Iron Deficiency and Iron Deficiency Anemia During Pregnancy—Opportunities to Optimize Perinatal Health and Health Equity

Abstract

Iron deficiency, with or without anemia, affects almost half of pregnancies worldwide, adversely impacting maternal and fetal outcomes.In North America, the estimated prevalence of iron deficiency during pregnancy is reported to be greater than 50%, and nearly 12% of pregnancies are affected by iron deficiency anemia. 1,2Iron deficiency anemia is associated with an increased risk of maternal complications, including preterm labor, cesarean delivery, postpartum hemorrhage, and maternal death, as well as fetal complications, like low birth weight and small for gestational age.Iron deficiency anemia is influenced by social determinants of health, such as race, ethnicity, socioeconomic status, nutritional status, and food insecurity.Thus, the US Preventive Services Task Force (USPSTF) examined the evidence regarding the benefits and harms of screening and supplementation for iron deficiency with or without anemia in asymptomatic pregnant individuals 3,4 to update its previously published recommendations from nearly a decade ago.In the evidence review and updated recommendation statement, 3,4 the USPSTF extended its review to include the benefits and harms of screening and supplementation for iron deficiency without anemia on maternal and infant health outcomes in asymptomatic pregnant individuals.Additionally, the evidence review and recommendation statement 3,4 examined studies on the relationship between change in maternal iron status and improvement in infant and maternal outcomes in pregnant individuals with iron deficiency with or without anemia.After reviewing the literature, the USPSTF did not find sufficient evidence that screening and supplementation for iron deficiency, with or without anemia, during pregnancy improved maternal and infant health outcomes (I statement).Additionally, they found insufficient evidence to determine the balance of benefits and harms of routine iron supplementation in pregnant individuals to prevent adverse maternal and neonatal health outcomes (I statement). 3,4 cohort studies suggest an association between latent (or nonanemic) iron deficiency and maternal and neonatal morbidity, 5 it is timely and relevant that the USPSTF included iron deficiency without anemia in this evidence review. 3,4This is a critical step to better understand these associations and the optimal ways to supplement or treat pregnant persons

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