Table 1 Summary of existing guidance for the management of anaemia or iron deficiency anaemia (IDA) in pregnancy in the UK

British Committee for Standards in Haematology [5]

2012

UK guidelines on the management of iron deficiency in pregnancy

• Women with Hb <110 g/l or <105 g/l in the second and third trimesters, should have a trial of oral iron as the first line diagnostic test for microcytic or normocytic anaemia; an increased Hb after two weeks of therapy is taken to be confirmatory (1B).

• Refer to secondary care for further investigation for other causes of anaemia if Hb does not improve after 2 weeks, severe <70 g/l, significant symptoms or late gestation (>34 weeks) (2B).

• Routine ferritin testing in non-anaemic pregnant women is not recommended unless they are ‘at risk’ of iron deficiency (2B).

• Treatment is suggested where ferritin is <30 mcg/l with rapid review and follow up of results (2A)

Women at risk include:

1. anaemic women where estimation of iron stores is necessary, e.g. women with haemogloblinopathies or prior to parenteral iron replacement

2. those who are not anaemic but at risk of iron depletion (previous anaemia, multiparity > 3, consecutive pregnancy, vegetarians, teenage pregnancies, recent history of bleeding)

3. Non-anaemic women where estimation of iron stores is necessary as significant blood loss may occur (high bleeding risk, Jehovah witnesses).

• Consider IV iron from the 2^nd trimester onwards if absolute non-compliance or intolerance to oral iron or proven malabsorption (1A)

• All women should receive dietary counselling detailing iron rich foods, inhibitory factors reinforced by provision of an information leaflet (1A)

• Evidence level AHCPR methodology

National Institute for Health and Care Excellence Clinical [4]

2008

Antenatal Care: routine care for the healthy pregnant woman. Guideline 62.

• Hb should be checked at booking and 28 weeks when other blood screening tests are being carried out (B)

• nutritional information should be offered to all pregnant women (A)

• Hb <110 g/l 1^st trimester and 105 g/l at 28 weeks should be investigated and iron supplementation considered in indicated (A)

• iron supplementation should not be offered routinely as there are unpleasant maternal side effects with no clearly demonstrated maternal and infant benefits (A)

• Evidence level GRADE methodology

Royal College of Obstetricians and Gynaecologists [6]

2007

Blood Transfusions in Obstetrics Green-top 47

• Anaemia should be treated to reduce probability of transfusion requirement (GPP).

• If Hb <105 g/l in the antenatal period, consider haematinic deficiency (GPP).

• Once haemoglobinopathies have been excluded, oral iron should be the first-line treatment for iron deficiency (GPP).

• Parenteral iron is indicated when oral iron is not tolerated, absorbed or patient compliance is in doubt (GPP).

• Evidence level AHCPR methodology + GPP (clinical good practice point where evidence lacking)