Iron deficiency during pregnancy: a common problem with a surprisingly simple solution. A recent study highlights a dramatic improvement in how we screen for and treat iron deficiency in pregnant women. This is crucial because, as we'll see, iron deficiency can have significant impacts on both mother and baby.
Within just one year, a collaborative project saw remarkable results: a sixfold increase in iron deficiency screening, a 20-fold jump in intravenous (IV) iron infusions, and a significant boost in hemoglobin levels.
Screening rates soared from a mere 10% to over 60% within a year. But here's where it gets controversial... Two-thirds of the screened pregnant patients were found to be iron deficient. This highlights a widespread, yet often overlooked, issue.
Dr. Richard Godby, a hematologist at the Mayo Clinic and lead author of the study, explains that women of childbearing age are particularly vulnerable. Factors like menstruation and a diet lacking in iron-rich foods are major contributors. Moreover, some common medications, such as proton pump inhibitors, can hinder iron absorption.
Why is this so important? The body needs extra iron during pregnancy. Iron deficiency and anemia during pregnancy have been linked to adverse outcomes, including restricted fetal growth, premature birth, low birth weight, and even impaired brain and nervous system development in the fetus.
Iron deficiency can be diagnosed through a simple blood test that measures ferritin, a protein that stores iron. However, current guidelines from the American College of Obstetrics and Gynecology (ACOG) recommend screening only for pregnant women already showing signs of anemia, defined as a hemoglobin level below 11 g/dL in the first or third trimester.
Dr. Godby and his team at the Mayo Clinic implemented a quality improvement project. They standardized the screening and treatment of iron deficiency in pregnancy. They added ferritin testing to the routine lab work done at 8 to 12 weeks and again at 24 to 28 weeks of pregnancy. If ferritin levels were low, oral iron supplements or IV iron dextran infusions were offered.
To measure the project's impact, the researchers compared two groups of patients: one before the project (the "Before" cohort, comprising 2,097 pregnancies) and one after (the "After" cohort, with 2,429 pregnancies).
The results were striking: Only 10% of patients in the "Before" cohort underwent ferritin testing, compared to 63% in the "After" cohort. Among those tested, iron deficiency was present in 66% of the "Before" group and 69% of the "After" group. The use of IV iron dextran infusions increased dramatically, from 0.9% in the "Before" group to 21% in the "After" group.
For patients who received IV iron infusions, the median hemoglobin level improved from 10.7 to 11.8 g/dL. Even those with hemoglobin levels already above the 11 g/dL cutoff saw an increase. Dr. Godby suggests that these findings warrant a reevaluation of the current anemia screening thresholds.
Furthermore, the need for blood transfusions during delivery decreased slightly after the project's implementation. While this difference wasn't statistically significant, it hints at another potential benefit of addressing iron deficiency during pregnancy.
And this is the part most people miss... Dr. Godby points out that most patients in both groups were already taking prenatal vitamins, which are supposed to contain iron. However, these supplements are often purchased over the counter, and their contents aren't always guaranteed.
As a next step, the team hopes to investigate whether treating iron deficiency can improve patients' quality of life, including less postpartum depression and an earlier return to work.
Dr. Godby presented this study on Sunday, December 7, 2025, at the Orange County Convention Center.
What are your thoughts? Do you think current screening guidelines are adequate? Could more widespread screening for iron deficiency during pregnancy improve outcomes? Share your opinions in the comments below!
