Women of reproductive age are at greater risk of anemia due to iron loss during menstruation and reduced dietary iron intake. Added concerns include especially heavy or frequent menses, frequent blood donation, and athletic-induced hemolysis and anemia . Signs and symptoms of non-anemic iron deficiency may include fatigue, restless legs, sleep disturbance, and fingernail breakage. Routine iron supplementation for those without iron deficiency is not recommended. When iron deficiency is present, supplementation is recommended as well as education on the difference between heme- and nonheme iron sources with regard to bioavailability. Nonheme iron is better absorbed in the presence of meat protein and should be consumed in the same meal with foods rich in vitamin C so as to enhance absorption . Iron deficiency in women who are not menstruating may merit exploration of nutrition intake or occult bleeding from gastrointestinal sources .
Folate and Vitamin B12
Adequate periconceptional and pregnancy intake of folate is well known to decrease the risk of neural tube defects and may also help prevent other complications of pregnancy including preeclampsia and miscarriage . Repeated miscarriages and infertility have been linked to insufficient amounts of vitamin B12 and folate. Pregnancy and lactation increase the need for both of these micronutrients. Women who are vegans or vegetarians with a history of limiting animal protein sources during pregnancy or lactation are at higher risk of vitamin B12 deficiency and may need supplementation. In older women, vitamin B12 deficiency has also been associated with increased hip bone loss .