Nutrition

body’s efficient reuse of iron, iron has a relatively small Recommended Daily Allowance (RDA). The RDA of iron for postmenopausal women is 10 milligrams; women of childbearing age (11 to 50 years) as well as nursing mothers require 15 milligrams, and pregnant women 30 milligrams. A multitude of national nutrition surveys report that as many as 90 percent of women do not consume enough iron.⁴

The Food and Nutrition Board of the National Academy of Sciences specifies certain increases in RDAs for pregnant and lactating women (see the chart Recommended Daily Dietary Allowance for Women). More iron is needed not only because of fetal demands, but also because the mother’s blood volume may be increased as much as 30 percent. Because the additional requirement for iron cannot be met by the usual American diet nor by existing stores in many women, iron supplements of 30 to 60 milligrams under supervision of a health care professional are recommended. 

Making the Connection: Nutrition and Steps to a HealthierUS In 2000, poor diet and physical inactivity—which contribute to obesity, cancer, cardiovascular disease, and diabetes—accounted for 400,000 actual deaths in the United States.  Only tobacco use caused more preventable deaths (435,000).  All four chronic conditions are targeted by Steps to a HealthierUS, making nutrition an especially important lifestyle choice promoted by the initiative.  For better health and wellness, women must establish and maintain healthful dietary behaviors.

Iron Deficiency Among Pregnant Females

The terms anemia, iron deficiency, and iron deficiency anemia often are used interchangeably but are not equivalent. Iron deficiency ranges from depleted iron stores without functional or health impairment to iron deficiency with anemia, which affects the functioning of several organ systems. Iron deficiency anemia is more likely than iron deficiency without anemia to cause preterm births, low birth weight, and delays in infant and child development.^{5, 6, 7}  Iron deficiency (with and without anemia) in adolescent females has been associated with decreased verbal learning and memory.⁸ The prevalence of iron deficiency anemia among females aged 12 to 49 years in 1988 to 1994 was 4 percent. 

The prevalence of iron deficiency among females of childbearing age increased from 1976–1980 to 1988–1994.⁹   From 1979 to 1996, the prevalence of third trimester anemia among low‑income pregnant females did not change.^{10, 11}  

Among pregnant non-Hispanics in their third trimester in 1996, 44 percent of blacks were anemic and 24 percent of whites. For Hispanic pregnant females, the percentage was 25 percent. Among low-income pregnant females the proportion of American Indian/Alaska females with anemia was 31 percent, compared to 26 percent of Asian/Pacific Islander females.

Nonpregnant females of childbearing age are at increased risk for iron deficiency because of iron loss during menstruation coupled with inadequate intake of iron.⁹  Pregnant females are also at increased risk because of the increased iron requirements of pregnancy.^{11, 12}  Consequently, an objective has been established to reduce the prevalence of anemia among low‑income pregnant females in their third trimester. Although groups other than low‑income females are considered at risk for iron deficiency during pregnancy, no nationally representative data exist on the prevalence of iron deficiency or iron deficiency anemia among pregnant females. 

National data indicate that only one‑fourth of all females of childbearing age (12 to 49 years) meet the U.S. recommended dietary allowance for iron (15 mg) through their diets.¹³   Iron deficiency among females of childbearing age may be prevented by periodic anemia screening and appropriate treatment and by counseling them about better eating practices, such as selecting iron‑rich foods, taking iron supplements during pregnancy, increasing consumption of foods that enhance iron absorption (for example, orange juice and other citrus products), and discouraging consumption of iron inhibitors (for example, coffee and tea) with iron‑rich foods.¹²  Some good sources of iron include ready-to-eat cereals with added iron; enriched and whole grain breads; lean meats; turkey dark meat; shellfish; spinach; and cooked dry beans, peas, and lentils.

Select Federal Resources on Nutrition     U.S. Department of Agriculture Food, Nutrition, and Consumer Services Food and Nutrition Information Center Center for Food Safety and Applied Nutrition Nutrition and Your Health: Dietary Guidelines for Americans U.S. Department of Health and Human Services  Centers for Disease Control and Prevention National Cancer Institute 5 A Day Program National Heart, Lung, and Blood Institute National Institute of Diabetes and Digestive and Kidney Diseases Weight-control Information Network

 

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¹ American Academy of Pediatrics, Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 100(6):1035-1039, 1997.

² Frazao, E. The high costs of poor eating patterns in the United States.  In Frazao, E., ed. American’s Eating Habits: Changes and Consequences. Washington, DC: U.S. Department of Agriculture, Economic Research Services, AIB-750, 1999.

³ National Center for Health Statistics (NCHS). Progress Review Focus Area 19.
Nutrition and Overweight. January 23, 2004.

⁴ National Women’s Health Information Center. Anemia FAQs. U.S. Department of Health and Human Services (HHS), 1998.

⁵ Idjradinata, P., and Pollitt, E. Reversal of developmental delays in iron-deficient anaemic infants treated with iron. Lancet 341(8836):1-4, 1993.

⁶ Lozoff, B.; Jimenez, E.; Wolf, A.W. Long-term developmental outcome of infants with iron deficiency. New England Journal of Medicine 325(10):687-694, 1991.

⁷ Scholl, T.O.; Hediger, M.L.; Fischer, R.L.; et al. Anemia vs iron deficiency: Increased risk of preterm delivery in a prospective study. American Journal of Clinical Nutrition 55(5):985-998, 1992.

⁸ Bruner, A.B.; Joffe, A.; Duggan, A.K.; et al. Randomized study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 348(9033):992‑996, 1996.

⁹ NCHS. Healthy People 2000 Review, 1998–99. DHHS Pub. No. (PHS) 99-1256. Hyattsville, MD: Public Health Service, 1997.

¹⁰ Perry, G.S.; Yip, R.; Zyrkowski, C. Nutritional risk factors among low-income pregnant U.S. women: The Centers for Disease Control and Prevention Pregnancy Nutrition Surveillance System, 1979 through 1993. Seminars in Perinatology 19(3):211-221, 1995.

¹¹ Centers for Disease Control and Prevention (CDC). Pregnancy Nutrition Surveillance, 1996. Full report. Atlanta, GA: HHS, CDC, 1998.

¹²  CDC. Recommendations to prevent and control iron deficiency in the United States. Morbidity and Mortality Weekly Report 47(RR-3):1-29, 1998.

¹³ U.S. Department of Agriculture (USDA), Agricultural Research Service (ARS). Data tables: Results from USDA’s 1994–96 Continuing Survey of Food Intakes by Individuals and 1994–96 Diet and Health Knowledge Survey. Riverdale, MD: USDA, ARS, Beltsville Human Nutrition Research Center, December 1997.