Iron optimisation in pregnancy: a Haematology in Obstetric and Women's Health Collaborative consensus statement

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Nutritional Science

Background:

• Iron deficiency (ID) in pregnancy is prevalent, affecting up to 70% of Australian pregnancies.
• ID's effects, including physical and neuropsychological symptoms, can precede anaemia development.
• Foetal and neonatal ID is linked to impaired neurocognitive development with lasting consequences.

Framework:

• Consensus statement developed by the Haematology in Obstetrics and Women's Health (HOW) Collaborative.
• Utilized the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for evidence evaluation.
• Provides evidence-based recommendations for identifying and managing obstetric ID.

Implementation:

• Routine ferritin screening recommended at booking and 24-28 weeks gestation (GRADE 1C).
• ID in pregnancy defined as ferritin level <30 μg/L (GRADE 1D).
• First-line therapy: appropriate oral iron formulation; alternate-day dosing considered for side effect management (GRADE 1B, 2B).
• Intravenous iron offered for oral iron intolerance/refractoriness or in the third trimester (GRADE 1B).

Implications:

• Aims to improve the underappreciated impact of obstetric ID on individual and population health.
• Establishes consensus for the identification and management of ID in pregnant women.
• Highlights the importance of early detection and treatment to mitigate adverse outcomes.