Abstract
SUMMARYThe aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL−1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.
Highlights
Searches of the following regional and international databases were conducted in August 2015: CENTRAL, Web of Science, POPLINE, Open Grey, DARE, IBECS, Scielo, World Health Organization (WHO) Global Index Medicus (GIM): African Index and Medicus (AIM), Index Medicus for the WHO Eastern, Mediterranean Region (IMEMR), LILACS, Pan American Health Library (PAHO), Western Pacific Region Index Medicus (WPRIM), Index Medicus for South-East Asia Region (IMSEAR) and the WHO Library (WHOLIS)
Studies were excluded if authors had not pre-specified values for iron deficiency according to serum ferritin concentrations prior to administering an intervention but had selected a value based on response to treatment
Of the remaining studies that did, 10 studies cited the World Health Organization (WHO) 2001 guidelines as the reference for the threshold used; 9 studies referenced the Centres for Disease Control and Prevention (CDC) 1998 guidelines (MMWR, 1998) as the reference for the threshold used; 8 of the included studies referenced primary studies, including comparing serum ferritin levels with bone marrow aspirates taken from pregnant populations; and/or studies deriving thresholds from statistical analyses of laboratory reference ranges
Summary
The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. There is variation in serum ferritin thresholds used to define iron deficiency in primary studies and in different policy documents (MMWR, 1998; World Health Organization, 2001). This makes it difficult to understand the scale of iron deficiency and interpret the effectiveness of interventions both at individual and population levels (Garcia-Casal et al, 2014). This systematic review was prospectively designed to investigate the range and characteristics of the thresholds of serum ferritin used to diagnose iron deficiency in pregnant women, used in primary intervention studies and national and international guidelines
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