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.


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OCR for page 24
--> 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 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. Do not treat with iron when the hemoglobin concentration is 11.0 g/dl and the serum ferritin concentration is >20 µg/liter. 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. 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. 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 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. 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. 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.

OCR for page 24
--> 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 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. Prescribe 60-120 mg of supplemental iron per day when the hemoglobin concentration is between 9.0 and 10.9 g/all. Prescribe 30 mg of supplemental iron per day when the hemoglobin concentration is 11.0 g/dl. 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 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. 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.