20 August 2024
2 minutes reading time
Key findings:
- According to the USPSTF, there is a lack of evidence to support or oppose iron supplementation in pregnant women.
- Given the lack of evidence, clinicians should trust their judgment, said a task force member.
In a final recommendation statement, the US Preventative Services Task Force stated that there is insufficient evidence to recommend for or against taking iron supplements during pregnancy.
The final declaration – published in JAMA – insufficient evidence was also cited to assess the risk versus benefit of screening for iron deficiency and iron deficiency anaemia in pregnant women or to determine whether such screening could lead to adverse health outcomes in infants.
The Level I recommendation is consistent with the Task Force’s draft opinion published in February and its 2015 decision on screening for iron deficiency anemia in pregnant women.
“Adequate iron is important for the health of pregnant women and their babies,” said USPSTF member Esa Davis, MD, MPH, said in a press release. “However, we do not have the evidence needed to determine whether checking iron levels or taking iron supplements improves health, so we call for further research on these two important topics.”
According to the task force, all pregnant women are at higher risk of developing iron deficiency and iron deficiency anemia because more iron is needed during pregnancy. Factors that may further increase the risk include a diet low in iron-rich foods, short pregnancy intervals, and medical conditions or medications that reduce iron absorption.
Certain populations may also be at higher risk, as African-Americans and Mexican-Americans are more likely to develop iron deficiency anemia during pregnancy than whites, the USPSTF added.
In the final evidence report Amy G. Cantor, MD, MPH, an associate professor of family medicine at Oregon Health & Science University School of Medicine, and colleagues reviewed 17 studies (n = 24,023) on the effects of routine iron supplementation.
They found that prenatal iron supplementation compared with placebo or no supplementation did not result in significant differences in maternal quality of life, cesarean sections, hypertension, incidence of gestational diabetes, and maternal bleeding.
None of the studies examined the harms and benefits of screening for iron deficiency or iron deficiency anemia during pregnancy.
“It is important to note that our recommendation only applies to people without signs or symptoms of iron deficiency or iron deficiency anemia,” said USPSTF member David ChelmowMD, the press release states. “Given the ongoing lack of evidence, we encourage healthcare professionals to use their judgement and listen to patient concerns when deciding whether their pregnant patients should be screened or take iron.”
In a related editorial Elaine L. Duryea, MD, Associate Professor at the University of Texas Southwestern Medical Center and Catherine Y. Spong, MD, A professor at the same institution stated that the lack of data on screening for iron deficiency anemia in pregnant women “should not lead clinicians to withhold this practice, which is routine in all populations”, warning that this would amount to another “form of exclusion” of pregnant people.
“Perhaps it is more important now than ever to remember that benefit to the pregnant patient is a sufficient reason for an intervention; however, benefit to the fetus or newborn is not required for an intervention to be worthwhile,” they wrote.
