Revisiting the basis for haemoglobin screening in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Global Public Health

Background:

• Anemia affects up to 50% of pregnancies globally, contributing to maternal and neonatal morbidity and mortality.
• Effective prevention and management of anemia in pregnancy remain critical public health priorities.
• Optimal strategies for identifying and treating anemia in pregnant women are debated globally.

Purpose of the Study:

• To review the current landscape of hemoglobin testing for anemia in pregnant women.
• To compare anemia identification and management approaches in low- and high-income countries.
• To highlight limitations of current diagnostic thresholds and treatment protocols.

Main Methods:

• Literature review of current practices in hemoglobin testing during pregnancy.
• Analysis of diagnostic thresholds and treatment strategies in diverse global settings.
• Synthesis of findings to inform future research and policy.

Main Results:

• Current anemia definitions rely on hemoglobin thresholds that may not accurately detect iron deficiency, the primary cause of maternal anemia.
• Historical thresholds were derived from mixed populations, potentially limiting their applicability to pregnant women.
• Iron therapy is often provided without investigating the underlying cause, which may be insufficient in regions with complex anemia etiologies.

Conclusions:

• Existing hemoglobin thresholds for defining anemia in pregnancy require re-evaluation.
• Future research and policy should prioritize developing optimal strategies to identify pregnant women at risk for anemia from all causes.
• A nuanced approach to anemia diagnosis and management is needed, considering diverse global contexts and etiologies.