Abstract
BackgroundIron deficiency anaemia is a common problem in pregnancy despite national recommendations and guidelines for treatment. The aim of this study was to appraise the evidence against the UK National Screening Committee (UKNSC) criteria as to whether a national screening programme could reduce the prevalence of iron deficiency anaemia and/or iron deficiency in pregnancy and improve maternal and fetal outcomes.MethodsSearch strategies were developed for the Cochrane library, Medline and Embase to identify evidence relevant to UK National Screening Committee (UKNSC) appraisal criteria which cover the natural history of iron deficiency and iron deficiency anaemia, the tests for screening, clinical management and evidence of cost effectiveness.ResultsMany studies evaluated haematological outcomes of anaemia, but few analysed clinical consequences. Haemoglobin and ferritin appeared the most suitable screening tests, although future options may follow recent advances in understanding iron homeostasis. The clinical consequences of iron deficiency without anaemia are unknown. Oral and intravenous iron are effective in improving haemoglobin and iron parameters. There have been no trials or economic evaluations of a national screening programme for iron deficiency anaemia in pregnancy.ConclusionsIron deficiency in pregnancy remains an important problem although effective tests and treatment exist. A national screening programme could be of value for early detection and intervention. However, high quality studies are required to confirm whether this would reduce maternal and infant morbidity and be cost effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0679-9) contains supplementary material, which is available to authorized users.
Highlights
Iron deficiency anaemia is a common problem in pregnancy despite national recommendations and guidelines for treatment
Search strategies were adapted for each database and included combinations of medical subject headings (MeSH terms) relevant to iron deficiency and iron deficiency anaemia in pregnancy combined with free text search terms
Results for criteria relating to policies for diagnostic investigation and treatment of iron deficiency and iron deficiency anaemia were presented together as they are discussed simultaneously in UK clinical guidelines
Summary
Iron deficiency anaemia is a common problem in pregnancy despite national recommendations and guidelines for treatment. The incidence and aetiology vary considerably between low and high-income countries, with iron deficiency considered the most common cause in the latter. Recent prevalence estimates of maternal anaemia in pregnancy in the UK and other high-income countries, suggest there has been no significant decrease in the prevalence of anaemia in pregnancy in the last. Iron deficiency in pregnancy is, in principle, identifiable, treatable and possibly preventable with iron supplementation, there is uncertainty about its significance as a clinical and public health problem, and whether systematic screening and treatment for iron deficiency and iron deficiency anaemia in pregnancy would improve maternal and infant outcomes. Recommendations for current practice in the UK are to assess the mother’s haemoglobin concentration at booking and at 28 weeks’ gestation and ensure there are systems in place to follow up abnormal results [4]; routine assessment of iron status is not recommended in all women [5]
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