"Iron Therapy in and around pregnancy"

I am writing to make practitioners aware of my particular clinical experience being prescribed iron therapy before, during and after a pregnancy, which I believe contributed to three instances of serious infection in an 18 month period, including one which developed not sepsis and endangered the life of myself and unborn baby.

I was initially prescribed a course of Fummous Fumarate, following blood tests which showed low iron. I found the tablets incredibly strong, so I was generally only taking a third of the dose, which I continued to take over a number of weeks, before stopping after feeling incredibly unwell and a period of four days at home to recover. In the run up to this, the tablets made me feel what I can only describe as like having too much of something in my system.

I was once again prescribed iron therapy when I got pregnant, following low iron on routine blood tests. Aware of my previous experience, I discussed this with the clinician, who although they did not recognize from their own clinical experience the symptoms I had experienced, supported my decision to opt for a lower dose form of therapy through SpaTone supplements.

7 month into my pregnancy, I became suddenly very unwell on a weekend away following the same feeling as previously of having too much of something in my system. We went to A&E, where I had an acute case of sepsis, and was immediately put onto broad spectrum IV antibiotics. There was a discussion about whether the baby may need to be delivered early because of his elevated heart rate. Although I responded quickly to the antibiotics, I was incredibly unwell and it took 3-4 weeks to recover from this illness if not more. I have no doubt that if I had been unable to get to emergency treatment as quickly as I did that the situation would have been much worse.

The third case happened 4 months post-partum. Once again following routine blood tests showing low iron I was prescribed iron therapy. By this point, very wary of the treatment, I opted for an even more cautious approach to using SpaTone – once every 2-3 days - this time not supported by my GP, who was insistent that low iron was likely behind the experiences discussed previously.

This time, a large abscess emerged on my face, again following a number of weeks of using iron supplements, and the same feeling of too much being in my system. The abscess quickly spread to cellulitis, and I began to feel very unwell. I was prescribed a strong course of Amox-Clav, which cleared the infection although prevented me breastfeeding for the duration, as the baby was experiencing side effects, which had a long tail, as I was unable to reestablish lactation properly for some days and weeks afterwards.

These experiences have been for me profoundly life impacting, and at times dangerous. I should also note that I was offered IV Iron Infusion during the later stages of my pregnancy, after my experience of sepsis, which I refused following fears outlined above.

Anecdotally, I am aware of a number of other women in and around pregnancy who have suffered acute infection. Having done some reading, I am aware of a condition called Iron Avidity, which is growing in recognition, where individuals can have low storage iron, and high iron circulating in their system. Apparently, young women undergoing iron therapy can be particularly prone to this. I have also discovered that it is well documented including by the WHO that Iron Therapy can exacerbate underlying infections, sometimes to a dangerous and even fatal level.

In my own case, I have been treating my own low ferritin using diet and lifestyle changes. I believe in my own case, my low storage iron has been caused by contributing factors - years of a vegetarian diet, being a menstruating woman, and drinking large amounts of herbal tea around meals, which I now understand inhibits the take up of dietary iron.

I suspect that this more gentle approach of eating some meat and fish as well as paying more attention to vegetarian forms of iron, as well as being careful with foods and drinks that inhibit absorption, is allowing my body to recover its stores albeit gradually. Although it should be noted, that blood tests showed that even in the presence of these more robust therapy treatments outlined above, that my storage iron was showing stubborn signs of not shifting upwards anyway.

I would be happy discuss further if required.