Q: I am 17 weeks pregnant and having a low Hb count of 8.2. I am also having beta thalassaemia. At the start of my pregnancy, my Hb level was 10.1. Since the Hb has gone so low, is it advisable to take iron supplement pills or will the iron pills cause more harm than good since I am beta thalassaemic? I was told by the health nurse here in Finlnad (where I live) that I should just eat a healthy diet. But I am worried whether my Hb would increase or not by just trying to eat healthy. So please advise if I should start taking iron pills or not and if I should take, then for how long should I continue taking it?

A:During pregnancy, the average total loss of iron (due to red cell formation in the baby, blood loss at delivery and lactation) is about 1 gm. As most women begin pregnancy with low iron stores, these additional demands lead to iron deficiency. Iron deficient mothers tend to have babies with low iron reserve. In other words, all pregnant women should take prophylactic iron. As you have not mentioned clearly, I presume you have beta-thal trait/carrier/minor. The Hb level in heterozygous state may fall to a lower level during pregnancy than in normal women. Any beta- thal carrier woman with a Hb of less than 9 g/dl should have serum ferritin levels done to document iron deficiency and then take both iron and folic acid. Anemia in this state is reflected in placental hyperplasia and fetal distress. You need to discuss with your doctor and take iron & folic acid supplements till the time you breast-feed the baby.