Pregnant patients should be screened for iron deficiency, study suggests

Forty percent of pregnant patients in Ontario aren’t tested for iron levels, even though half of those tested have iron deficiency, a new study from researchers at the University of Toronto suggests. Given the results of their study, the researchers called for prenatal care guidelines to recommend routine ferritin testing in pregnancy. “Despite the very high prevalence of iron deficiency in pregnancy, and how easy it is to treat, we are not doing a very good job of checking for it,” said Dr. Jennifer Teichman, lead author on the study and a hematology resident in the department of medicine at University of Toronto’s Temerty Faculty of Medicine. “It’s not top of mind, in part, because of inconsistent recommendations for ferritin testing across clinical guidelines.” Dr. Teichman and colleagues looked at the test results of 44,552 pregnant patients who had prenatal testing at community-based laboratories in Ontario over a five-year-long period. Of these patients, 59.4% had ferritin checked during pregnancy. A quarter were found to be iron insufficient, with ferritin levels between 30 to 44 µg/L, and 52.8% were found to be iron deficient, with ferritin levels below 29 µg/L. Eight percent of pregnant patients tested were anemic, with hemoglobin levels lower than 105 g/L. More patients who were severely anemic got a follow-up ferritin test later in their pregnancy compared to patients who had less severe anemia. Read: POP QUIZ: SSRI/SNRI antidepressants in pregnancy and breastfeeding Ferritin levels can change during pregnancy and researchers investigated at what stage of pregnancy patients were tested for iron deficiency. Of those who had bloodwork to test ferritin levels, 71.4% were tested in the first trimester of pregnancy, when the risk of iron deficiency is at its lowest, the researchers said. “Iron deficiency becomes more common as women progress through pregnancy,” Dr. Teichman said in a University of Toronto press release about the study. “If we don’t re-evaluate iron stores later in pregnancy, we miss a lot of women who are becoming iron deficient in later trimesters.” The researchers also found that pregnant patients from lower household incomes were less likely to get a ferritin test compared to those with the highest household incomes. This raises questions of health equity, they wrote. Iron deficiency anemia is the most common cause of anemia in pregnancy and has been associated with a greater risk of premature delivery, low birth weight and post-partum depression. Iron deficiency in early pregnancy has been linked with neurodevelopmental delays, often persisting until children reach school age or older. Low levels of iron can also cause fatigue and weakness. Iron deficiency is treated with iron supplements, which contain more iron than prenatal vitamins. “Prenatal vitamins contain only a sprinkling of iron and many combine iron with calcium, which can inhibit the absorption of iron,” Dr. Teichman said. “The way to address the problem is by identifying iron deficiency early on and then supplementing women with therapeutic doses of iron, which has 10 times the amount found in most prenatal vitamins.” The paper was published in the journal Blood Advances. Read: SOGC 2021 menopause guidelines on sexuality highlights new treatments

Pregnant patients should be screened for iron deficiency, study suggests

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