National Academies Press: OpenBook

Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age (1993)

Chapter: RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN

« Previous: RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN NONPREGNANT WOMEN OF CHILDBEARING AGE
Suggested Citation:"RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

Recommended Guidelines For Preventing And Treating Iron Deficiency Anemia In Pregnant Women

A. Screen for Anemia at the First Prenatal Visit and Treat as Appropriate

  1. If the first prenatal visit occurs in the first trimester, draw blood and determine hemoglobin and ferritin concentrations. Obtain medical evaluation when the hemoglobin concentration is <9.0 g/dl or the hemoglobin is between 9.0 and 10.9 g/dl and the serum ferritin concentration is >30 µ/liter.
  2. Do not treat with iron when the hemoglobin concentration is 11.0 g/dl and the serum ferritin concentration is >20 µg/liter.
  3. Give 30 mg of supplemental iron when the hemoglobin concentration is between 9.0 and 10.9 g/dl and the serum ferritin concentration is between 12 and 20 µg/liter, or the hemoglobin concentration is 11.0 g/dl and the ferrit-in concentration is 20 µg/liter.
  4. Give 60-120 mg of supplemental iron when the hemoglobin concentration is between 9.0 and 10.9 g/dl and the ferritin concentration is <12 µg/liter.
  5. At subsequent prenatal visits, evaluate the hemoglobin concentration. If there has been no response to iron supplementation, refer for additional medical evaluation. If the hemoglobin concentration is normal for that stage of pregnancy, lower the supplemental iron dose to 30 mg of iron per day.

NOTE: Blacks may normally have hemoglobin levels 0.8 mg less than those for other races. Adjustments should be made for higher hemoglobin levels observed in women accustomed to higher altitudes or those who smoke cigarettes.

B. Screen for Anemia at the Second-Trimester Visit and Treat as Appropriate

  1. At a scheduled second-trimester visit, or if the first prenatal visit occurs in the second trimester, obtain a blood specimen and determine the hemoglobin and serum ferritin concentrations. Although the serum ferritin concentration declines during the second trimester of pregnancy, the measurement can be useful in assisting with the interpretation of the hemoglobin value. Refer for additional medical evaluation when the hemoglobin concentration is <9.0 g/dl.
  2. Prescribe 60-120 mg of supplemental iron per day when the hemoglobin concentration is between 9.0 and 10.4 g/dl in the presence of a serum ferritin concentration of < 12 µg/liter.
  3. Prescribe 30 mg of supplemental iron per day when the hemoglobin concentration is 10.5 g/dl in the presence of a serum ferritin concentration of 20 µg/liter. If the serum ferritin concentration is >20 µg/liter, no treatment is needed.
Suggested Citation:"RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
  1. Stop supplemental iron at delivery (at the 4- to 6-week postpartum visit if anemia continued through the third trimester).

C. Screen for Anemia at the Third-Trimester Visit and Treat as Appropriate

  1. At a scheduled third-trimester visit, or if the first prenatal visit occurs in the third trimester, obtain a blood specimen and determine the hemoglobin concentration. Obtain medical evaluation when the hemoglobin concentration is <9.0 g/dl.
  2. Prescribe 60-120 mg of supplemental iron per day when the hemoglobin concentration is between 9.0 and 10.9 g/all.
  3. Prescribe 30 mg of supplemental iron per day when the hemoglobin concentration is 11.0 g/dl.
  4. Stop supplemental iron at delivery (at the 4- to 6-week postpartum visit if anemia continued through the third trimester).

D. Screen High-Risk Women for Anemia at the 4- To 6-Week Postpartum Visit

Screen women at high risk for iron deficiency anemia at the 4- to 6-week postpartum visit (risk factors include anemia continued through the third trimester, excessive blood loss during delivery, or multiple births). Obtain a blood specimen and determine the hemoglobin concentration. Interpret the results with the same criteria as for nonpregnant women.

E. Advise on Diet at Each Prenatal Visit

  1. Eat a varied diet of iron-rich foods and foods that enhance iron absorption (meats and ascorbic acid-rich fruits). Items that inhibit absorption of iron (tea, coffee, whole-grain cereals [particularly bran], unleavened whole-grain breads, and dried beans) should be consumed separately from iron-rich foods.
  2. Follow the guidelines of Nutrition and Your Health: Dietary Guidelines for Americans (DHHS/USDA, 1991) and Nutrition During Pregnancy and Lactation: An Implementation Guide (IOM, 1992b).

NOTE: If 120 mg of supplemental iron per day is prescribed, recommend delivery of one 60-mg tablet twice a day.

Suggested Citation:"RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
Page 24
Suggested Citation:"RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
Page 25
Next: RECOMMENDATIONS FOR RESEARCH »
Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age Get This Book
×
Buy Paperback | $44.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

This book summarizes information related to public health measures on the prevention, detection, and management of iron deficiency anemia. It presents draft guidelines and recommendations related to this area, as applicable in primary health care and public health clinic settings, and it formulates recommendations for research. This volume is intended both to provide a common frame of reference for health professionals in preventing and treating iron deficiency anemia and to enable the U.S. Centers for Disease Control and Prevention to prepare national guidelines and recommendations for the prevention and control of iron deficiency anemia.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!