USPSTF calls on clinicians to ‘use their judgment’ for prenatal iron supplementation

Key takeaways:

• USPSTF said evidence is lacking to recommend for or against iron supplementation in pregnant persons.
• Clinicians should use their judgment amid a lack of evidence, a task force member said.

In a final recommendation statement, the U.S. Preventative Services Task Force said there is insufficient evidence to recommend for or against the use of iron supplements during pregnancy.

The final statement — published in JAMA — also cited inadequate evidence to assess the risk vs. benefits of screening for iron deficiency and iron deficiency anemia in those who are pregnant or whether such screening could contribute to adverse health outcomes in infants.

The grade I recommendation is consistent with the task force’s draft statement released in February and its 2015 ruling on screening for iron deficiency anemia in pregnant people.

“Having enough iron is important for the health of pregnant people and their babies,” USPSTF member Esa Davis, MD, MPH, said in a press release. “However, we don’t have the evidence we need to determine whether or not screening for iron levels or using iron supplements improve health, so we are calling for more research on both these important topics.”

According to the task force, all pregnant people are at a greater risk for developing iron deficiency and iron deficiency anemia because of the need for more iron during pregnancy. Factors that can further increase the risk include a diet low in iron-rich foods, short intervals between pregnancies and conditions or medications that decrease iron absorption

Certain diverse populations may also be at a greater risk because Black and Mexican American individuals have higher rates of iron deficiency anemia during pregnancy than white individuals, the USPSTF added.

In the final evidence report, Amy G. Cantor, MD, MPH, an associate professor of family medicine at the Oregon Health & Science University School of Medicine, and colleagues reviewed 17 studies (n = 24,023) on the impact of routine iron supplementation.

They noted that prenatal iron supplementation did not result in any significant differences in outcomes like maternal quality of life, cesarean delivery, hypertensive disorders, rates of gestational diabetes and maternal hemorrhage compared with placebo or no supplementation.

None of the studies examined the harms and benefits of screening for iron deficiency or iron deficiency anemia during pregnancy.

“Importantly, our recommendation is only for people without signs or symptoms of iron deficiency or iron deficiency anemia,” USPSTF member David Chelmow, MD, said in the release. “Given the continued lack of evidence, we encourage health care professionals to use their judgment and listen to patient concerns when deciding whether their pregnant patients should be screened or take iron.”

In a related editorial, Elaine L. Duryea, MD, an associate professor at the University of Texas Southwestern Medical Center, and Catherine Y. Spong, MD, a professor at the same institution, explained that the absence of data on screening for iron deficiency anemia in pregnant people “should not lead clinicians to withhold this practice that is routine in all populations” and cautioned that to do so would serve as another “form of exclusion” for pregnant persons.

“Perhaps now more than ever, it is important to remember that benefit to the pregnant patient is reason enough for an intervention; benefit to the fetus or neonate is not required to make an intervention worthwhile,” they wrote.

References:

• Cantor A, et al. JAMA. 2024;doi:10.1001/jama.2024.13546.
• Dureya E, Spong C. JAMA. 2024;doi:10.1001/jama.2024.13545.
• U.S. Preventive Services Task Force issues final recommendation statement on screening and supplementation for iron deficiency during pregnancy. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/iron-deficiency-anemia-pregnancy-final-rec-bulletin.pdf. Published August 20, 2024. Accessed Aug. 20, 2024.
• USPSTF. JAMA. 2024;doi:10.1001/jama.2024.15196.