Iron during pregnancy: iron-rich foods in Singapore, hawker choices, blood tests and how to take iron tablets

Iron during pregnancy matters because your body makes extra blood for you and your baby, and low iron is the usual reason pregnant women's blood counts drop, HealthHub says. SingHealth's prenatal guidance gives a daily amount of 27mg. Food can cover much of it in Singapore: red meat, chicken, fish and liver give the iron your body absorbs best, while tofu, beans, kailan, wolfberries and brown or cargo rice add plant iron that absorbs better with vitamin C from guava, papaya or oranges. Keep kopi and teh away from meals, go to your blood tests at about 10 to 12 and 24 to 28 weeks, and leave iron tablets until your doctor prescribes them. Here's what to eat, at the hawker centre too, and how to take iron tablets well.

Why iron matters, and who runs short

Anaemia in pregnancy affects both of you. SingHealth's KKH team says mothers may have weakness and poor concentration, more infections, more blood loss at delivery, preterm birth and postnatal depression, and that newborns may have a low birth weight. HPB, citing the World Health Organization, says up to 40% of women of reproductive age in Southeast Asia had anaemia in 2011.

SingHealth lists the women at higher risk of anaemia in pregnancy: vegetarians, women who have had anaemia before, those carrying twins, those with less than a year between pregnancies, heavy periods or bleeding, and long-term illness. If any of these is you, take the food advice below seriously and ask about your blood count early.

Iron-rich foods in Singapore

HealthHub splits iron into two kinds. Haem iron, from animal foods, is the form your body absorbs best; a KKH dietitian puts it the same way. Non-haem iron, from plants, absorbs less well, so it needs a vitamin C partner at the same meal.

For full meal ideas, see our guide to eating well in pregnancy in Singapore. If you don't eat meat, our vegetarian pregnancy diet guide shows how to plan around plant iron.

Hawker choices that add iron

A KKH dietitian's guides to hawker food in pregnancy make swaps easy:

Eat hot, freshly cooked food when you buy out. Our guide to what pregnant women can eat explains why chicken rice that's been sitting out is the one to skip.

Getting more from the iron you eat

• Pair plant iron with vitamin C. HealthHub suggests guavas, papayas, oranges and kiwis eaten with your non-haem iron foods.
• Move tea and coffee away from meals. A KKH dietitian says it's the tannins and polyphenols in tea and coffee, not the caffeine, that block iron, so decaf counts too. KKH advises no tea or coffee within an hour of main meals, and HealthHub says two hours before or after; aiming for one to two hours covers both.
• Mix haem and non-haem at the same meal where you can, such as chicken with kailan, or fish with tofu and greens.
• Keep milk and other calcium-rich foods at least 2 hours away from iron tablets, as SingHealth advises.

Our guide to coffee while pregnant covers the daily caffeine limit as well.

Blood tests and anaemia in pregnancy

Anaemia usually shows up on a routine blood test before you notice anything. SingHealth's KKH team sets out the schedule:

• A full blood count (FBC) early in pregnancy, at 10 to 12 weeks, with thalassaemia screening if it's indicated.
• A repeat FBC at 24 to 28 weeks.
• If you're anaemic, iron tablets, with a repeat blood test four weeks later to check they're working.
• An iron infusion may be considered if haemoglobin stays below 10 despite the tablets.
• Another FBC when you're admitted to deliver. If you're anaemic or bleed a lot at delivery, a blood transfusion may be needed.

Thalassaemia, an inherited blood condition, also causes anaemia, and SingHealth says testing is offered to some women if it's indicated. HealthHub lists it among the conditions to tell your doctor about before taking iron, because it needs a different approach. Our guide to prenatal check-ups and scans in Singapore shows where these tests fall.

Iron tablets: how to take them

Take iron only when your doctor advises it. When anaemia is diagnosed, SingHealth says the dose is 60 to 100mg of elemental iron a day, more than a prenatal multivitamin contains.

• Timing: SingHealth says to take iron before food, on an empty stomach, for better absorption, except Maltofer (iron polymaltose), which can go with food.
• Spacing: keep it at least 2 hours apart from coffee, black tea, milk and calcium-rich foods or calcium tablets, as SingHealth and HealthHub advise.
• Dark stools: harmless, HealthHub says.
• Constipation: SingHealth suggests plenty of fluids and foods such as bran and prunes. Tell your doctor if it's bad; another iron product may suit you better.
• Allergy: HealthHub says to stop the medicine and see a healthcare professional immediately if you get signs of an allergic reaction, such as a swollen face, eyes, lips or tongue, difficulty breathing, or an itchy rash all over.

Our prenatal vitamins guide explains how iron fits with folic acid, calcium and the rest.

When to see your doctor

SingHealth lists the symptoms of anaemia: tiredness, giddiness, headache, shortness of breath, chest pain, a fast or irregular heartbeat, cold hands and feet and pale skin. Tiredness alone is common in pregnancy, so mention it at your next check-up. Chest pain, a racing heart or breathlessness at rest needs a doctor the same day. Our guide to feeling breathless during pregnancy lists which signs are urgent.

Frequently asked questions

How much iron do I need during pregnancy?

SingHealth's prenatal guidance gives 27mg a day. An older KKH dietitian table gives 19mg, so ask your doctor what suits you; your blood tests decide whether you need tablets.

What are the best iron-rich foods in Singapore?

Red meat, chicken, fish and liver give the best-absorbed iron. Tofu, tempeh, lentils, kailan, wolfberries and brown or cargo rice add plant iron, which absorbs better with vitamin C.

Can I drink kopi if I'm low in iron?

Yes, but not with meals. Tea and coffee tannins block iron, so KKH says no tea or coffee within an hour of main meals, and HealthHub says two hours.

When is anaemia checked in pregnancy?

SingHealth's schedule is a full blood count at 10 to 12 weeks and again at 24 to 28 weeks, plus another on admission for delivery.

Should I take iron tablets without a prescription?

No. HealthHub says not to self-medicate with iron, because too much iron causes its own problems, and thalassaemia needs a different approach.

Is liver good for iron in pregnancy?

It's the richest source, but it's high in vitamin A, so SingHealth says to keep it to 50g a week in the first trimester, and HealthHub says to cook it well.