Screening, Treatment, and Monitoring of Iron Deficiency Anemia in Pregnancy and Postpartum

Abstract

Iron deficiency anemia is the most prevalent form of anemia worldwide. In the United States, clinicians routinely screen for iron deficiency anemia upon initiation of prenatal care, at the start of the third trimester, and prior to birth. Treatment of iron deficiency anemia generally begins with oral supplementation of elemental iron, which is associated with adverse gastrointestinal effects. These adverse effects can decrease adherence, leading to subtherapeutic treatment. Newer evidence highlights the benefits of early screening for iron deficiency before the onset of anemia, as well as the use of intravenous iron to expedite the treatment of iron deficiency anemia. More research is needed on the potential consequences of over-supplementation and iron deficiency without anemia to guide treatment. This article reviews the evidence for best practices for screening, treatment, and continued monitoring of iron deficiency anemia during pregnancy and postpartum. Maternal, fetal, and neonatal implications are reviewed, as well as the risks and benefits of treatment options. Finally, an evidence-based algorithm is proposed to guide clinicians on continued monitoring after treatment.

Iron deficiency in pregnancy: an Italian survey

“…When the serum ferritin level is higher than 70 µg/L, iron stores are adequate to support pregnancy and no supplementation is given; on the contrary, when serum ferritin is less than 30 µg/L, the patient is treated with 80-100 mg elemental iron/day orally. Iron intravenous administration is indicated when oral iron fails because of compliance/tolerance issues, in subjects affected by comorbidities which may affect iron absorption or ongoing iron losses that exceed absorptive capacity [13,14]. In the last years, several activities (e.g.…”

Identification and treatment of iron‐deficiency anemia in pregnancy and postpartum: A systematic review and quality appraisal of guidelines using AGREE II

“…Creative solutions are required to address these issues. These could include optimizing pre‐pregnancy iron stores, identification and treatment of non‐anemic ID, and adoption of alternative dosing regimens 47 …”

“…These could include optimizing pre-pregnancy iron stores, identification and treatment of non-anemic ID, and adoption of alternative dosing regimens. 47 Reproductive-aged non-pregnant females have high rates of ID, with rates described from 8.8% to 36%. 48 Preconception anemia has been associated with an increased risk of adverse pregnancy outcomes, reduced infant growth, 49 and increased rates of childhood anemia.…”

Effective preconception preparation for women with iron deficiency

“…Сначала уменьшаются запасы гемосидерина и ферритина, а затем снижается концентрация железа в плазме, что сопровождается низким насыщением трансферрина железом и повышением железосвязываю щей способности сыворотки крови. Позднее снижается уровень гемоглобина в единице объема крови, возникают гипохромия и микроцитоз эритроцитов [5]. Уменьшение количества гемоглобина и миоглобина вследствие дефицита железа приводит к вторичной тканевой гипоксии, которая проявляется быстрой утомляемостью, мышечной слабостью.…”