Researchers in South Africa studied 419 pregnant women to understand how common low iron levels (anemia) are during pregnancy and what causes it. They found that about 1 in 3 pregnant women in the Vhembe District had low iron levels, which can make pregnancy riskier. Most cases were mild or moderate, but the study discovered something important: many women with low iron levels didn’t have enough food to eat. The good news is that when supplements were available, women took them reliably. This research shows that food insecurity—not having steady access to nutritious meals—is a major reason why pregnant women develop low iron levels.

The Quick Take

  • What they studied: How many pregnant women in one South African region have low iron levels (anemia) and what causes it
  • Who participated: 419 pregnant women visiting prenatal clinics between April and June 2021. The average age was about 27 years old, and most were in their second or third trimester (around 30 weeks pregnant)
  • Key finding: About 32 out of every 100 pregnant women had low iron levels. Of those, most had mild cases (59%) or moderate cases (38%), with only 3% having severe anemia. Interestingly, women took their iron and folic acid supplements over 96% of the time when they were available
  • What it means for you: If you’re pregnant or planning to become pregnant, low iron levels are common but often manageable with supplements and good nutrition. However, having enough food to eat is just as important as taking supplements. If you struggle to afford nutritious food, talk to your healthcare provider about resources that might help

The Research Details

This was a snapshot study, meaning researchers looked at a group of pregnant women at one point in time rather than following them over months or years. Researchers collected information from 419 pregnant women who came to prenatal clinics in the Vhembe District (a region in South Africa) over three months in 2021. They gathered data in two ways: by looking at the women’s medical records and by asking them questions about their medications and food access. This approach is quick and affordable, making it useful for understanding health problems in a specific community.

This type of study is valuable because it shows what’s actually happening in real healthcare settings. Rather than studying a small group in a lab, researchers looked at everyday pregnant women getting regular prenatal care. This makes the findings more relevant to actual communities and helps health officials understand what problems need attention.

The study has several strengths: it included a reasonably large group of women (419), had very high participation rates for taking supplements (over 96%), and looked at real medical records rather than relying only on what people remember. However, the study only looked at women who came to prenatal clinics, so it might miss women who don’t have access to these services. The research was conducted in one specific region, so results might be different in other areas. Additionally, the study was a snapshot in time, so we can’t know if the same patterns continue or what causes what—only that things are connected

What the Results Show

The main finding was that low iron levels affect about 32% of pregnant women in the Vhembe District. This is considered a moderate public health concern—not rare, but common enough to be a real problem. When researchers looked at how severe the low iron levels were, they found that most women (about 6 in 10) had mild cases, meaning their iron levels were only slightly low. About 4 in 10 had moderate cases, where iron levels were noticeably reduced. Only about 1 in 30 women had severe anemia, which is the most serious form. The average age of the pregnant women studied was about 27 years old, and most were in their second or third trimester of pregnancy.

Two important secondary findings stood out. First, women’s adherence to taking supplements was excellent—96.5% of women took their iron supplements as prescribed, and 97.3% took their folic acid supplements. This shows that when supplements are available, pregnant women are very willing to take them. Second, the study found that many pregnant women with low iron levels experienced food insecurity, meaning they didn’t have reliable access to enough nutritious food. Additionally, the researchers found that supplements were sometimes out of stock at clinics—iron supplements were unavailable 27% of the time and folic acid supplements 30% of the time. This supply problem could prevent women from getting the help they need even when they’re willing to take supplements.

Low iron levels during pregnancy are a well-known problem worldwide, especially in developing countries. This study’s finding of 32% prevalence fits within the range seen in other African countries, suggesting that South Africa faces a similar challenge to neighboring regions. The strong connection between food insecurity and low iron levels aligns with previous research showing that nutrition is fundamental to preventing anemia. What makes this study unique is its emphasis on food insecurity as a key factor—many previous studies focused mainly on supplement availability, but this research highlights that having enough food to eat is equally important.

This study has several important limitations to consider. First, it only included women who came to prenatal clinics, so it might not represent all pregnant women in the region—some women don’t access prenatal care. Second, the study was conducted during a specific three-month period in 2021, so results might be different at other times or in other years. Third, because this was a snapshot study, researchers could only show that food insecurity and low iron levels are connected, not prove that lack of food causes the anemia. Fourth, the study didn’t measure other important factors that might affect iron levels, such as infections or specific dietary patterns. Finally, the study was limited to one district in South Africa, so findings may not apply to other regions with different resources or populations

The Bottom Line

Healthcare providers should: (1) Continue offering iron and folic acid supplements to all pregnant women, as women clearly take them when available—this is a proven, effective strategy. (2) Ensure supplements are consistently stocked at clinics to prevent the 27-30% shortage rates found in this study. (3) Screen pregnant women for food insecurity and connect those struggling to feed themselves with nutrition assistance programs. (4) Provide nutrition education about iron-rich foods that are affordable and accessible. These recommendations have moderate to strong evidence support based on this and previous research.

Pregnant women and those planning pregnancy should care about this research, especially if they live in areas with limited food access or healthcare resources. Healthcare providers, clinic managers, and public health officials should use these findings to improve prenatal services. Government and nonprofit organizations focused on maternal health should consider this evidence when planning nutrition and food security programs. Women who are already taking iron supplements shouldn’t stop—the research shows supplements work when taken consistently. However, this research is most directly relevant to communities similar to the Vhembe District; women in areas with better food security and healthcare access may face different risks.

If a pregnant woman starts taking iron supplements and improves her nutrition, she may see improvements in her blood iron levels within 4-8 weeks, though this varies by individual. However, preventing low iron levels from developing in the first place is easier than treating it after it develops. For long-term benefits, consistent supplement use throughout pregnancy and good nutrition are needed. Women should expect to take supplements for the entire pregnancy and possibly beyond if breastfeeding. Results depend heavily on consistent adherence and adequate food intake

Want to Apply This Research?

  • Track daily iron supplement intake (yes/no) and weekly food security status by logging: (1) Did I take my iron supplement today? (2) Did I have enough nutritious food this week? (3) Any side effects from supplements? This creates a simple but meaningful record that shows patterns over time
  • Users can set a daily reminder to take iron supplements at the same time each day (like with breakfast). Additionally, users can log affordable, iron-rich foods they eat (beans, lentils, leafy greens, eggs, fortified grains) to track nutrition. The app could provide a weekly food security check-in and connect users to local food assistance resources if they report food insecurity
  • Over the course of pregnancy, track supplement adherence monthly to identify any barriers to taking medications. Monitor reported food security weekly—if a user reports food insecurity multiple weeks in a row, the app could prompt them to discuss this with their healthcare provider. At prenatal visits, users can log their blood iron level results to see if their efforts are working. This creates accountability and helps identify when additional support is needed

This research describes a health situation in one South African region and should not be used for self-diagnosis or self-treatment. If you are pregnant or planning to become pregnant, consult with your healthcare provider about your individual risk for low iron levels and appropriate screening and treatment. Do not start, stop, or change any supplements without medical guidance. While this study suggests food insecurity is linked to low iron levels, only a healthcare provider can diagnose anemia and recommend appropriate treatment. If you experience symptoms like extreme fatigue, shortness of breath, or dizziness during pregnancy, seek immediate medical attention. This information is for educational purposes and does not replace professional medical advice