Three physicians advocated for universal iron deficiency screening during pregnancy, directly challenging recent U.S. Preventive Services Task Force (USPSTF) recommendations that cited insufficient evidence for routine screening.
In a letter published in JAMA, the physicians argued that the USPSTF's stance could have significant real-world consequences, particularly for patients with complex blood group antigen patterns and those who decline blood transfusions.
"We are concerned that if clinical judgment regarding whether to screen for iron deficiency and iron deficiency anemia and whether to provide routine iron supplementation during pregnancy is not done in a liberal fashion, serious consequences may arise," wrote Peter Kranke, MD, MBA, MME, of University Hospital Würzburg; Daniel Surbek, MD, of Inselspital Bern; and Maureen O. Achebe, MD, MPH, of Brigham and Women’s Hospital.
The authors emphasized that iron deficiency affects at least 5% of people, with women experiencing higher rates than men. Approximately 20% of pregnant individuals are iron deficient. Without treatment, this condition can progress to iron deficiency anemia, potentially leading to adverse outcomes, including the need for peripartum transfusions, maternal infections, preterm birth, and neurodevelopmental disorders in children.
The physicians noted that symptoms of iron deficiency and its associated anemia often mirror typical pregnancy symptoms, complicating identification without screening protocols. They emphasized that iron deficiency anemia can be asymptomatic and frequently develops in otherwise healthy pregnant individuals due to increased iron requirements during pregnancy.
"Thus, we call for greater clarity in the USPSTF recommendations and meanwhile advocate for universal screening for iron deficiency in pregnant women," the authors concluded, recommending "early detection and treatment of iron deficiency in pregnancy, including the use of intravenously administered iron when necessary, to prevent adverse maternal and fetal outcomes."
Full disclosures can be found in the letter.
