Case Report: A Naturopathic Doctor’s Treatment for Anemia in Pregnancy Using IV Iron 

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

Naturopathic doctors are trained to address the complexities of anemia during pregnancy

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.

Editor’s Note

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

Clinical References

  1. 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
  2. Bauer, K. (2019). Maternal adaptations to pregnancy: Hematologic changes. In C. J. Lockwood (Ed.), UpToDate. Retrieved September 1, 2019, from
  3. 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 
  4. 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
  5. 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 
  6. 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
  7. 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 
  8. 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
  9. 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

Anna-Liza Badaloo is a writer and program consultant, working at the intersection of health, environment, and social justice. With over 10 years of experience at non-profit organizations, she brings a combination of content writing, copywriting, and journalism to her work. Using her strong storytelling ethic, Anna-Liza strives to amplify traditionally silenced voices such as BIPOC, youth, and 2SLGBTQIA+ communities.

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon

Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.