Ferritin

The Ferritin test is considered the gold standard for assessing iron stores and status, yet it may not be as accurate as we think. Using the ferritin test alone may miss key data needed to truly assess iron absorption, metabolism and storage function. 

Ferritin Testing

The ferritin blood test measures the level of ferritin in the blood. 

Ferritin is one of the stored forms of iron. In our bodies, it helps to keep iron in a safe and non-toxic form until it is needed. Small amounts of ferritin are released into circulation to help carry iron safely through the bloodstream. Serum ferritin is a secondary measure of ferritin stores within the tissues. It is generally accepted that serum ferritin correlates with tissue ferritin stores. In certain cases, this may not be accurate, such as with cell damage, acute illness, or chronic inflammatory disease. 

​The synthesis of ferritin is controlled by the levels of iron in the bloodstream, as well as oxidative stress and inflammatory chemicals.

Ferritin in Pregnancy

During the first trimester, with the cessation of the menstrual cycle and the decrease in iron absorption, ferritin levels may increase slightly, remain the same, or decrease slightly.

From 12 weeks, ferritin levels begin to consistently decrease, reaching the lowest point between 35 and 38 weeks. They then increase in the last month of pregnancy before delivery. This is primarily due to the changes in iron absorption and utilization throughout pregnancy. 

​A drop in ferritin is normal after delivery, as the iron stores are used to rebuild red blood cells after blood loss. Ferritin levels should begin to increase by six weeks postpartum.

​Ferritin level testing in early pregnancy can set a baseline of ferritin levels throughout pregnancy.

High Ferritin in Pregnancy

Elevated serum ferritin concentrations in early gestation are associated with an increased risk of gestational diabetes. There was an observed 1.5-fold increased risk of gestational diabetes in women who had serum ferritin levels >45 ng/mL in the first trimester, and a 2.4-fold risk if levels are >80 ng/mL.

Several studies have linked elevated first-trimester ferritin with higher risks of hypertension and preeclampsia in pregnancy, with varying cutoff between 80 and 130 ng/mL. Other studies have also shown a connection to higher ferritin levels at 30 weeks as a predictive marker of preterm birth and low fetal birth weight.

​Currently, there is no consensus on what the upper end of the range for the first trimester should be based on these studies. Studies do seem to indicate that lower serum ferritin levels in pregnancy are more protective for pregnancy than elevated levels.

Most Common Causes of High Ferritin in Pregnancy

• Iron Overload/Hemochromatosis
• Inflammation/Cell Damage
• Acute Infection
• Thalassemia
• Sickle Cell Anemia
• Rheumatoid Arthritis
• Hyperthyroidism
• Hypoxia
• Sleep Apnea/Snoring
• Insulin Resistance
• Overexercising 
• Nutritional Deficiencies (vitamin A, vitamin B6 (pyridoxine))

Low Ferritin in Pregnancy

Ferritin levels <27.23 ng/mL are a predictive biomarker of pregnancy anemia, regardless of CBC indices in the first trimester.

At the lowest point in pregnancy (between 35 and 38 weeks gestation), ferritin levels can be as low as between 15 and 20 ng/mL and be a normal presentation.

Ferritin <15 ng/mL in the early third trimester is associated with small-for-gestational-age growth.

Ferritin <8 ng/mL 48 hours after delivery increases the risk of postpartum depression.

Most Common Causes of Low Ferritin in Pregnancy

• Hypothyroidism
• Low Progesterone
• Low Protein Diets
• Heavy Metal Exposure
• Myeloproliferative Diseases
• IBD Conditions
• Nutritional Deficiencies (iron, vitamin D, zinc, copper, vitamin C, vitamin A)

Want to Learn More?

Take a look at my online course, "Advanced Functional Lab Analysis in Pregnancy"
MEAC CE Credit Approved

See Details Here

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Medical Disclaimer:
This content is for educational purposes only and is intended for licensed medical professionals. It is based on current research, subject to change, and not intended to diagnose, treat, or prevent any medical condition. This information does not replace consultation with a qualified healthcare provider. Seek professional medical evaluation and treatment from a licensed provider. Use of this information is at your own risk.​

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