Screening and Treatment of Obstetric Anemia: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines


Project Status:
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
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  1. What is the clinical effectiveness of screening obstetric iron deficiency in the first or second trimester using ferritin testing?
  2. What is the cost effectiveness of for screening obstetric iron deficiency in the first or second trimester using ferritin testing?
  3. What are the evidence-based guidelines for assessing and treating obstetric iron deficiency?

Key Message

This review included ten guidelines. No clinical or economic studies were identified on screening for obstetric iron deficiency anemia in the first or second trimester using ferritin testing.Routine hemoglobin measurement at each trimester of pregnancy is generally recommended to assess iron deficiency anemia. Serum ferritin testing should be reserved for pregnant persons with possible hemoglobinopathies (e.g., thalassemia, sickle cell anemia), anemia of infection, vitamin B12 or folic acid deficiency, unexplained iron deficiency anemia, non-anemic persons at risk of iron deficiency, or suspected chronic blood loss. After delivery, hemoglobin should be measured within 24 to 48 hours in persons with blood loss more than 500 mL, those with uncorrected anemia detected during pregnancy or those with symptoms suggestive of anemia postnatally. Oral iron is the first line treatment with repeated measure of hemoglobin to assess compliance, correct administration and response to treatment. Intravenous iron should be used in persons who are intolerant of, or do not respond to oral iron treatment, or those with moderately severe to severe anemia. One guideline could not assess the benefits and harms of screening and iron supplementation in pregnant persons due to insufficient evidence. While the scope and purpose of the included guidelines were clearly described, only half of the identified guidelines were explicit in terms of rigour of development and authors assessed the level of evidence, which was deemed to be of very low to moderate quality. Therefore, these recommendations should be interpreted with caution.