This article is more than 5 years old. Information may no longer be current.
USPSTF: Insufficient evidence to screen for iron deficiency anemia in pregnant women, young children
Click Here to Manage Email Alerts
The U.S. Preventive Services Task Force released draft recommendations stating there is not enough evidence available to recommend for or against screening for iron deficiency anemia or routine iron supplementation in pregnant women and young children.
In each of the draft recommendations — one that focused on asymptomatic pregnant women and the other on asymptomatic children aged 6 and 24 months — the U.S. Preventive Services Task Force (USPSTF) wrote a lack of evidence exists on the benefits or adversities of screening for iron deficiency anemia and routine iron supplementation in these populations.
“Iron deficiency is a common cause of anemia in the United States,” David C. Grossman, MD, MPH, USPSTF co-vice chairman, said in a press release. “However, since most people in the United States get enough iron by eating a well-balanced diet, it’s unclear whether iron supplementation or screening for iron deficiency anemia in the current era can improve health.”
Systemic review articles that served as a basis for each of these recommendations were published in Annals of Internal Medicine and Pediatrics. In both reviews, Marian McDonagh, PharmD, professor in the department of medical informatics and clinical epidemiology at Oregon Health and Science University, and colleagues evaluated existing evidence on the benefits and harms of screening for iron deficiency anemia and of routine iron supplementation in pregnant women and young children.
In the analysis of pregnant women, researchers found no study directly compared clinical outcomes or harms of screening vs. not screening this population for iron deficiency anemia.
The review included 12 trials evaluating iron supplementation; however, there were no controlled observational studies that met the inclusion criteria.
Results from 11 of these trials demonstrated routine iron supplementation had inconsistent effects on rates of cesarean delivery, small size for gestational age and birth weight. These studies indicated iron supplementation had no effect on maternal quality of life, gestational age, Apgar scores, preterm birth or infant mortality.
Twelve trials reported improvements in hematologic indices; however, the researchers deemed these improvements statistically insignificant.
However, a pooled analysis of four trials resulted in a statistically significant improvement in the incidence of iron deficiency anemia at term with supplementation (RR = 0.29; 95% CI, 0.17-0.49).
Maternal iron supplementation had no effect on infant iron status at 6 months.
Researchers also noted harms, none of which were serious, were inconsistent in 10 trials.
In the analysis focused on young children, researchers were unable to identify studies of iron supplementation that reported on the diagnosis of neurodevelopmental delay.
Five of the six trials that included analyses on growth outcomes found no clear evidence of supplementation benefit. Further, there were inconsistent findings for hematologic measures across 10 trials that assessed iron supplementation in children.
Results from two trials indicated Bayley Scales of Infant Development scores were not significantly different after 3 months vs. 12 months of supplementation in children.
Evidence regarding harms of supplementation in young children was limited, but indicated no significant differences. There were no studies that assessed the harms or benefits of screening or any association between clinical outcomes and an improvement of impaired iron status.
“The Task Force is dedicated to improving the health of pregnant women and their babies as well as young children,” USPSTF member Francisco Garcia, MD, MPH, said in the release. “Additional research is needed to evaluate whether screening for iron deficiency anemia can improve health outcomes for mothers and young children.”
The USPSTF will accept public comment on these draft recommendations through April 27. – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Janis L. Abkowitz, MD
Medical practice is generally driven by evidenced-based observations, and excellent criteria have been developed to evaluate the quality of data and to establish guidelines. In these papers, the authors critically evaluate the evidence supporting two common practices: (1) routine iron supplementation to avert iron deficiency and iron deficiency anemia (IDA) in pregnancy; and (2) screening of young children for IDA. They show that evidence supporting these practices is lacking, in part because the prior studies did not assess all clinical endpoints — including harm — and/or they lacked power (ie, they lacked adequate numbers of patients or numbers of controls) for definitive conclusions. Given the lack of conclusive data regarding these questions, it seems likely that practitioners will make choices based on their practice styles, unless more specific guidelines are suggested by the U.S. Preventive Services Task Force (USPSTF).The authors argue that better studies are needed. I agree with this conclusion but have mixed feelings about the recommendation because iron supplementation during pregnancy —
such as prenatal vitamins with iron — has unclear harm. If gastrointestinal upset is problematic, one easily can stop the oral iron. Cost is low. Thus, what is the cost vs. gain of funding a study sufficiently powered to answer this question when there are so many competing funding priorities? To me, it would be helpful if the authors addressed this issue directly.
What the USPSTF will recommend as practice guidelines was not explicitly stated in these manuscripts. This would represent a thoughtful interpretation of the limited data and would likely, and appropriately, guide practice.
Finally, this analysis focused on studies in developed countries, not developing countries where more severe IDA during pregnancy and in childhood is more common. Thus, whether it is beneficial to screen for iron deficiency or IDA in developing countries — including for correctable causes, such as hookworm infection — is not addressed. It would therefore be inappropriate to extend the findings worldwide. The authors recognize this and have carefully defined their inclusion criteria.
Click Here to Manage Email Alerts