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Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnant Women

A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation

Evidence Syntheses, No. 123

Investigators: , PharmD, , MD, MHS, , MPH, , MLS, and , MPH.

Author Information
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 13-05187-EF-2

Structured Abstract

Background:

In 2006, the U.S. Preventive Services Task Force (USPSTF) recommended routine screening for iron deficiency anemia in asymptomatic, pregnant women but found insufficient evidence to recommend for or against routine iron supplementation for nonanemic pregnant women.

Purpose:

To systematically update the prior USPSTF reviews on screening and supplementation for iron deficiency anemia in pregnancy.

Data Sources:

We searched Cochrane and Ovid MEDLINE® databases (1996 to August 2014) and reviewed the reference lists of relevant systematic reviews to identify studies published prior to 1996.

Study Selection:

We included randomized, controlled trials and controlled observational studies of supplementation, screening, and related treatment on maternal and infant clinical outcomes; prevalence of iron deficiency anemia and iron deficiency; hematological indexes and ferritin levels; and harms.

Data Extraction:

One investigator abstracted details about each article's study design, patient population, setting, screening method, treatment regimen, analysis, followup, and results. A second investigator reviewed data abstraction for accuracy. Two investigators independently applied criteria developed by the USPSTF to rate the quality of each study. Discrepancies were resolved through a consensus process.

Results:

Eleven trials of routine maternal iron supplementation reported various clinical outcomes for women and infants. One study reported no differences in maternal quality of life. There was inconsistency among studies reporting an effect of maternal iron supplementation on rates of Cesarean delivery and infant outcomes, including small for gestational age and low birthweight. Studies reported no effect of maternal iron supplementation on infant gestational age, Apgar scores, preterm birth, and infant mortality. Twelve trials reported some improvement in maternal hematological indexes with variable doses of iron supplementation versus placebo at various timepoints, although not all were statistically significant. Pooled analysis of four trials reporting a lower incidence of iron deficiency anemia at term (two statistically significant and two with no difference) resulted in a statistically significant difference between groups favoring supplementation. One followup study reported no difference in infant iron status at 6 months. No study directly compared clinical outcomes between pregnant women screened and not screened for iron deficiency anemia. Evidence on the effects of prenatal iron therapy on long-term maternal or infant clinical outcomes remains sparse or unavailable.

Limitations:

Non–English-language articles were excluded. Studies conducted in developing countries were excluded, but some data from trials in countries with limited generalizability to U.S. populations were included. Studies were methodologically heterogeneous and possibly underpowered.

Conclusions:

Evidence supports the effectiveness of routine iron supplementation during pregnancy for improving maternal hematological indexes, but the clinical significance for both pregnant women and infants remains unclear. No studies addressed the benefits or harms of screening for iron deficiency anemia during pregnancy. More research is needed to understand the clinical effects of routine screening for and treatment of iron deficiency anemia during pregnancy.

Contents

Acknowledgments: The authors thank AHRQ Medical Officers Tina Fan, MD, MPH, and Iris Mabry-Hernandez, MD, MPH, as well as current and former members of the U.S. Preventive Services Task Force who contributed to topic deliberations.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, . Contract No. HHSA-290-2012-00151-I, Task Order No. 2 Prepared by: Pacific Northwest Evidence-based Practice Center2

Suggested citation:

McDonagh M, Cantor A, Bougatsos C, Dana T, Blazina I. Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnant Women: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 123. AHRQ Publication No. 13-05187-EF-2. Rockville, MD: Agency for Healthcare Research and Quality; 2015.

This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2012-00151-I, Task Order No. 2). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

2

Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239; www​.ohsu.edu/epc

Bookshelf ID: NBK285986PMID: 25927136

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