Is there a link between iron status and postpartum depression?

Photo by Siobhan Calder

Although the focus is so often just on what not to eat, paying attention to your nutritional status in pregnancy is critical, not only for the health of your growing bub, but for your own physical and mental health; not only during pregnancy but longer-term post-birth.

Sadly, it’s not often that nutrient levels are checked. If they are, blood markers that are checked can differ between postcodes and it’s pretty unheard of to even be asked how our diet is (unless we’re in gestational diabetes territory). Even recommended intakes vary depending on the country you are in. This is so frustrating, as deficiencies can have a significant impact on a new mama’s quality of life, iron is a great example of this.

80% of anemia during pregnancy occurs due to iron deficiency. Women are commonly going into pregnancy with low iron stores, in the UK, women of child-bearing age are one of the groups with intake levels below recommended guidelines, with 50% suffering from deficiencies (1). These levels are then only further depleted in pregnancy. On top of this, some of us may experience significant blood loss at delivery, and we continue to lose blood (hello, my good friend, post-partum nappies) for about a month after delivery. And blood loss = more iron loss.  

Common physical symptoms of anaemia include; 

• Fatigue

• Pale skin

• Shortness of breath

• Unusually rapid heartbeat

• Leg cramps

• Insomnia

• Fatigue

• Thyroid dysfunction

It can also have a destructive impact on our mental health, impacting;

• cognitive function

• short-term memory

• attention span and concentration

• postpartum depression risk (2)

A meta-analysis (which pools data from a lot of studies together) found that “anaemia during pregnancy and after pregnancy significantly increased the risk of postpartum depression. Therefore, prevention, identification and treatment of anaemia in pregnant women seem necessary” (2).

There are a number of reasons why iron deficiency and depression may be linked. Iron is distributed to different cell types in the brain. It is also a co-factor for a number of enzymes involved in neurotransmitter synthesis, such as tryptophan hydroxylase and tyrosine hydroxylase, required for serotonin and dopamine synthesis respectively – a.k.a. our ‘happy’ hormones.

So, iron deficiency is linked to this array of physical and mental symptoms that are all too often ignored or dismissed as just part and parcel of ‘being a mum’. Yet they hugely impact on a mother’s quality of life, and our capacity to be the mama we truly want to be. 

Despite all of this, there is no routine screen for a full iron panel blood test in our 6-week post-partum check. Even more frustratingly, often when iron tablets are prescribed it is in a form that comes with the side-effect of constipation - the last thing we want when feeling already bunged up in pregnancy, or facing enough fear about that first post-birth poo! This can mean compliance to take the supplements is low, which feeds into the cycle of depletion. The symptoms can go ignored for months, or even years. I have seen clients experiencing secondary infertility, with iron deficiency being undetected and significantly impacting their hormonal health and thus fertility. But importantly, also impacting their mental wellbeing.

Sadly, in my experience even during pregnancy it can be a postcode lottery for what markers are checked for iron deficiency, and they are often looked at in isolation. Thankfully, as a nutritionist I kept on top of my levels via private testing and having felt increasingly fatigued, I picked up a more sensitive marker of iron depletion by reviewing my comprehensive iron panel. From this, I was able to act quickly before it cascaded. Little did I know, this would go on to have a hugely beneficial impact when I had a postpartum haemorrhage. To the point, the midwives couldn’t understand why my blood markers were so good following the birth, looking confused at my partner whilst I enjoyed a blissful post-birth shower, “it’s as if she hasn’t even given birth”. I am so grateful for this, but it is only because I’ve spent 7 years studying nutrition and carry out clinical work with clients that I was able to do this for myself.

So, should I just supplement iron to be safe?

No! It’s really important not to supplement iron without knowing your levels. Iron can accumulate and is actually a pro-oxidant, so excess levels can potentially cause tissue damage and inflammation. Focus on ensuring you are incorporating iron-rich foods in the diet. If you do need to supplement, monitor levels and know there are different forms and regimes to help mitigate any side effects. Read more about iron and female health here.

These intricate links between diet, physical and mental health is why I am so passionate about empowering other women to take control of their health through the motherhood journey. If you have any concerns about nutrient status before, during or following pregnancy - please do reach out and book in a chat with me to understand more about nutrient screening we can do.

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1. Great Britain, Scientific Advisory Committee on Nutrition, Jackson A. Iron and health. London: Stationery Office; 2011. 

2. Azami M, Badfar G, Khalighi Z, Qasemi P, Shohani M, Soleymani A, et al. The association between anemia and postpartum depression: A systematic review and meta-analysis. Casp J Intern Med. 2019;10(2):115–24.