The first several months of a baby’s life can be a period of great joy for a mother. However, this is not always the case. The postpartum period that follows the birth of a child carries a high risk of both physical and mental health challenges.

QUESTION: What health challenges are most common during the postpartum period?

ANSWER: Challenges include increased fatigue, anxiety, sleeping problems, decreased short-term memory, ADHD types of symptoms and compromised immune function. Also, postpartum depression is increasingly recognized as an especially serious problem for many new mothers.

Most people expect a new mother to be fatigued, but they may not realize that all of these health problems can be caused by iron deficiency.

Q: How common is postpartum iron deficiency?

A: According to research reviewed by Dr. Lisa Bodnar at the University of Pittsburg, postpartum iron deficiency may occur in almost 50 percent of the women in some racial/ethnic groups. Unfortunately, this low iron state too often goes unrecognized.

Q: Why is the link between postpartum symptoms and iron deficiency so common?

A: Iron needs during pregnancy are very high because a woman’s diet must meet requirements both for the developing fetus and for an increase in the mother’s blood volume. When a woman completes pregnancy in a well-nourished state, day-to-day iron needs typically decrease after delivery. However, it should not be forgotten that a woman loses almost a pint of blood during a normal childbirth and up to a liter of blood with a normal Caesarean birth. Restoring the iron lost in birth can take many months.

One factor that helps to protect iron status after giving birth is exclusive breast-feeding because it generally delays the return of the menstrual cycle. The iron lost in breast milk is significantly less than typical menstrual losses of iron. However, for a woman who completes pregnancy with a poor iron status, the need for iron can remain high for a period of time after pregnancy.

Q: How much dietary iron is needed during pregnancy to meet the needs of both mom and the developing child?

A: Iron needs are very high during pregnancy. Recommended intake increases from 18 milligrams per day in the nonpregnant condition to 27 milligrams per day during pregnancy if the diet includes red meat. For a vegetarian diet, recommended iron intake increases to about 50 milligrams per day because a lower percentage of iron is absorbed from plant foods.

Consuming this much iron can be quite challenging for many women. A British study reported that 2 out of 3 pregnant women did not meet even the estimated average requirement for iron. Additionally, dietary calcium inhibits iron absorption, so individuals striving to consume plenty of calcium for breast-feeding may not realize that this further increases their iron needs.

Q: Can a woman’s iron status affect her unborn child?

A: Yes. A pregnant woman with a lower iron status is more likely to have a baby with a low iron status. Consequences of iron deficiency to the baby can be serious. It is well established that brain development is seriously compromised by a lack of adequate iron. This results in compromised intelligence, behavioral problems, a challenged immune system and increased susceptibility to many health problems.

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Alan Titchenal, Ph.D., C.N.S., and Joannie Dobbs, Ph.D., C.N.S., are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii-Manoa. Dobbs also works with University Health Services.