Author: Dr. Maryam Mahanian, DTCM, RAc
Iron deficiency Anemia during pregnancy according to TCM
It makes sense that iron deficiency anemia is very common during pregnancy. During pregnancy, your blood volume increases and so does the amount of iron you need. It is said that blood volume can increase an average of 35 to 50% above pre-pregnancy levels.
The other types of anemia include sickle cell anemia, thalassemia, and pernicious anemia. Iron deficiency anemia is the most common and the one I’ll be talking about in this article.
Anemia is defined as a deficiency in the number of red blood cells or in their hemoglobin content. Within the red blood cells, hemoglobin functions to carry oxygen throughout the body. It has a pigment called haem and haem contains iron.
If there isn’t enough hemoglobin in the blood, anemia develops with symptoms like excessive fatigue, shortness of breath, low resistance to infection, and heart palpitations.
There are two times in pregnancy when a woman is most vulnerable to being iron deficient.
- Around the 20th week of pregnancy when a woman’s blood volume increases.
- In the last 4 to 6 weeks of pregnancy when the baby is laying down its own iron stores to use in the first six months of their life before they begin on solids.
Routine blood work is done at these times and also at the beginning of pregnancy (because many women are anemic prior to getting pregnant) to check hemoglobin levels.
All women are susceptible to becoming anemic during pregnancy but there are some that are at higher risk:
- those who were malnourished prior to pregnancy
- those who haven’t been able to eat a nutritious diet since getting pregnant
- those carrying more than one fetus
- those who have had several pregnancies and/or miscarriages close together
Anemia during pregnancy can lead to low birth weight and preterm labor so it’s important to do everything you can to correct the anemia.
After giving birth, iron levels can decrease due to blood loss so it’s important to keep your iron levels up. Iron deficiency in postpartum can contribute to mastitis, low milk supply, blocked ducts and delayed healing.
Chinese medicine perspective
What is the Traditional Chinese medicine (TCM) perspective on why anemia is so much more common during pregnancy?
During pregnancy, the body is more depleted by blood because the mother’s blood is being sent to nourish the fetus. In TCM this is called blood deficiency. So needless to say that blood deficiency happens much more easily during pregnancy.
But I will also say that in healthy women with no pre-existing blood deficiency signs, anemia might not occur. Because there is no menstrual blood loss during pregnancy, it provides more blood to be available to the mother.
Is blood deficiency the same as iron deficiency?
No, it is much more.
In TCM, anemia is mostly diagnosed as Qi (energy/life force) and blood deficiency.
As the baby grows, there is a higher demand on your body to produce more Qi and blood. It’s key to nourish the organ systems that are involved in producing Qi and blood.
There are two main organ systems that contribute to the production of Qi and blood:
Spleen organ system: produce Qi and blood from the food/fluids we consume
Kidney organ system: Qi and blood is transformed from the yin aspect of kidney-essence
The heart and liver are then affected by this lack of blood production because the heart controls the blood and the liver stores the blood.
In clinical practice, I focus most on the spleen, liver and heart organ systems when it comes to anemia during pregnancy.
Spleen: Anemia coming from the spleen being weak can show up as reduced appetite, loose stools, bloating, gas, weakness in arms and legs, shortness of breath with exercise and pale swollen tongue.
Liver: Anemia coming from a liver blood deficiency shows up as a pale complexion, pale lips, blurry vision or floaters, muscle cramps, tingling or numbness in the limbs.
Heart: Anemia coming from a heart blood deficiency shows up as a pale complexion, pale lips, palpitations, insomnia, poor memory, anxiety
Stagnation of Qi is another pattern often found in pregnancy because of the obstruction caused by the fetus. This is more prominent in the later stages of the pregnancy. The obstruction of the fetus prevents the proper ascending and descending of the Qi and leads to stagnation. This stagnation can weaken the spleen and cause further blood deficiency.
In TCM we give specific dietary suggestions to correct anemia but also work on healthy living as a whole. This means how well your digestive system is working, how and when you eat, quality of sleep, proper rest, mental and emotional well-being, and more. All of the suggestions I give are customized to the individual’s unique constitution and underlying imbalances.
Let’s start with some simple dietary recommendations that you can implement now:
Food sources high in Iron:
- Red meat (beef and lamb) and the dark meat of chicken – the iron in red meat is easier to absorb than the iron found in plant foods
- Dark green vegetables (preferably not consumed raw)
- Nuts (cashews, almonds, peanuts, hazelnuts)
- Seeds (chia, sesame, pumpkin seeds)
- Dried apricots
- Blackstrap molasses
- Legumes and beans
- Grains like quinoa
- Berries (goji berries, blackberries, dark grapes, raspberries)
- Fresh fruits and vegetables high in Vitamin C like oranges, strawberries, black currants, green and red peppers, broccoli, tomatoes, and avocados.
To help your spleen organ system to function better to produce Qi and blood, try to eat more warm cooked foods instead of cold raw foods. This is easier on your digestion to increase blood production. This is so simple and can be so key in improving iron levels.
Warming spices like ginger, cinnamon, garlic, cardamom, cumin, fennel and nutmeg are also beneficial to warm up your digestive system and improve your spleen’s function to produce blood.
Women who are vegetarians and anemic should try to be vigilant to consume good sources of iron from plant foods frequently and to also avoid substances that deplete iron stores from the body like smoking, alcohol, and caffeine. Antacid medication can also impair iron absorption because you need enough hydrochloric acid present in the stomach to absorb iron from the diet.
Rest is very important to help women build blood. A midday nap or even just lying down for half an hour in the day can make a big difference. Resting between 1 to 3 pm is the most important time according to the Chinese medicine organ clock. The organ clock shows 2 hour intervals of when an organ system functions at its best and also at its worst. 1 to 3 pm is when the liver energy is at its lowest function so resting during that time can give your liver the support it needs.
Acupuncture and Pregnancy
Acupuncture during pregnancy is highly recommended! It will help to improve your mood, relieve stress, circulate better Qi (energy) and blood and increase your energy. When the body is well rested and these aspects are improved, your body will in turn produce more Qi and blood to correct the iron deficiency. This sets the stage for a well-balanced healthy postpartum phase.
Chinese herbal formulas and Anemia
There are many effective Chinese herbal formulas that can correct anemia and are safe to be taken during pregnancy. In my clinical practice, I give customized herbal formulas that fit the individual’s pattern. Here are some of the different patterns I see and the herbs I give accordingly. In practice, many patients will have more than one of these patterns combined.
Qi and blood deficiency patterns involve dizziness, pale lips, pale complexion and palpitations: Ba Zhen Tang (eight treasures decoction) benefits the Qi (energy) and builds the blood. This is the most common presentation I see in my clinic and the most common herbal formula that I give for anemia.
Heart and Spleen deficiency patterns involve palpitations, forgetfulness, insomnia, anxiety and fatigue. Gui Pi Tang nourishes the heart and spleen, builds blood and strengthens Qi.
Kidney yang deficiency pattern involves cold extremities, cold body, weak achy knees, cold sensation and soreness in lower back, and exhaustion. You Gui Wan warms and strengthens kidney yang deficiency.
In many patients, they may show signs of Liver Qi stagnation and liver blood deficiency. I modify formulas accordingly depending on the patient.
If you’d like more information or to book an online consult or in-person appointment, feel free to reach out to me!
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