Feasibility or Oral Lactoferrin to Prevent Iron Deficiency Anemia in Obese Pregnancy

Inclusion criteria

• naturally conceived, single pregnancy
• at risk of IDA [Hb 11.0 - 12.0 g/dL (first trimester)/10.5 - 11.5 g/dL (second trimester) for non-Black women and 10.2 - 11.2 g/dL (first trimester)/9.7 -- 10.7 g/dL (second trimester) for Black women]42 based on new OB complete blood count (CBC) results obtained from the EMR
• 18 - 45 years old
• pre-conception BMI ≥ 30.0 kg/m2 [based on measured height in EMR and recent pre-conception weight (within 3 months of pregnancy) from EMR if available or self-reported]; < 20 WG
• fluency in English to provide consent and complete study procedures;
• ability to provide consent
• ownership of a smartphone (currently more than 90% of our patient population at the Center for Women's Health)

Exclusion criteria

• birth, or other pregnancy in the previous 12 months
• IDA requiring high dose supplemental iron
• allergy to milk proteins or wheat
• vegan (due to content of the supplements)
• recent blood transfusion
• previously diagnosed type 1 or type 2 diabetes
• autoimmune disorder (e.g., rheumatoid arthritis)
• inflammatory bowel disease
• premature rupture of membranes or chorioamnionitis
• previous spontaneous preterm birth
• current bacterial or viral infection
• history of bariatric surgery
• malabsorptive disease
• current hyperemesis
• current eating disorder
• hematologic disorder or trait carrier (e.g., hemochromatosis, β-thalassemia)
• current tobacco, alcohol or illicit drug use (including marijuana)
• regular use of medications that may interfere with nutrient absorption
• unstable housing, first trimester PHQ-9 score > 10, and/or a recent traumatic event (e.g., death of a significant other or parent) may make it difficult to comply with the interventions, hence these women will also be excluded.