A healthy 34-year-old G1P0 patient comes to see you in your office for a routine OB visit at 12 weeks’ gestational age. She tells you that she has stopped taking her prenatal vitamins with iron supplements because they make her sick and she has trouble remembering to take a pill every day. A review of her prenatal laboratory tests reveals that her hematocrit is 39%.
Which of the following statements is the best way to counsel this patient?
A. Tell the patient that she is not anemic, and therefore she will not need the iron supplied in prenatal vitaminsThe amount of iron that can be mobilized from maternal stores and obtained from the diet is insufficient to meet the demands of pregnancy. A pregnant woman with a normal hematocrit at the beginning of pregnancy who is not given iron supplementation will develop iron deficiency during the latter part of gestation, as iron requirements increase significantly during the second half of pregnancy. It is important to remember that the fetus will not have impaired hemoglobin production, even in the presence of maternal anemia, because the placenta will transport the needed iron at the expense of maternal iron store depletion. The hematocrit in pregnancy normally falls in pregnancy due to plasma volume expansion and therefore is not used as a parameter to determine when to begin iron supplementation.