Iron deficiency during pregnancy underrecognized, undertreated
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Key takeaways:
- Only 15% of pregnancies underwent screening for iron deficiency.
- Better understanding of iron deficiency during pregnancy could have significant impact on public health.
Iron deficiency during pregnancy went underrecognized and undertreated among a large sample of unique deliveries at Mayo Clinic, according to study results presented at ASH Annual Meeting and Exposition.
Researchers therefore recommend additional studies “to better characterize iron deficiency during pregnancy as well as clinical sequelae for both mothers and infants,” they wrote in the abstract.
Study impetus
“Given the widespread prevalence of iron deficiency, pregnancy is likely an especially high-risk population for iron deficiency because of the increased needs and utilization of iron,” Richard C. Godby, MD, fellow in the department of hematology/oncology at Mayo Clinic, told Healio. “Iron deficiency can lead to many symptoms and health sequalae, including anemia, which is a late complication. This has led to the recommendation for prenatal vitamins to contain iron, though over-the-counter formulations vary.”
However, despite the ease of testing and treatment for iron deficiency, current guidelines do not recommend routine assessment for iron deficiency in pregnancy, Godby added.
“Better understanding of iron deficiency in pregnancy has the potential for large impacts on public health and policy,” he said.
For this reason, researchers conducted a retrospective review and analysis of 2,141 obstetric deliveries (median age at delivery, 31 years; 82% white) included in the electronic health record at Mayo Clinic between June 2022 and May 2023. They defined iron deficiency as a ferritin < 50 µg/L and anemia as hemoglobin < 11 µg/L.
Overall, 42% of pregnancies received a diagnosis of anemia at least once throughout gestation. The frequency of anemia increased by 2% during the first trimester, 11% during the second trimester, 17% during the third trimester and 38% from hospital delivery admission to peripartum.
Researchers recorded 102 documented packed red blood cell transfusions from hospital admission through the peripartum period.
Testing frequency
Iron deficiency screening through ferritin testing occurred among only 15% of pregnancies.
Researchers identified iron deficiency in 70% of pregnancies between the last menstrual period and 12 weeks’ gestation, in 79% between 13 and 27 weeks’ gestation, in 80% between 28 and 40 weeks’ gestation and in 78% during postpartum.
Researchers additionally found that prescriptions for oral iron increased throughout gestation, with supplementation during pregnancy among 8% before 12 weeks’ gestation, 14% for those 13 to 27 weeks’ gestation, and 23% for those 28 to 40 weeks’ gestation.
Further, results showed an increase in IV iron infusions throughout gestation during pregnancy among 0.3% before 12 weeks’ gestation, 0.7% during 13 to 27 weeks’ gestation and 4% during 28 to 40 weeks’ gestation, according to the researchers.
Of note, researchers found that 90% of pregnancies had documented consumption of prenatal vitamins throughout gestation. However, most contained variable amounts of elemental iron.
Looking ahead
“We found that only a small fraction of pregnancies were screened for iron deficiency, despite increasing rates of anemia throughout gestation,” Godby told Healio. “Of those that were screened, a majority were likely iron-deficient despite prenatal vitamin supplementation. Iron deficiency in pregnancy is both underrecognized and undertreated.”
Godby recommended for hematologists, obstetricians and others to consider iron deficiency during pregnancy and its treatment strategies within local practices.
“As more data become available through various studies and quality improvement efforts, this will hopefully prompt broader discussions around current guidelines in order to optimize public health and improve outcomes,” he said.
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Godby RC, et al. Abstract 5011. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2024; San Diego.
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