Iron Deficiency Among Pregnant Women: ‘A Problem of Epidemic Proportions’

By Michael Vlessides, /alert Contributor
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Iron deficiency in rampant in pregnancy. That’s the conclusion of a Canadian research team, whose study found that more than three in four pregnant women are iron deficient, a problem they say is underappreciated at most centers.

In a presentation at the American Society of Hematology Annual Meeting & Exposition, investigators from St. Michael’s Hospital in Toronto noted that while women of childbearing age are at greatest risk of iron deficiency, the odds climb even higher during pregnancy when fetal growth and blood-volume expansion increase iron demand to approximately 5.0mg/day by the third trimester.

Pregnant woman taking iron supplement. Source: Getty

Prenatal iron deficiency is associated with a host of potential negative sequelae in both the child (diminished cognitive performance, language ability, and motor functions) and mother (risk of blood transfusion and postpartum depression).

“Despite international recommendations and guidelines on the management of ID in pregnancy,” the authors wrote, “it remains a problem of epidemic proportions and is often unrecognized and left untreated.”

To help bridge this gap, the investigators implemented a quality-improvement project — dubbed IRON MOM — at the institution on January 1, 2017. The project’s first phase involved adapting lab requisitions and workflow in the obstetrics clinic to incorporate routine ferritin measurements at week 12, 16, and 28 of pregnancy. Once this was in place, the study then sought to assess the prevalence of iron deficiency in pregnant women.

To do so, the researchers collected administrative laboratory data from the institution’s electronic medical record system between January 1 and December 31, 2017. Sub-optimal iron stores were defined as serum ferritin between 30 and 50 μg/L. Similarly, iron deficiency was defined as serum ferritin between 15 and 29μg/L; severe iron deficiency was defined as <15μg/L. Finally, significant anemia was defined as hemoglobin levels <100 g/L.

The analysis found that 2,400 ferritin tests were completed on pregnant women at the institution during the one-year study period. Among these, 76.8% of tests (1,844/2400) demonstrated iron deficiency, with ferritin levels <30μg/L.

Of those, 30.2% of women (726/2400) had ferritin levels between 15 and 29μg/L, while 46.6% (1118/2400) were severely iron deficient (ferritin <15μg/L).

A total of 3,282 hemoglobin checks were performed during the study. Of these, 10.5% of patients (345/3282) were found to be significantly anemic (<100 g/L). What’s more, 6.2% (204/3282) had hemoglobin levels between 90 and 99g/L, 2.6% (85/3282) had hemoglobin levels between 80 and 89g/L, and 1.7% (56/3282) had hemoglobin levels less than 80g/L.

These findings, the researchers concluded, indicate that iron deficiency is commonplace in pregnant women. “This confirms that iron deficiency remains an underappreciated problem, even at a tertiary care [center],” they wrote.

“Our findings highlight a tremendous gap in awareness, which demands strategies to improve knowledge translation.” Future directions, they added, include the simplification and digitization of their quality-improvement project, which will help empower pregnant women to advocate for their own care.