VIDEO: Hematologist provides guidance for managing iron deficiency anemia in pregnancy

In a video interview with Healio, Michael Auerbach, MD, FACP, discussed the importance of managing iron deficiency anemia — which he described as the most common “malady on the planet” — in pregnancy.

According to the Mayo Clinic, iron deficiency anemia during pregnancy increases the risk of preterm birth, low birth weight, postpartum depression and infant death.

Additionally, a study published in Blood Advances showed that more than 50% of pregnancies were affected by iron deficiency anemia and 25% involved severe iron deficiency anemia. However, researchers found that only 59.4% of pregnant women were screened for iron deficiency anemia, 71.4% of which were ordered during the first trimester — the trimester with the lowest risk for iron deficiency anemia.

Despite this, screening of asymptomatic pregnant women and babies for iron deficiency anemia is not currently recommended by the U.S. Preventive Services Task Force, although guidelines for management of iron deficiency anemia in pregnant women are now under review. ACOG recommends screening of pregnant women during the first trimester and between 24 and 28 weeks (+ 6 weeks) of gestation, but it categorized the recommendation as having lower levels of evidence “based primarily on consensus and expert opinion.”

Auerbach, a private practitioner of hematology and oncology in Baltimore and a clinical professor of medicine at Georgetown University School of Medicine, emphasized that screening should become a routine practice regardless of whether symptoms are present.

“It belies common sense and flies in the face of a host of quality publications and quality journals to not do it,” Auerbach said.

As for treatment, Auerbach suggested iron replacement should be facilitated with IV iron rather than oral iron.

“You have a safe and effective alternative with four formulations which allow you to completely replace iron in 20 to 60 minutes, which will accomplish what a year of oral iron would require without any of the gastrointestinal perturbation,” he said.

References:

• ACOG Committee on Practice Bulletins—Obstetrics. Obstet Gynecol. 2021;doi: 10.1097/AOG.0000000000004477.
• Iron deficiency anemia during pregnancy: Prevention tips. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455. Published Feb. 9, 2022. Accessed April 18, 2022.
• Iron deficiency anemia in pregnant women: Screening and supplementation. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/iron-deficiency-anemia-in-pregnant-women-screening-and-supplementation. Published Sept. 7, 2015. Accessed April 18, 2022.
• Iron deficiency anemia in young children: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/iron-deficiency-anemia-in-young-children-screening. Published Sept. 7, 2015. Accessed April 18, 2022.
• Screening and supplementation for iron deficiency anemia during pregnancy. https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/iron-deficiency-anemia-during-pregnancy-screening-supplementation. Published March 31, 2022. Accessed April 18, 2022.
• Teichman J, et al. Blood Adv. 2021;doi:10.1182/bloodadvances.2021004352.