Pregnancy and lactation most commonly unmask a deficiency in key vitamins and minerals. This is due to increased bodily demand during these times. In particular, vitamin B12, folate and copper deficiencies are often only detected once pregnant. As these three nutrients are all vital for proper red blood cell production, anaemia is often the first sign of deficiency.
There are a number of reasons why your intake of these nutrients may be inadequate. Dietary restrictions such as being vegetarian, vegan, or having a wheat free diet, or conditions that affect your nutrition intake such as anorexia nervosa or alcoholism will require you to take extra supplements during pregnancy. Improper absorption of these nutrients may also occur due to:
- Use of antacids or pancreatic insufficiency
- Previous surgery that removed any part of your gastrointestinal system
- Bacterial overgrowth (or sprue) in your gut
Vitamin B12, folate and copper are available from a wide variety of nutritional sources.
Copper deficiency is a rarer cause for nutritional anaemia, despite this element being vital to production of new red blood cells, in part because only a small amount is required to maintain sufficiency in your body. Shellfish and nuts are the richest sources, followed by grains and legumes. Dietary insufficiency is seldom the cause of anaemia, as most diets exceed the recommended daily intake of 1.3mg, but we would consider this in patients with anaemia with unknown cause as part of a secondary screen.
Bariatric (gastric bypass) surgery with proximal bowel resection is a well-known cause of copper deficiency, as this procedure removes the primary site of copper absorption in your gut. As most people have a surfeit of dietary copper, this usually compensates for malabsorption. However given the additional nutritional demands of pregnancy in someone with already depleted copper stores, copper levels should be checked in patients with overt anaemia as their pregnancy progresses.
Correction of nutritional deficits generally results in a rapid improvement in symptoms. As treatment is readily available, well-tolerated, affordable and effective, the role of your doctor is vital in the timely detection of these deficiencies, done by screening those who are in any of these high-risk groups and/or investigating abnormal clinical or blood test findings.
Sometimes taking an extra supplement or a once-off iron infusion is all it takes to get you feeling back to normal. For more information, see this handy factsheet from Mothersafe: https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Royal_Hospital_for_Women/Mothersafe/documents/VitaminsmineralspandbupdateSept19.pdf