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Iron in
Pregnancy
Presenter's Notes
Iron in Pregnancy
Purpose:
• To encourage eating foods high in iron during pregnancy for a healthy pregnancy and prevention of iron
deficiency anemia.
Activity contents:
• 17 cards with questions on the front and answers on the back.
• Some answer cards have grey boxes that contain extra information for the facilitator. You may choose
to share this information depending on the group.
• 2 ‘blood bottles’ (pretend blood made from water and food coloring). They can be used to demonstrate
a woman’s blood before pregnancy and during pregnancy if she is low in iron (anemic). *See the next
page for a detailed instruction page to make the bottles.
• ‘High-Iron Foods’ handout.
How to use the activity:
• Read the questions to the group and discuss.
• Use ‘blood bottles’ to aid discussion.
• Have the ‘High-Iron Foods’ handout available to participants.
• Gather the following grocery items to add visuals to enhance the topic:
• Can of light tuna
• Can of sardines
• Can of black beans
• Can of kidney beans
• Egg carton
• Peanut butter
• Package of tofu
• Dried beans and lentils
• Packages of chicken, ground beef, pork
• Container of nuts
* Pictures of foods can also be a great tool if you don’t have the containers of foods (included in kit)
2
Note to facilitator:
How to make blood bottles for your group:
• Use 2 empty clear water bottles (each 1 litre in size) and remove
outside labels.
• Fill bottle #1 with 500 ml of water and add 8 drops red food coloring
so it is a deep red color. Label this bottle as ‘Blood before
pregnancy’.
• Fill bottle #2 with 750 ml water and add 3 drops of red food coloring
so it is a pale red (pink) color. Label this bottle as ‘Extra blood
during pregnancy and low in iron’.
Source: Women & Anemia: Increased Need for Iron During Pregnancy. 2008
How to explain blood bottles: • Bottle #1 shows a woman’s blood before pregnancy – the deep red color represents good levels of
iron in the blood.
• Bottle #2 shows what blood may look like during pregnancy if she is low in iron (anemic). The pale
pink color represents a low level of red blood cells.
• As a pregnant women’s body grows, so does the amount of blood in her body. By the end of
pregnancy, she will have about 50% more blood in her body. To make more red blood cells, the
mother needs extra iron from food to make hemoglobin that carries oxygen to other cells.
• When you don’t have enough iron to make hemoglobin, you become anemic.
• Eating high-iron foods during pregnancy is really important.
3
How many pounds of blood do
we gain during pregnancy?
2 pounds 6 pounds
OR
4
We gain almost 6 pounds (2.7 kg)
of blood during pregnancy.
6 pounds
Source: Making Connections – You and Your Growing Baby 2010
How many pounds of blood do we gain during pregnancy?
5
Why do pregnant women need
more iron?
6
Source: Building Healthy Babies. A Prenatal Nutrition Resource Manual. First Nations and Inuit Health Branch. Health Canada. 2003.
Blood before pregnancy
(deep color - good levels of iron)
Blood during pregnancy
(pale color – if iron is low)
To keep blood healthy and to make more blood!
• Blood goes to the fetus and placenta to support brain development in the
fetus.
• Did you know…
During pregnancy, a woman’s blood increases by 50%.
• Note to facilitator: Show 2 bottles of “blood” to group and explain.
Why do pregnant women need more iron?
7
How will I feel if I don’t eat
enough foods high in iron?
8
If you don’t eat enough foods high in iron,
you may have iron deficiency anemia.
You may:
• Feel very weak
• Feel tired
• Feel dizzy
• Feel sick
• Have trouble concentrating
• Have a fast heartbeat
• Be short of breath
• Have pale skin, lips and nails
www.webmd.com/baby/guide/anemia-in-pregnancy
You may have “iron deficiency anemia” or you may not.
It’s important to go to your prenatal check-ups. Your healthcare provider will check
your blood at your first prenatal check-up and after 27 weeks of pregnancy.
How will I feel if I don’t eat enough foods high in iron?
9
What could happen if I have
iron-deficiency anemia during
pregnancy?
10
If the iron-deficiency is severe or not treated,
you are at increased risk to have:
• A baby born early
• A baby with a low birth weight
• A baby with anemia
• A stillborn
• A baby that does not survive after birth
www.webmd.com/baby/guide/anemia-in-pregnancy, www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-
eng.php
http://www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-eng.php
This condition is preventable!
Eat iron-rich foods and take one prenatal vitamin a day.
If your doctor has prescribed iron supplements, be sure to take the amount
prescribed.
What could happen if I have iron-deficiency anemia during pregnancy?
11
Does the amount of iron I eat
affect my growing baby?
12
YES • Pregnant women need more iron to support the extra
blood. This blood goes to the fetus and placenta and
helps baby’s brain develop normally.
After 30 weeks of pregnancy, high amounts of iron are moved from the mother to the baby’s liver
where it is stored.
The iron your baby gets from you needs to last until they are 6 months old (which is in your
breastmilk or in iron enriched formula.) Then they are ready to eat iron-rich foods like puréed
chicken, beef, beans, lentils and eggs.
Sources: www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-eng.php
http://ajcn.nutrition.org/content/71/5/1280s.full
Does the amount of iron I eat affect my growing baby?
13
How does my doctor or midwife
know if I have low iron?
14
Blood tests show iron
counts.
Iron Pills
If your iron is low
your doctor may
give you a
prescription for an
iron pill.
How does my doctor or midwife know if I have low iron?
15
Sources: www.anemia.org/patients/feature-articles/content.php?contentid=000245
www.webmd.com/baby/guide/anemia-in-pregnancy
I vomit a lot from morning sickness
I have had 2 pregnancies close together
I am pregnant with more than one baby
I do not eat enough foods high in iron (like meats, fish, beans/lentils)
I skip meals often or cut out foods
I had low iron before I got pregnant
I am a teenager
I had heavy menstrual flow before pregnancy
Read out to the group:
If you answer yes to any of these statements, you may be at a higher
risk for low iron. Talk to your healthcare provider.
16
It is important to eat foods high in
iron during pregnancy. Which
foods should I eat?
17
Eat foods with iron 2 to 3 times a day
beef chicken pork lamb, goat
fish tofu egg yolk
peanut butter
nuts & seeds
wild meat
(moose, deer)
legumes
(beans, lentils)
It is important to eat foods high in iron during pregnancy. Which foods should I eat?
1 serving = 75 grams
or 2 ½ ounce 18
Note to Facilitator:
• Provide the group with the High-iron
Foods Handout.
• Show group visual props of high-iron foods
such as: – Can of light chunk tuna
– Can of sardines
– Can of black beans
– Can of kidney beans
– Egg carton
– Peanut butter
– Package of tofu
– Dried beans and lentils
– Packages of chicken, ground beef, pork
– Container of nuts
– Pictures of foods can also be a great tool if you don’t have the containers of foods
19
Liver is high in iron. Is it
safe to eat liver while I am
pregnant?
cooked liver liver sausage
20
NO
• Limit liver during pregnancy.
Liver and liver products are very high in vitamin A.
Too much vitamin A may cause birth defects, especially during the first trimester.
If you choose to have liver, eat no more than 75 grams (2 ½ ounces) or 1 serving per week.
75 grams (2 ½ ounces) = the size
of your palm and thickness of your
little finger
Sources: PEN: Practice-based evidence in Nutrition, Healthy Eating Guidelines for Pregnancy. Dietitians of Canada. Last reviewed 2014-10-23, Pregnancy Evidence Summary Last updated
2014-05-15.
Liver is high in iron. Is it safe to eat liver while I am pregnant?
21
Is eating spinach a good way
to get more iron?
22
NO
• Spinach has iron but our bodies have a
hard time using it.
• Spinach has other important vitamins so it
is a great vegetable to eat!
Source: www.Parentingscience.com/iron-absorption.html
Is eating spinach a good way to get more iron?
23
True or False?
Having a hard-boiled egg with an orange
will increase the iron your body uses by
4 times.
24
True
• Include one food high in vitamin C at every
meal to help your body use iron.
• This is most important when the meal has
a non-meat iron source.
Foods high in vitamin C:
Oranges, strawberries,
cantaloupe, lemons, kiwis,
mangoes, potatoes, broccoli,
sweet peppers, tomatoes,
tomato sauce
Non-meat sources of iron:
Eggs, peanut butter, beans,
lentils, nuts, peanuts,
sunflower seeds, tofu, cereal,
bread, pasta
Source: www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-eng.php, www.beefinfor.org/
True or False? Having a hard-boiled egg with an orange will increase the iron your body uses by 4 times.
25
True or False?
Having peanut butter on toast with
strawberries increases the iron your body
uses by 4 times.
26
True
• Peanut butter has iron and bread is
enriched with iron. Vitamin C in
strawberries helps your body use the iron.
Note: There are other citrus fruits, like
oranges, apples etc., that have
Vitamin C and can be help to use the
iron. www.beefinfo.org/
True or False? Having peanut butter on toast with strawberries increases the iron your body uses by 4 times.
27
Does drinking tea or coffee with
meals affect how much iron your
body can use ?
28
YES • Drinking tea or coffee with meals lowers
the amount of iron your body can use.
• Drink tea or coffee 1 or 2 hours before or
after meals.
In pregnancy, less caffeine is best!
Limit caffeine to 300 milligrams per day:
About 2 cups of coffee = 300 mg caffeine
About 3 cups strong tea = 300 mg caffeine
*Soft drinks, hot chocolate, iced tea, chocolate and
energy drinks may contain caffeine also.
Sources: PEN: Practice-based evidence in Nutrition, Healthy Eating Guidelines for Pregnancy. Dietitians of Canada. Last reviewed 2014-10-23, Pregnancy
Evidence Summary Last updated 2014-05-15.
http://www.phac-aspc.gc.ca/hp-gs/know-savoir/caffeine-eng.php
Does drinking tea or coffee with meals affect how much iron your body can use ?
29
True or False?
A vegetarian needs 2 times as much
iron as a meat-eater.
30
True
• It is harder for the body to use the iron
from meat alternatives (eggs, beans,
lentils, tofu and peanut butter).
www.beefinfo.org.
True or False? A vegetarian needs 2 times as much iron as a meat-eater.
31
Can TUMS™ block iron from
a meal?
32
Yes
• Tums contain calcium. Calcium blocks the
amount of iron your body can use.
• Do NOT take antacids with calcium (e.g.
TUMS™) or calcium supplements with meals.
Source: www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-eng.php,
PEN: Practice-based evidence in Nutrition, Vitamin D and Calcium: Updated Dietary Reference Intakes. Updated 2010-12-01
Take only the amount of antacid or calcium supplement advised by your
doctor. Do not take over 2500 mg calcium per day from supplements,
antacids and food.
Do not take an antacid at the same time as an iron supplement or
prenatal vitamin.
Can TUMS™ block iron from a meal?
33
Which food can you
add to bean chili
to get more iron
from it?
A) Beans B) Pasta C) Ground beef
34
Ground Beef
• Meat sources of iron (beef, chicken, fish)
help your body use the iron from non-
meat sources of iron (beans, lentils,
eggs, tofu)
www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-eng.php
Combine:
meat sources of iron + non-meat sources of iron + vitamin C at meals!
Example: Ground beef with beans and tomatoes.
Which food can you add to bean chili to get more iron from it?
35
To get the best level of iron during
pregnancy:
A) Eat foods
high in iron
every day
B) Eat meat,
fish, and
chicken
every day
C) Eat foods
high in
vitamin C
with meals
D) All of the
above
36
All of the above
• Try to combine meat sources of iron,
non-meat sources of iron and vitamin C
at meals!
37
“Iron in Pregnancy”
has been developed and produced in partnership by
Healthy Child Manitoba and Healthy Start for Mom & Me
For more information about feeding your baby, please contact:
The information in this presentation kit is not meant to replace physician advice.
Where Can I Get Help?
This kit was developed in February 2015.
It is not intended as a handout for program participants.
Iron
for
Baby
Presenter’s Notes
Iron for Baby
Purpose:
• To enhance knowledge about the importance of iron for babies for optimal growth and development and
to prevent iron deficiency anemia.
• To teach about which foods are high in iron and which foods are low in iron.
Activity contents:
• 18 cards with questions on the front and answers on the back.
• Some answer cards have grey boxes that contain extra information for the facilitator. You may choose
to share this information depending on the group.
• “High-Iron Foods for Baby over 6 Months” handout
How to use the activity:
• Read the questions to the group and discuss. (Note: This activity can be used as a shorter topic by
using only a few of the iron questions during the session.)
• Have the ‘High-Iron Foods’ handout available to participants.
• Collect the following grocery items to enhance the visuals for this topic:
• Can of light tuna
• Can of sardines
• Can of black beans
• Can of kidney beans
• Egg carton
• Peanut butter (note: for older babies only – for spreading thinly on a cracker)
• Package of tofu
• Dried beans and lentils
• Packages of chicken, ground beef, pork
* Pictures of foods can also be a great too if you don’t have the containers of foods (included in kit)
2
Did you know?
A 7-month-old baby needs more
iron than an adult man
3
• Babies need iron for their brains to develop.
• Iron carries oxygen in the body. It gives energy.
• Babies’ blood volume amount triples in their first year. They need a lot of extra
iron to keep that blood healthy.
• The iron that the baby stored from you during pregnancy only lasts until they
are 6 months old.
Why do babies need iron?
5
How do I know if my baby
has low iron?
6
Babies may show these signs if they
have low iron:
• pale skin
• sleep more than usual
• small or no appetite
• upset and difficult to calm down (fussy)
• slow weight gain
Babies with low iron may be less active and develop more slowly.
www.caringforkids.cps.ca/handouts/iron_needs_of_babies_and_children
How do I know if my baby has low iron?
7
How do babies under 6
months old get iron?
8
From Birth to 6 Months:
• Breastfed babies get iron from
their mother’s milk.
• Formula-fed babies need formula
with added iron.
How do babies under 6 months old get iron?
9
At 6 months, baby will need
more iron. Which high iron
foods do I give?
10
Continue breastfeeding or giving formula.
Offer iron-rich foods every day:
Use a blender to make a smooth texture of meat, tofu, fish, beans, lentils or egg yolk.
• Peanut butter can cause choking.
• Wait until baby is close to 1 year old.
• Spread thinly on toast or crackers.
• Do not give on a spoon.
PEN: Practice evidence based nutrition – Meeting your baby’s iron needs (6 to 12 months). Updated 2014-08-14
At 6 months, your baby will need more iron. Which high iron foods do I give?
11
Note to Facilitator:
• Provide the group with the High-Iron
Foods for Baby Handout.
• Show group pictures and/or visual props
of high-iron foods such as: – Can of light chunk tuna
– Can of sardines
– Can of black beans
– Can of kidney beans
– Egg carton
– Peanut butter (note: for older babies only – for spreading thinly on a cracker)
– Package of tofu
– Dried beans and lentils
– Packages of chicken, ground beef, pork
12
Is cow’s milk a good source
of iron for baby?
13
NO
• Cow’s milk is low in iron.
• Wait until your baby is 9 to 12 months old to give cow’s milk.
• Drinking too much cow’s milk can lead to low iron levels. Baby can get sick.
• After 9-12 months of age, 3.25% homogenized whole milk can be given, in small
amounts along with breastmilk.
• At 12 months, offer up to 2 cups (500 mL) of cow’s milk a day, and not more than 3
cups (750 mL).
• At 12 months, wean baby from the bottle.
• Give milk and other fluids in a regular cup at meal times.
PEN: Practice evidence based nutrition – Meeting your baby’s iron needs (6 to 12 months). Updated 2014-08-14
Is cow’s milk a good source of iron for baby?
14
How much iron-rich food
should I feed my baby?
15
Feed baby 2 or more iron-rich
foods each day.
• Continue to breastfeed for up to two years or longer.
• Start with puréed foods. Slowly change to mashed, then
diced food as baby gets older.
• Try one new food at a time. Wait at least 2 days before
trying another new food. Some easy iron-rich meals to give baby:
• Thick soup made with minced soft-cooked beef, beans, enriched pasta and mixed chopped
vegetables.
• Ground meat mixed with baked beans served with mashed baked potato and small pieces of soft-
cooked vegetables.
• Iron-fortified infant cereal served with a chopped hard-boiled egg and chopped fruit.
• Tuna-and-broccoli noodle casserole served with fruit cut into small pieces.
PEN: Practice evidence based nutrition – Meeting your baby’s iron needs (6 to 12 months). Updated 2014-08-14, Feeding Your Breastfed Baby, 2014.
How much iron-rich food should I feed my baby?
16
How do I cook chicken for
my baby?
17
How to cook Chicken
for your baby:
Remove skin and
bones from chicken.
Boil chicken until no
longer pink inside.
How do I cook chicken for my baby?
18
What texture of chicken is
safe for my baby to eat?
19
Chicken
6 months
Smooth blended with
cooking water in a
blender
7 to 8 months
Minced or mashed
Blended (no water)
9 to 12 months
Finely chopped with
a knife
What texture of chicken is safe for my baby to eat?
20
True or False?
Having a hard-boiled egg with broccoli
increases the iron the body uses by
4 times.
21
True
• Include one food high in vitamin C at meals to
help use the iron.
• This is most important when the meal has a non-
meat source of iron.
Foods high in vitamin C:
Strawberries, cantaloupe,
kiwis, mangoes, potatoes,
broccoli, cooked sweet
peppers, soft tomatoes,
tomato sauce
Non-meat sources of iron:
Eggs, beans, lentils, tofu,
infant cereal, bread, pasta,
cooked spinach, peanut
butter
Source: www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-eng.php, www.beefinfor.org/
True or False? Having a hard-boiled egg with broccoli increases the iron the body uses by 4 times.
22
True or False?
The iron in kidney beans is used better
when beef is in the chili too.
23
True
• Meat (beef, chicken, fish) helps your body use
the iron from non-meat sources of iron (beans,
lentils, eggs, tofu).
Tip – Try to combine meat sources of iron, non-meat sources of iron
and vitamin C at meals!
True or False? The iron in kidney beans is used better when beef is in the chili too.
24
• Juice does not have iron.
26
• Babies DO NOT need juice.
• Only give your baby breastmilk or formula to drink.
• Give mashed fruit and vegetables.
Does juice have iron?
NO
Does my baby need an iron
supplement?
27
NO
• Most babies do not need an iron supplement.
• Do not give your baby a supplement unless
recommended by a doctor. Too much iron can be
harmful.
Infants with lower iron stores are more likely to get iron deficiency.
This includes:
• A baby born prematurely (less than 37 weeks)
• A baby with a birth weight of less than 3 kg (6 pounds 10 ounces)
• A baby born to an iron-deficient mother, a mother with diabetes or mothers who drank heavily during
pregnancy
*Babies who are not fed according to the current recommendations are also at higher risk of iron
deficiency (such as babies fed homemade evaporated milk formula or babies fed cow’s milk).
Talk to your healthcare provider
http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php, PEN: Practice evidence based nutrition – Meeting your baby’s iron needs (6
to 12 months). Updated 2014-08-14.
Does my baby need an iron supplement?
28
Is bacon a good source
of iron?
29
How many slices of bacon would a baby need to eat to meet
their iron needs in a day?
55 slices
NO
• There is not much iron in bacon.
• Bacon is mainly fat. It also has chemicals (nitrates) that
may cause cancer.
• (Hard for your baby to chew)
Is bacon a good source of iron?
30
How many jars of “Chicken
Casserole” would a baby
need to eat to get enough
iron for the day?
31
12 ½ jars (not a good choice)
• Notice that the first ingredient is water.
• Real homemade chicken or other meats will give your baby more iron.
Nutrition Facts
1 jar (128 ml):
% Daily Value
Vitamin A 50 %
Vitamin C 0 %
Calcium 2 %
Iron 8 %
For a product to be a good iron source for baby, the % Daily Value should be
over 15%. This jar of baby food is not over 15% so it is not a high source of iron.
http://www.heinzbaby.com/en_ca/baby/triple_tested_products/stage2/baby_food/meat_combinations/Chicken_Casserole_with_Vegetables_&_Rice/55/
How many jars of “Chicken Casserole” would a baby need to eat to get enough iron for the day?
32
Are Cheerios™ a good iron
food for baby at 9 months?
33
NO
• 3 ½ cups of Cheerios™ have the same amount of
iron in just ⅓ cup of infant cereal. Infant cereal is the
best choice.
• A baby’s stomach size at 9 months old is only ½ cup.
The baby will fill up quickly on Cheerios™and not
have room for breastmilk or healthy foods.
Are Cheerios™ a good iron food for baby at 9 months?
34
Is it okay to feed my baby a
vegetarian diet?
35
YES,
but it takes good planning!
• Iron from plant foods is not as easily used by the body.
• Vegetarians need almost twice as much iron as non-vegetarians.
• Offer a variety of iron-rich plant foods along with vitamin C-rich
foods every day to allow the body to use the iron.
PEN: Practice evidence based nutrition – Meeting your baby’s iron needs (6 to 12 months). Updated 2014-08-14.
Is it okay to feed my baby a vegetarian diet?
36
Black beans, kidney beans,
chickpeas are high in iron.
Are green beans high in iron?
Black beans, kidney
beans, chickpeas, lentils
Green beans
37
Kidney beans have 8 times more iron than green beans.
Black beans, kidney beans, chickpeas are high in iron.
Are green beans high in iron?
38
NO
• Green beans are low in iron.
“Iron for Baby”
has been developed and produced in partnership by
Healthy Child Manitoba and Healthy Start for Mom & Me
For more information about feeding your baby, please contact:
The information in this presentation kit is not meant to replace physician advice.
Where Can I Get Help?
This kit was developed in February 2015.
It is not intended as a handout for program participants.
High-Iron Foods for Babies over 6 Months
Tofu Shrimp
Fish (no bones)
Canned Light Tuna or Salmon
Sardines Egg Yolk (yolk contains the iron)
Peanut Butter (spread thinly) Beans Infant Cereal
Lentils Chickpeas
Healthy Start for Mom & Me, 2015, www.hsmm.ca/
Beef Pork Goat Lamb
Wild Game (Moose, deer)
Chicken/Turkey
High-Iron Foods for Adults
*Especially Important for Women During Pregnancy & Breastfeeding*
Nuts
Pork
Beef
Goat Lamb
Chicken/Turkey
Canned Light Tuna or Salmon
Tofu Fish Shrimp Sardines Whole Egg
Peanut Butter Chickpeas Beans Lentils
Wild game (Moose, deer)
Healthy Start for Mom & Me, 2015, www.hsmm.ca/
