Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec;109(6):633-642.
doi: 10.1111/ejh.13870. Epub 2022 Oct 4.

The incidence, complications, and treatment of iron deficiency in pregnancy

Ashley E Benson  1 , Joseph J Shatzel  2   3 , Kim S Ryan  1 , Madeline A Hedges  1 , Kylee Martens  2 , Joseph E Aslan  2 , Jamie O Lo  1
Affiliations
Review

The incidence, complications, and treatment of iron deficiency in pregnancy

Ashley E Benson et al. Eur J Haematol. 2022 Dec.

Abstract

Iron deficiency and/or iron deficiency anemia (IDA) complicate nearly 50% of pregnancies globally, negatively impacting both maternal and fetal outcomes. Iron deficiency can cause a range of symptoms that range from aggravating to debilitating including fatigue, poor quality of life, pagophagia, and restless leg syndrome. Iron deficiency and IDA are also associated with maternal complications including preterm labor, increased rates of cesarean delivery, postpartum hemorrhage, and maternal death. Fetal complications include increased rates of low birth weight and small for gestational age newborns. Prenatal maternal anemia has also been associated with autism spectrum disorders in the neonate, although causation is not established. Deficiency in the newborn is associated with compromised memory, processing, and bonding, with some of these deficits persisting into adulthood. Despite the prevalence and consequences associated with iron deficiency in pregnancy, data show that it is routinely undertreated. Due to the physiologic changes of pregnancy, all pregnant individuals should receive oral iron supplementation. However, the bioavailability of oral iron is poor and it is often ineffective at preventing and treating iron deficiency. Likewise, it frequently causes gastrointestinal symptoms that can worsen the quality of life in pregnancy. Intravenous iron formulations administered in a single or multiple dose series are now available. There is increasing data suggesting that newer intravenous formulations are safe and effective in the second and third trimesters and should be strongly considered in pregnant individuals without optimal response to oral iron repletion.

Keywords: anemia; blood loss; iron deficiency; oral iron; pregnancy.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Maternal and offspring complications imparted by iron deficiency anemia
Figure 2.
Figure 2.
Proposed algorithm for diagnosing and treating iron deficiency anemia in pregnancy. *Our institutional practice is to treat isolated iron deficiency with IV iron in the 2nd and 3rd trimester
See this image and copyright information in PMC

References

    1. WHO/UNICEF/UNU. Iron deficiency anaemia: assessment, prevention and control, a guide for programme managers. World Health Organization; Geneva Switzerland. 2001. WHO/NHD/01.3. In.
    1. Lee AI, Okam MM. Anemia in pregnancy. Hematol Oncol Clin North Am. 2011;25(2):241–259, vii. - PubMed
    1. Bill & Melinda Gates Foundation. Maternal Mortality. 2022. Available from https://www.gatesfoundation.org/goalkeepers/report/2021-report/progress-.... Last accessed September 19, 2022.
    1. Murray C, Lopez AD. Global and regional cause-of-death patterns in 1990. Bulletin of the World Health Organization. 1994;72(3):447. - PMC - PubMed
    1. Osungbade KO, Oladunjoye AO. Preventive treatments of iron deficiency anaemia in pregnancy: a review of their effectiveness and implications for health system strengthening. J Pregnancy. 2012;2012:454601. - PMC - PubMed