UK guidelines on the management of iron deficiency in pregnancy

Abstract

SummaryIron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally. Although it is particularly prevalent in less-developed countries, it remains a significant problem in the developed world, even where other forms of malnutrition have already been almost eliminated. Effective management is needed to prevent adverse maternal and pregnancy outcomes, including the need for red cell transfusion. The objective of this guideline is to provide healthcare professionals with clear and simple recommendations for the diagnosis, treatment and prevention of iron deficiency in pregnancy and the postpartum period. This is the first such guideline in the UK and may be applicable to other developed countries. Public health measures, such as helminth control and iron fortification of foods, which can be important to developing countries, are not considered here. The guidance may not be appropriate to all patients and individual patient circumstances may dictate an alternative approach. Keywords: iron, iron depletion, iron deficiency, anaemia, pregnancy.The guideline group was selected by the British Society for Haematology, Obstetric Haematology Group (BSH OHG) and British Committee for Standards in Haematology (BCSH), to be representative of UK-based medical experts. MEDLINE and EMBASE were searched systematically for publications from 1966 until 2010 using the terms iron, anaemia, transfusion and pregnancy. Opinions were also sought from experienced obstetricians and practice development midwives. The writing group produced the draft guideline, which was subsequently considered by the members of the BSH Obstetric Haematology Group and revised by consensus by members of the General Haematology Task Force of the BCSH. The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH and the BSH Committee and comments incorporated where appropriate. Criteria used to quote levels of recommendation and grades of evidence are as outlined in the Procedure for Guidelines Commissioned by the BCSH. Summary of key recommendations• Anaemia is defined by Hb <110 g/l in the first trimester, <105 g/l in the second and third trimesters and <100 g/l in the postpartum period.• Full blood count (FBC) should be assessed at booking and at 28 weeks.• All women should be given dietary information to maximize iron intake and absorption.• Routine iron supplementation for all women in pregnancy is not recommended in the UK.• Unselected screening with routine use of serum ferritin is generally not recommended although individual centres with a particularly high prevalence of 'at risk' women may find this useful.• For anaemic women, a trial of oral iron should be considered as the first line diagnostic test, whereby an increment demonstrated at 2 weeks is a positive result.• Women with known haemoglobinopathy should have serum ferritin checked and offered oral supplements if their ferritin level is <30 lg/l. • Women with unknown haemoglobinopathy status with a normocyti...

Iron supplement use in pregnancy – Are the right women taking the right amount?

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“…The dose of elemental iron (in mg) consumed per week from an iron-containing supplement was calculated by adding the dosage from each iron-only or MV and mineral preparation that women reported using during the current pregnancy. To compare the amount of elemental iron consumed from iron-containing supplements with recommended doses from other developed countries, 8,11,12 the average daily dose of elemental iron from iron-containing supplements was categorised as low dose (<30 mg), preventative dose (30-65 mg), intermediary dose (66-99 mg), treatment dose (100-200 mg) and high dose (>200 mg). Due to the small numbers, to examine possible determinants of the amount of iron consumed from iron-containing supplements, categories were combined and <30, 30-99 and ≥100 mg were used to define low, preventative and treatment dosages of daily elemental iron, respectively.…”

“…women with previous anaemia, multiple pregnancy, consecutive pregnancies with less than a year's interval between, and vegetarians). 11 The recommended dosage of daily elemental iron to treat IDA is 120 mg in the US, 8 100-200 mg in the UK 11 and 100 mg in Norway. 12 In Australia, there are no national guidelines that provide recommendations on dosage of iron supplementation during pregnancy.…”

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

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Knowledge and self-reported practices on prevention of iron deficiency anemia among women of reproductive age in rural area.

“…The most common nutritional deficiency anaemia affecting more than 2 billion people globally is iron deficiency anaemia [1]. Iron deficiency anemia (IDA) is found in all age groups and can occur in any region of the world.…”