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Screening for Iron Deficiency Anemia and Iron Supplemen-tation in Pregnancy: U.S. Preventive Services Task Force Recommendations

Who developed these recommendations? The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care. What is the problem and what is known about it so far? Anemia is a condition in which people have fewer red blood cells than normal. Red blood cells help to carry oxygen to body cells, so people with anemia can develop symptoms, such as tiredness, shortness of breath, and lightheadedness. A common cause of anemia is low levels of iron or iron deficiency. Some studies estimate that just over 18% of women have low iron levels, and just over 16% of pregnant women with low iron develop anemia. Some doctors routinely test pregnant women for low iron and/or prescribe iron supplements during pregnancy, thinking that raising iron levels could improve health outcomes for pregnant women and their babies. In 2006, the USPSTF found that there was too little information available to know whether this practice actually improved health outcomes and should be recommended. The USPSTF wanted to update its recommendations based on studies that have become available since 2006. How did the USPSTF develop these recommendations? The USPSTF reviewed published research to evaluate the benefits and harms of screening for iron deficiency anemia and iron supplementation in pregnant women. What did the authors find? The USPSTF found no studies that evaluated the effects of testing iron levels in healthy pregnant women with no symptoms of anemia on the health outcomes of women or their babies. They also found little evidence that treating low iron levels in pregnant women improves outcomes. Although routine iron supplementation increases iron levels and blood count, studies show that it does not affect pre-mature births or Apgar scores of the infant. The Apgar score is a measure of an infant's general health and alertness at birth. No studies examined the harms of screening for or treatment of iron defi-ciency anemia in pregnancy. Harms of routine iron supplementation are small and temporary; symptoms include nausea and constipation. What does the USPSTF recommend that patients and doctors do? Doctors and patients should be aware that there is not enough information to know whether screening for or treating iron deficiency in healthy pregnant women helps women or their babies. Doctors and patients should also be aware that there is not enough information to know whether routine prescription of iron supplements to healthy pregnant women benefits women or their babies. What are the cautions related to these recommendations? These recommendations do not apply to pregnant women who have symptoms of anemia, are malnourished, or have special conditions that may increase their need for iron.