Plasma begins to increase in early 1st trimester (42-50%) while RBC's typically only increase by half that. First time moms will see lower increases.

  • To evaluate hemoglobin to determine if you're truly anemic we need to know more than just the hemoglobin value. We also factor in hematacrit levels (the proportion of RBC's in your blood) as well as ferritin levels (the protein in RBC's that stores iron)

  • Maintaining a good iron level in pregnancy decreases the risks of premature birth, IUGR, lowers the risk of placental development concerns (optimal hemoglobin is a vital building block for placental health), and your risks of postpartum depression are decreased as well

  • While all stages of pregnancy require good hemoglobin to effectively develop as needed, 1st trimester iron level are important for brain development and protecting from neurological defects; 3rd trimester iron levels are where baby will build their own iron stores to see them through the starting of solid foods around 6-8 months of age

  • Iron deficiency lowers your resistance to infections

Basic Information about Iron

Iron Foods & Supplements

Heme iron is more readily assimilated by your body and only comes in the form of foods such as red meats and organ meats, poultry, seafood and oysters, clams, mussels and canned light tuna and canned sardines.

Heme iron does not have the same indications or contraindications as non-heme, and does not need the high dose vitamin C to accompany it for assimilation. It can be taken in a closer timeframe with thyroid, zinc, magnesium and virtually any other supplement other than calcium. Calcium will compete with all iron absorption.

Heme iron is generally without side effects. Maximum dose is 60mg daily. If your care provider suggests a higher dose of heme iron, space doses out 4 hours apart.

Best supplement: Simply Heme, Iron Repair Simply Heme by Three Arrows Nutra, Proferrin Clear, Ancient Nutrients, Pure encapsulations OptiFerin-C or Iron Liquid, Garden of Life Vitamin Code Raw Iron, MegaFood Blood Builder

Non-Heme iron sources include fortified cereals, enriched breads and rice, beans, dark chocolate (45% or higher), lentils, spinach, potatoes with the skins, nuts and seeds. This source of iron is not as easily absorbed for use in the body.

Ferrous gluconate contains less elemental iron than ferrous sulfate (so a higher dose would be necessary to correct the deficiency issue), and typically sold in liquid form. It's also more expensive, but it is more accepted into the body. Ferrous sulfate is typically found in tablet form, offers a slow release formula to help decrease gastrointestinal distress, but it contains less available iron for the body.

Non-heme elemental iron is best taken on an empty stomach in the morning and early afternoon, each with a high dose of vitamin C (not in the form of orange juice) to be absorbed fully and used by the body to decrease deficiency issues. Your body MUST HAVE several cups of water and high dose vitamin C (1000mg or more) with each dose non-heme elemental iron to be assimilated into the body. Buffered vitamin C is a good option - NutriBiotic Immunity powder

Best supplement: Thorne Bisglycinate, Iron Ease 45mg *if you currently suffer from gastrointestinal issues, they can become more severe when starting a Bisglycinate. Try NovaFerrum 125 High Potency Liquid instead

IHerb: Ferrex 150mg, NovaFerrum 50mg, Vitron-C 65mg, Hematex 100mg Liquid, Gaia Herbs Plant Force Liquid, Floradix Liquid, MaryRuth Organics Vegan Liquid Iron,

You should avoid these supplements and medications within 1-4hrs of taking an iron supplement as they can block the iron absorption or decrease the efficacy of the medication:

Magnesium, calcium, zinc, manganese, phosphorus

Tannins and polyphenols such as coffees and black tea

Turmeric, cur cumin, quercitin

Phytates of physic acid such as whole grains, cereals, soy, nuts, and legumes

Fibers and osalaries

Phosphoproteins such as eggs

Proton pump inhibitors such as Prilosec, Prevacid, Nexium, Dexilant, etc

Ulcer medications such as Tagamet, Zantac, Pepcid, Axid, etc

Thyroid medications (Levothyroxine, Levodopa

ACE inhibitors for high blood pressure such as captopril, lisinopril, enalapril

Antibiotics such as Cipro,Noroxin, Levaquin, doxycycline, minocycline, and tetracycline

Always refer back to your Health Provider before selecting or altering your supplements, herbs, or medications.

Hands and Hearts Birth has a handout available with additional information we provide our clients upon request.


National Institutes of Health

The Nutrition Source, Harvard T.H. Chan School of Public Health

FoodNerd Inc

Massachusetts General Hospital, Center for Women's Mental Health



Mayo Clinic

Cleveland Clinic

Notice of Disclaimer, Deanna Smith/Hands and Hearts Birth Services:

So many other things are involved with each of these 'symptoms' of pregnancy so always review your symptoms with your Healthcare Provider.

Deanna Smith/Hands and Hearts Birth Services is not a Physician, and the relationship between Deanna/Hands and Hearts Birth and the reader is not one of prescriber and patient but educator and reader. It is fully the readers choice whether or not to take advantage of the information shared in this post or on this website.

Homeopathy in the example of this blog, addresses the entire person as a matter of wholeness that is an educated process, not a medical one. Deanna Smith/Hands and Hearts Birth Services urges you to discuss your diagnosis with your Physician before starting or stopping any medical treatment.

Deanna Smith/Hands and Hearts Birth Services disclaims all liability for any loss or risk, personal or otherwise incurred, as a consequence of the use of any material on this website. This information is not a substitute for professional medical advice, diagnosis, or treatment.

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