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How HFE Genetics Affect Iron Balance During Pregnancy

Pregnancy increases nutrient needs to support both the mother and the developing baby. Iron is one of the most important minerals during this time because it helps transport oxygen, supports fetal growth, and fuels the increase in maternal blood volume. The HFE gene helps regulate how much iron your intestines absorb from food. Variants in HFE can change that regulation and shift your risk toward either iron deficiency or iron overload.

Why this matters

Too little iron can cause fatigue, reduced oxygen delivery, and, in some cases, complications for the pregnancy. Too much iron can generate oxidative stress and interfere with absorption of other minerals, including manganese, which is important for fetal development and antioxidant enzymes. Understanding your HFE genotype can help guide monitoring, diet, and supplement decisions during pregnancy.

What to watch for during pregnancy

  • Regular iron testing: serum ferritin and transferrin saturation are useful measures to track iron stores and absorption.
  • Avoid routine high-dose iron supplementation unless laboratory tests show deficiency.
  • Include manganese-rich and antioxidant-rich foods to support fetal development and reduce oxidative stress risk.
  • Balance vitamin C intake to help with iron absorption when needed, but avoid excessive vitamin C if iron stores are high.
  • Discuss personalized care and testing with your healthcare provider before changing supplements or diet.

Genetic interpretations

GG — two effect alleles (higher iron absorption)

You have two copies of the effect allele at rs1799945. This genotype is associated with increased iron absorption because the HFE protein's regulation of iron uptake is partially impaired.

Potential effects

  • Higher likelihood of elevated iron stores and increased ferritin.
  • Reduced risk of pregnancy-related iron deficiency compared with average.
  • Higher iron can lower manganese absorption, which may reduce manganese levels important for fetal development.
  • Mildly increased lifetime risk for hereditary hemochromatosis compared with non-carriers, though often less severe than other HFE variants.

Practical recommendations

  • Order regular iron tests: ferritin and transferrin saturation at baseline and periodically during pregnancy.
  • Avoid taking routine high-dose iron supplements unless testing confirms deficiency.
  • Limit excessive intake of very iron-rich foods and fortified products if labs show elevated iron.
  • Increase manganese-containing foods: leafy greens, nuts, whole grains, legumes, and seeds.
  • Include antioxidant-rich foods such as colorful fruits and vegetables to help offset oxidative stress.
  • Moderate vitamin C intake with meals when iron is high, since vitamin C increases nonheme iron absorption.
  • Work with your healthcare provider to interpret labs and adjust prenatal vitamins or iron dosing as needed.
CG — one effect allele (mildly increased iron absorption)

You carry one copy of the effect allele at rs1799945. This genotype may modestly increase iron absorption and storage compared with the average population.

Potential effects

  • Mildly higher ferritin levels are possible, which can reduce the chance of iron deficiency during pregnancy.
  • Higher iron may modestly reduce manganese absorption and lower manganese levels.
  • No strong or inevitable development of hemochromatosis, but slightly higher lifetime risk than non-carriers.

Practical recommendations

  • Check iron status with periodic ferritin and transferrin saturation measurements during pregnancy.
  • Do not start or increase iron supplements without documented deficiency.
  • Include manganese-rich foods such as whole grains, leafy greens, nuts, legumes, and seeds.
  • Eat a varied, plant-forward diet with plenty of fruits and vegetables to support overall mineral balance and antioxidant capacity.
  • Discuss prenatal vitamin composition with your healthcare provider to confirm appropriate iron dose for your test results.
CC — zero effect alleles (typical iron regulation)

You have two copies of the non-effect allele at rs1799945. This common genotype indicates typical HFE function and standard iron absorption from food.

Potential effects

  • Normal iron absorption rates; no increased genetic risk for iron overload from this variant.
  • Standard pregnancy iron needs and risks similar to most pregnant individuals.
  • Less likelihood of manganese imbalance related to iron genetics.

Practical recommendations

  • Follow routine prenatal care and screening for anemia as recommended by your healthcare provider.
  • Use prenatal vitamins with iron if your clinician recommends them based on blood tests or overall needs.
  • Eat a balanced diet containing iron-rich foods such as lean meats, legumes, fortified grains, leafy greens, and vitamin C–rich fruits to support iron absorption when needed.
  • Include manganese-containing foods as part of a varied diet for fetal development support.

Diet and supplement guidance during pregnancy

Diet and supplements should be personalized based on lab results and medical history. Below are general suggestions to discuss with your healthcare provider.

  • Foods to emphasize: colorful fruits and vegetables, leafy greens, whole grains, legumes, nuts, seeds, and modest amounts of lean animal proteins if tolerated.
  • Foods high in manganese: spinach, kale, quinoa, brown rice, oats, almonds, and chickpeas.
  • Iron sources: heme iron from lean meats is absorbed efficiently; nonheme iron from plant sources is supported by pairing with vitamin C but limited when iron stores are high.
  • Avoid excessive intake of iron-fortified products or supplements unless deficient; more is not always better during pregnancy.
  • Consider a prenatal vitamin chosen with your provider that matches your current iron status.

Lifestyle and monitoring

  • Have ferritin and transferrin saturation checked early in pregnancy and repeated as advised by your clinician.
  • Report symptoms such as unusual fatigue, joint pain, abdominal pain, or skin changes to your provider, as these can be signs of iron imbalance.
  • Maintain a balanced exercise routine approved for pregnancy to support cardiovascular health and metabolic balance.
  • Keep a symptom and supplement log to bring to prenatal visits to aid shared decision making.

Important disclaimer

PlexusDx provides educational information about genetic predispositions only. This content is not medical advice and does not replace consultation with a qualified healthcare professional. Always consult your healthcare provider for personalized testing, diagnosis, and treatment recommendations related to pregnancy, nutrition, vitamins, and iron management.