Iron Needs During Pregnancy: Why Heme Iron Makes a Difference

If you're pregnant, your blood volume expands by up to 50 per cent, which means your body needs roughly double the iron to make all those new red blood cells.¹ This isn't a minor inconvenience. Iron deficiency in pregnancy is linked to premature delivery, low birth weight, and reduced cognitive development in infants.¹ The stakes are genuinely high. But here's the overlooked part: not all iron is absorbed equally, and the iron supplement most doctors prescribe sits somewhere between ineffective and actively harmful to digestion.

Why your body needs more iron in pregnancy

Let's start with the mechanism. In pregnancy, your plasma volume expands dramatically. Your heart pumps harder. Your body is essentially preparing to feed two organisms through one set of blood vessels. That requires haemoglobin, the protein in red blood cells that carries oxygen.

A non-pregnant woman needs around 18 milligrams of iron daily. A pregnant woman needs 27 milligrams.¹ That's not a suggestion. Your body will take iron from your own stores to ensure the baby gets what it needs, which is why many women emerge from pregnancy severely depleted. But here's what makes this genuinely frustrating: the standard pharmaceutical approach to pregnancy iron is crude. Ferrous sulphate supplements deliver iron, yes, but they also commonly cause constipation, nausea, and stomach cramping. Women often reduce the dose or stop taking it because they feel worse. The intended solution backfires.

Not all iron is created equal. The form matters more than the amount on the label.

Heme iron versus non-heme iron: the absorption story

Iron exists in two forms in food: heme and non-heme. This distinction is everything.

Heme iron comes exclusively from animal products: red meat, fish, poultry, and organ meats. Your body absorbs heme iron at a rate of 15 to 35 per cent.² It's absorbed directly by a dedicated pathway in your intestines that doesn't get significantly affected by what else you're eating. Non-heme iron comes from plant sources like leafy greens, beans, fortified grains, and lentils. Your body absorbs only 2 to 20 per cent of non-heme iron. And here's the critical bit: absorption is blocked by substances in plant foods like phytates, polyphenols, and calcium. A bowl of spinach sounds iron-rich until you realise your body might only absorb 2 to 3 per cent of what's there.

This matters intensely during pregnancy. If you're relying on plant-based iron sources, you're fighting basic physiology. A serving of red meat delivers more absorbable iron than a mountain of spinach ever could. This isn't a value judgment about plant foods. It's simply biology.

How your spleen changes everything

Your spleen isn't just sitting there. During pregnancy, your spleen expands and becomes far more metabolically active. It's essentially a blood-building organ, recycling old red blood cells and supporting the creation of new ones. When you eat heme iron, particularly from organ meats like liver and spleen, you're feeding exactly the mechanism your body is trying to amplify. Liver contains not just iron but also folate, B12, and copper. All of these are critical cofactors in red blood cell production. Spleen is particularly rich in iron and works almost like a natural blood builder.

Compare this to a ferrous sulphate supplement, which delivers iron in isolation without the supporting nutrients. Your body has to work harder to utilise it, and the side effects are more common.

If you're pregnant and iron-deficient, liver isn't a nice-to-have. It's a genuine intervention.

Iron sources that actually work

The clearest sources of absorbable iron during pregnancy are animal foods. Beef and lamb contain heme iron at densities of 1.5 to 3.5 milligrams per 100 grams, plus B12 and selenium. Regular consumption three to four times weekly makes a measurable difference. Liver is the most nutrient-dense option available. A small 100-gram serving contains 5 to 36 milligrams of iron depending on the source animal, plus folate and copper. Even once or twice weekly shifts your iron status significantly. Spleen is exceptionally rich in iron and has traditionally been used to support blood recovery. It works like a natural blood builder. Fish and shellfish like mackerel and sardines provide heme iron plus omega-3 fats. Oysters and clams are exceptionally iron-dense but require careful sourcing during pregnancy. Eggs contain iron in the yolk, plus choline which is essential for fetal brain development. Eggs alone won't meet your iron needs, but they're a reliable daily contribution.

Practical strategies for iron throughout pregnancy

If you're pregnant, approaching iron intentionally from the second trimester onward makes sense. Your needs spike, and your stores deplete quickly if you're not replacing what you're losing. Aim for heme iron sources at least three to four times weekly.³ A dinner built around beef, lamb, or liver delivers more absorbable iron than weeks of plant-based eating. If you dislike liver, consider mincing it finely into bolognese or meatballs. The taste disappears into the tomato sauce whilst the iron remains. Pair iron-rich foods with vitamin C like citrus, tomatoes, or berries if you're eating non-heme sources, as vitamin C enhances absorption. But don't rely on this pairing to solve the fundamental absorption gap. Animal foods remain superior. Avoid coffee and tea immediately before or after iron-rich meals, as they contain polyphenols that inhibit non-heme iron absorption. This matters less with heme iron, but the habit supports overall iron status.

When supplementation makes sense

If your blood work shows anaemia with haemoglobin below 10.5 grams per decilitre, supplementation is worth considering. But ask your GP or midwife about ferrous bisglycinate instead of ferrous sulphate. It's absorbed better and causes fewer digestive side effects. Better still, use supplementation as a bridge whilst you increase dietary iron. If you take a supplement, take it with food contrary to standard advice to reduce nausea, and separate it from calcium-rich foods or supplements by at least two hours. Some women find liquid iron supplements gentler than tablets. Others respond better to slower-release formulas. The goal is consistency, and if you feel ill, you won't stick with it.

Iron status in pregnancy isn't just about numbers on a blood test. It's about your energy, your delivery, and your postpartum recovery. It deserves attention.

The bottom line

Your iron needs during pregnancy are real and substantial. Heme iron from animal products is absorbed at rates five to ten times higher than non-heme iron from plants. If you're pregnant or planning pregnancy, prioritise red meat, fish, and liver. These aren't optional extras. They're nutritional medicine. Pair this with occasional supplementation if blood work indicates anaemia, and you'll emerge from pregnancy with depleted but manageable reserves rather than severe deficiency. Your body knows what it's doing. Give it the iron it's asking for.

Remember: iron status before pregnancy fundamentally matters for everything that follows. Start eating heme iron sources now consistently if you're planning to conceive. If you're already pregnant and anaemic, act immediately. Your baby's entire nervous system development depends on adequate oxygen delivery, which depends entirely on iron.

On UK NHS guidance and liver in pregnancy

The NHS recommends pregnant women avoid liver and liver products entirely, on the grounds that liver is dense in preformed retinol and high doses of preformed retinol are teratogenic. That guidance errs heavily on the side of total avoidance. The published evidence is more specific.

The Rothman 1995 NEJM study, which underpins most modern retinol-in-pregnancy advice, found increased risk of birth defects in women whose chronic intake of preformed retinol exceeded roughly 10,000 IU per day (about 3,000 mcg RAE per day) during the first trimester. That figure is also the NIH ODS Tolerable Upper Intake Level for adults.

A 100-gram serving of cooked beef liver delivers roughly 7,800 to 11,100 mcg RAE depending on preparation (USDA FoodData Central; NIH ODS). The published threshold is for chronic daily intake, not for a single serving — Rothman 1995 explicitly framed the risk around habitual intake during the first trimester, not occasional consumption. A 30-gram serving once a week averages around 330 mcg RAE per day across the week, well below the 3,000 mcg/day UL. Even a 50-gram weekly portion averages around 600 mcg per day. Traditional pregnancy diets observed by Weston Price across multiple cultures included occasional liver as a sacred food, in portions and frequencies consistent with this weekly-average framing rather than daily heavy consumption.

Our position: the brand recommends small, occasional liver servings (30 to 50 grams once or twice a week) for pregnant and preconception women who choose to include it, alongside the rest of a nutrient-dense whole-food diet. If you want to follow NHS guidance and avoid liver entirely, you can still hit the same fat-soluble-vitamin profile through pastured egg yolks, grass-fed dairy and modest amounts of cod liver oil. Discuss any pregnancy nutrition decision with your midwife or obstetrician, particularly if you are already supplementing with vitamin A, multivitamins containing retinol, or acne-treatment retinoids.

References

1. 1. National Institutes of Health, Office of Dietary Supplements. Iron — Health Professional Fact Sheet.
2. 2. Hurrell R, Egli I. Iron bioavailability and dietary reference values. American Journal of Clinical Nutrition, 2010. PMID 20200263.
3. 3. NHS. Foods to avoid in pregnancy.
4. Rothman KJ, Moore LL, Singer MR, Nguyen UD, Mannino S, Milunsky A. Teratogenicity of high vitamin A intake. New England Journal of Medicine. 1995;333(21):1369-1373. https://pubmed.ncbi.nlm.nih.gov/7477116/
5. National Institutes of Health, Office of Dietary Supplements. Vitamin A and Carotenoids: Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/ [accessed May 2026].