Expert consensus on the screening, diagnosis, and management of perinatal iron deficiency anemia in Egypt

Iron deficiency anemia (IDA) during the perinatal period, including pregnancy and postpartum, is a significant public health challenge among Egyptian women. Although its prevalence has improved, there are still gaps in screening, diagnosis, and management, which negatively impact maternal and child health. This expert consensus offers a broad view of risk factors, preventive measures, early screening, diagnosis, and commits to deliver actionable recommendations for managing perinatal and pregnancy-related IDA in our setting, with applicability to resource-limited societies.

A comprehensive systematic search in PubMed, Scopus, and the Cochrane Library on IDA in pregnancy, including risk factors, prevention, diagnosis, management, and follow-up, was conducted from January to February 2024. The Delphi technique was applied over three rounds with 12 experts, and statements were retained at ≥80% agreement level.

The literature search yielded 56 studies. Forty-seven open-ended questions were formulated, generating 54 statements, refined to 53 final statements. The consensus emphasized the importance of early screening of at-risk women through regular hemoglobin (Hb) and ferritin tests to encourage early interventions. Pregnant women should have at least one IDA screening every trimester, with frequency adjusted as per the clinical severity. IDA was diagnosed using Hb thresholds in combination with red blood cell indices, serum ferritin levels < 30 μg/L, and additional tests when indicated. Diagnostic Hb cutoffs vary by pregnancy trimester: <12 g/dL in nonpregnant women, <11 g/dL in the first and third trimesters, <10.5 g/dL in the second trimester, and <10 g/dL postpartum. IDA severity is classified into three categories: mild (Hb 10-10.4 g/dL), moderate (9-9.9 g/dL), and severe (<9 g/dL). Oral iron is the first-line treatment for mild and moderate IDA. Intolerant patients, those suffering from severe anemia, or requiring rapid correction should receive intravenous iron formulations, with ferric carboxymaltose having proven efficacy and safety. Blood transfusion is the last resort for patients with very severe states with cardiovascular instability. The consensus emphasizes the importance of counseling, diet, and micronutrient supplementation for IDA prevention.

This expert consensus provided a comprehensive approach and a systematic framework for IDA management in Egypt. It guaranteed a timely diagnosis and prompt intervention to mitigate complications for both the mother and the fetus. Further research is needed to optimize screening and analyze treatment options and their impact over time.