ACOG Practice Bulletin no. Anemia in pregnancy. Article type [CB]. Practice Guidelines. Citation [CB]. Obstet Gynecol ; Appropriate evaluation and treatment of anemia in pregnancy; Iron of Obstetricians and Gynecologists (ACOG); Jul. 7 p. (ACOG practice bulletin; no. 95). Anemia, the most common hematologic abnormality, is a reduction in the concentration of erythrocytes or hemoglobin in blood. The two most common causes of.

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The USPSTF found inadequate evidence that specifically addressed the accuracy of screening tests in asymptomatic pregnant women.

Studies were reviewed and evaluated for quality according to the method outlined by the U.

Effect of iron supplementation in normal pregnancy. Users may make print copies for use as hand-outs for pregancy audience the user is personally acob but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP.

Further, of 4 studies 15, 20—22 reporting on small-for-gestational-age infants, 1 study 22 reported no significant difference in rates between supplemented and nonsupplemented groups, 2 studies 15, 21 reported fewer small-for-gestational-age infants in supplemented groups, and 1 study 20 reported more small-for-gestational-age infants in the supplemented group. Studies on individual infant birth outcomes were sparse, were ih underpowered, or reported inconsistent findings overall.

To aid practitioners in making decisions about appropriate obstetric and gynecologic care To provide a brief overview of the causes of anemia in pregnancy and review iron requirements To provide recommendations for screening and clinical management of anemia during pregnancy.

No electronic copies available Print copies: Iron status markers and serum erythropoietin in mothers and newborn infants.

Department of Health and Human Services. Well-designed and adequately powered studies that evaluate the effects of iron supplementation, or change in maternal iron status as a result of intervention, on maternal and infant health outcomes for example, postpartum hemorrhage, maternal illness, preterm delivery, low birthweight, prsctice perinatal death are needed, particularly in settings similar to the United States with respect to nutrition, hemoparasite burden, and socioeconomic prctice.

Of the 7 studies 13—19 reporting serum ferritin levels xcog term or delivery, 5 13, 15, 17—19 reported a ackg higher ferritin level in the supplemented versus control groups In its review of the evidence to update the recommendation, the USPSTF found no good- or fair-quality studies on the benefits or harms of screening that would be applicable to the current U.

A Systematic Review for the U. Consistent with the USPSTF, the American Academy of Family Physicians concludes that the current evidence is insufficient to assess the balance of anejia and harms of screening for iron deficiency anemia in pregnant women to prevent adverse maternal health and birth outcomes Although adequate evidence shows that iron supplementation improves maternal hematologic indexes, the clinical significance of this improvement needs to be defined.


Recommendations to prevent and control iron deficiency in the United States. In most of these studies, the supplemented groups had higher mean hemoglobin levels than the nonsupplemented groups; however, both groups reported values bulletun normal limits.

Both the and the current recommendation statements found insufficient evidence to determine the balance of the benefits and harms of iron supplementation during pregnancy Many observational studies have explored the association between adverse maternal and infant health bylletin such as postpartum hemorrhage, preterm birth, low birthweight, and perinatal death and iron deficiency or iron deficiency anemia in pregnancy, but findings have been inconclusive 2.

Potential Benefits Appropriate evaluation and treatment of anemia in pregnancy Iron supplementation decreases the prevalence of maternal anemia at delivery Potential Harms There is little evidence that iron supplementation results in morbidity beyond gastrointestinal symptoms, except in patients with hemochromatosis or certain other genetic disorders.

Screening for iron deficiency anemia in young children is addressed in a separate recommendation statement available at www. The usual dose is 60 to mg of elemental iron per day 2, 5. In pgactice, no new studies that would be applicable to the current U. Bullwtin pregnancy, iron is also needed for the development of the fetus and placenta and to expand maternal erythrocyte mass.

ACOG Practice Bulletin No. anemia in pregnancy.

The major concern about iron deficiency anemia in pregnant women is whether it has adverse effects on maternal health or infant outcomes. Preventive Services Task Force recommendation. Given the lack of studies on screening, the USPSTF did not find sufficient evidence to determine the balance of benefits and harms of screening for iron ln anemia and thus cannot make a recommendation in favor of or against screening. Iron status markers in nonanemic pregnant women with and without iron supplementation.

The slide sets may be used only by the person who downloads or purchases aocg and only for the purpose of presenting them during not-for-profit educational activities. It does not address pregnant women who are malnourished, have symptoms of iron deficiency anemia, or have special hematologic conditions or nutritional needs that may increase their need for iron. All pregnant women should be screened for anemia, and those with iron deficiency anemia should be treated with supplemental iron, in addition to prenatal vitamins.

Disclosures can also be viewed at www. All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP.


Most reported harms, including nausea, constipation, and diarrhea, were transient and not serious. Please Choose One of the Following Options. Treatment of iron deficiency anemia in pregnant women is similar to that in nonpregnant women and includes additional iron intake through oral iron pills, prenatal vitamins, and diet.

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ACOG Practice Bulletin No. 95: anemia in pregnancy.

Of the 6 studies reporting on low birthweight 12, 13, 16, 17, 21, 22only 1 21 found a significantly lower rate of low-birthweight infants; however, these studies may have been underpowered to detect a change. Although the statement recommended screening for iron deficiency anemia in pregnant women, the current recommendation found insufficient evidence to recommend for or against screening.

PressmanElizabeth M. Federally regulated iron fortification of U. Studies on cesarean delivery and maternal quality of life were sparse or reported inconsistent results. A few comments requested more information on which populations are at increased risk for iron deficiency anemia and to which population the recommendation applies.

Given the inconsistent findings and lack of adequately powered studies on the effect of supplementation on maternal and infant health outcomes, the USPSTF did not find sufficient evidence to determine the balance of benefits and harms of supplementation and thus cannot make a recommendation in favor of or against iron supplementation.

Most effective education programs should be performed to the anemic group during pregnancy. This recommendation is consistent with the recommendation statement on iron supplementation during pregnancy. American Prqctice of Family Physicians.

ACOG Practice Bulletin no. 95. Anemia in pregnancy

Inthe Centers for Disease Control and Prevention recommended screening for anemia and initiating low-dose iron supplementation at the first prenatal care visit for all pregnant women 5. Gestational weeks at the time of delivery and birth weight of babies were recorded. Blood group A mothers are more likely to develop anemia during antenatal intravenous immunoglobulin treatment of fetal and neonatal alloimmune thrombocytopenia. Evidence on the effects of supplementation on birthweight was mixed.

Natural food sources of iron include certain fruits, vegetables, meat, and poultry. To receive access to the full text of freely available articles, alerts, and more. Further, studies evaluating these outcomes are often conducted in countries whose nutritional status and hemoparasite burden vary significantly from those of the United States.

Clinicians should understand the evidence but individualize decision making to the acig patient or situation.