USPSTF finds insufficient evidence for screening for iron deficiency anemia during pregnancy

1. From a systematic review, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend screening asymptomatic pregnant women for iron deficiency anemia.

2. There was also insufficient evidence to recommend routine iron supplementation during pregnancy.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Pregnant women are at an increased risk for iron deficiency due to increased iron demand for fetal and placental development. The prevalence of iron deficiency among U.S. pregnant women is estimated at 18.6%, and an estimated 16.2% of those women are anemic. Because of this significant disease burden, the U.S. Preventive Services Task Force (USPSTF) sought to update its 2006 recommendations on screening for iron deficiency anemia and on iron supplementation in asymptomatic pregnant women. However, based on its systematic review of the current literature, the USPSTF found the current evidence inadequate to effectively weigh the benefits and risks of both screening and supplementation. However, the USPSTF did find adequate evidence that iron supplementation improves maternal serum ferritin and hemoglobin levels. There was also adequate evidence to suggest that supplementation has no effect on length of gestation or infant Apgar scores at 1 and 5 minutes. Additionally, the USPSTF found that the side-effects of nausea, constipation and diarrhea for routine iron supplementation were minimal and not significant. Overall, there is a critical need for generalizable evidence regarding the effects of screening for iron deficiency anemia on maternal health and birth outcomes.

Click to read the study published today in the Annals of Internal Medicine

Relevant Reading: Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes

In-Depth [systematic review]: The focus of this USPSTF review was on evaluating evidence that examined the association between iron supplementation in pregnant women and improvement in maternal and infant health outcomes. The only adequate evidence found in the review examined benefits and harms of iron supplementation. Twelve randomized, controlled trials (RCTs) evaluated the effects on iron supplementation on maternal hematologic indexes. There was a significantly higher mean hemoglobin level in supplemented versus control groups (122-139 g/L vs. 115-128 g/L, respectively). There was also a significantly higher ferritin level in supplemented versus control groups (12.0-30.0 mcg/L vs. 6.2-24.9 mcg/L, respectively). Ten trials reported on the harms of iron supplementation and found no significant difference between rates of adverse effects (including nausea, constipation and diarrhea) in supplemented and control groups.

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