The following is a naturopathic case report summary of a naturopathic doctor’s treatment for anemia in pregnancy using IV (intravenous) iron. There are many layers of a naturopathic approach to anemia in pregnancy. As this case report shows, finding the right treatment may take an integrative approach from a naturopathic doctor, midwife and hematologist. This case report is for informational purposes only and should not be used to diagnose or self-treat anemia or any other condition.
A naturopathic case report summary of a patient with anemia during pregnancy receiving IV iron
Here’s What We Know
- Pregnant women are at risk for several types of anemia, which could increase risk of low birth weight and premature birth.
- Naturopathic Doctors collaborate with other healthcare practitioners such as midwives and hematologists to provide a complete circle of care for patient-centered wellness.
- As in this case, IV therapy may safely address iron deficiency anemia during pregnancy, and help reduce fatigue.
Five Months Pregnant and Exhausted
When 27-year-old Sarah* first came to see Dr. B.* she was exhausted. Who doesn’t feel tired at 5 months pregnant? But this was more than just standard, pregnancy-related fatigue. Constantly tired, she couldn’t get through the day without a nap. It was getting harder and harder to care for her toddler.
Why was she so tired? As it turns out, Sarah had a long history of anemia. She had experienced iron deficiency issues since she started getting her period. She had iron deficiency anemia in her first pregnancy, which was effectively treated with IV iron infusions. In fact, Sarah’s midwife had referred her to Dr. B for IV iron infusions, to treat her iron deficiency anemia during her current pregnancy.
Lab results provided by the midwife showed that her normocytic anemia had worsened in the last two months. In other words, her blood cells were of normal size, but she didn’t have enough of them. Luckily, the lab results also ruled out other conditions that may contribute to anemia, such as abnormal thyroid function, viral infections like rubella and hepatitis B, and bacterial infections like syphilis. Sarah wasn’t taking any medications, but she was taking supplements of iron, vitamin C, vitamin B9 (folic acid), vitamin B12 and a prenatal multivitamin.
Dr. B’s physical exam and lab tests revealed nothing unusual, except for low ferritin levels, meaning her iron stores were low. This result often indicates iron deficiency anemia. Interestingly, her iron levels were within normal range. This could indicate that Sarah was in the early stages of iron deficiency anemia. Ferritin levels are the most accurate sign of iron deficiency in pregnancy.
Dr. B. agreed that anemia was a factor. But there are many kinds of anemia, and related blood disorders. Instead of jumping to a premature diagnosis without enough evidence to back it up, Dr. B. decided to keep the diagnostic options open. She concluded that Sarah may be experiencing one or more of the following: physiologic anemia of pregnancy, iron deficiency, B12/folate deficiency, hemolytic anemia, anemia of chronic disease, myelodysplasia, aplastic anemia and/or hemoglobinopathies.
The Anemia Plot Thickens
Since Sarah’s iron deficiency anemia in her first pregnancy had responded very well to IV iron infusions, Dr. B. prescribed an initial course of IV iron infusions once a week for three weeks. Although more convenient than IV infusions, research indicates that oral iron supplements, may cause stomach upset, and take months to raise iron levels. Pregnant women are also more likely to experience constipation. Dr. B. also provided dietary and lifestyle counseling to Sarah, to make sure she was getting enough iron in her diet.
After the first course of IV treatment was complete 3 weeks later, Sarah had a lot more energy. She no longer needed to take daily naps. Lab tests done two weeks later showed that her ferritin levels had improved, and her iron was still within normal range.
But her story didn’t end there. One month after her last IV infusion, Dr. B’s re-testing revealed low iron and low red blood cell levels. This wasn’t great news overall, but there was a bigger problem. Sarah was keen to have a home birth. According to the midwife, the percentage of red blood cells in Sarah’s body was too low for her home birth plans to move ahead.
Committed to ensuring that her patient could give birth at home, Dr. B. took action. She prescribed another course of IV iron infusions: two infusions, two weeks apart. Dr. B. also provided additional dietary counselling. She confirmed that Sarah’s diet was indeed iron-rich, and that she was still taking an oral iron supplement.
One month after this last round of IV infusions, Dr. B’s re-testing showed a big improvement in her ferritin levels. Better still, she had absolutely no low iron symptoms like low energy. Although the midwife requested further IV iron infusions, Dr. B. disagreed. In fact, Dr. B. changed Sarah’s diagnosis from iron deficiency anemia to physiological anemia of pregnancy.
During pregnancy, there are many changes in the body, including to the blood. Over half of our blood is liquid plasma (made of water, salts and protein). The rest is solid (red blood cells, white blood cells and platelets). Physiological anemia can happen in pregnancy because the plasma increases faster than red blood cells, thus diluting the blood.
The midwife referred Sarah to a hematologist for testing to rule out any other potential causes of chronic anemia. The hematologist confirmed Dr. B’s diagnosis of physiological anemia of pregnancy, and agreed that further IV infusions would not fix the problem. The home birth was on. At 40 weeks, Sarah gave birth to a healthy baby boy at home, with no complications.
How a Naturopathic Doctor May Address Anemia in Pregnancy
For pregnant women experiencing iron deficiency anemia, IV iron infusions may raise iron status, improving health for both mom and fetus. However, as you can see from the complexity of the situation, this is not something that a pregnant mother can take care of by herself.
Sarah’s wish for a home birth came true. Even better, it was a smooth delivery with no complications. By the end of treatment, her extreme fatigue was gone. She no longer needed a nap to get through the day. With a new baby and a toddler, this increased energy came just in time.
What does Sarah’s case tell us about naturopathic medicine and anemia during pregnancy? Here are some key takeaways:
NDs Know How to Interpret Complex Lab Results. Although Sarah brought test results from her midwife, Dr. B. did further testing. At first her ferritin was low, but her iron was normal. Some practitioners may have concluded that her iron status was normal. Dr. B. knew that this test result combination often reflects early stages of iron deficiency anemia.
NDs Know What Factors Impacts Iron. Sarah’s iron status was doing well for a while, then dropped. Dr. B. did her due diligence by prescribing another course of IV therapy. By making sure that Sarah was still taking an oral iron supplement, and that her diet was full of iron-rich foods, she ensured that all potential factors impacting her iron status were taken into consideration.
NDs Collaborate with Other Healthcare Professionals for Truly Patient-Centred Care. Sarah had a circle of care of three main health care providers: Dr. B, her midwife and a hematologist. The midwife recognized that licensed and IV certified NDs are experienced at providing IV therapy and supporting the health of pregnant women – hence the referral. When the midwife concluded that a home birth would not be possible based on Sarah’s iron status, Dr. B. jumped into action. Although the midwife desired further IV iron treatments, Dr. B. realized they were no longer necessary. The hematologist confirmed Dr. B’s diagnosis and decision not to continue IV infusions. Thanks to Dr. B’s collaborative efforts, Sarah had a healthy, complication-free birth, at home.
Anemia may affect over 36% of pregnant women worldwide.
Are you wondering how IV iron may help you or your loved ones reduce anemia-related fatigue during pregnancy? A Naturopathic Doctor certified to perform IV Therapy can help! Find a Naturopathic Doctor in your area with our Find an ND search portal.
This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing health care systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:
- Education – Reveal the unique benefits and outcomes of naturopathic medicine
- Access – Connect patients to licensed naturopathic doctors
- Research – Expand quality research of this complex and comprehensive system of medicine
- Achebe MM, Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood. 2017;129(8):940-949. doi:10.1182/blood-2016-08-672246
- Bauer, K. (2019). Maternal adaptations to pregnancy: Hematologic changes. In C. J. Lockwood (Ed.), UpToDate. Retrieved September 1, 2019, from https://www.uptodate.com/contents/maternal-adaptations-to-pregnancy-hematologic-changes
- Cook, J. D., & Skikne, B. S. (1989). Iron deficiency: definition and diagnosis. Journal of Internal Medicine, 226(5), 349–355. doi: 10.1111/j.1365-2796.1989.tb01408.x
- Elstrott B, Khan L, Olson S, Raghunathan V, DeLoughery T, Shatzel JJ. The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol. 2020;104(3):153-161. doi:10.1111/ejh.13345
- Esen, U. I. (2016). Iron deficiency anaemia in pregnancy: The role of parenteral iron. Journal of Obstetrics and Gynaecology, 37(1), 15–18. doi: 10.1080/01443615.2016.1180505
- Gerb J, Strauss W, Derman R, et al. Ferumoxytol for the treatment of iron deficiency and iron-deficiency anemia of pregnancy. Ther Adv Hematol. 2021;12:20406207211018042. Published 2021 May 31. doi:10.1177/20406207211018042
- Rahman, M., Abe, S., Rahman, S., Kanda, M., Narita, S., Bilano, V., … Shibuya, K. (2016). Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis1,2. The American Journal of Clinical Nutrition, 103(2), 495–504. doi: 10.3945/ajcn.115.107896
- Shin HW, Go DY, Lee SW, et al. Comparative efficacy and safety of intravenous ferric carboxymaltose and iron sucrose for iron deficiency anemia in obstetric and gynecologic patients: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(20):e24571. doi:10.1097/MD.0000000000024571
- Wesström J. Safety of intravenous iron isomaltoside for iron deficiency and iron deficiency anemia in pregnancy. Arch Gynecol Obstet. 2020;301(5):1127-1131. doi:10.1007/s00404-020-05509-2