BMJ 2015;350:h1841 doi: 10.1136/bmj.
h1841 (Published 7 April 2015)
News
Evidence for iron deficiency screening inadequate,
US panel concludes
Michael McCarthy
Seattle
The evidence to support routine screening of asymptomatic
pregnant women and children for iron deficiency anemia is
inadequate, the US Preventive Services Task Force has found.
The task force is an independent body commissioned by the US
government to make recommendations concerning the
effectiveness of preventive care services for asymptomatic
patients. Its panels do not have regulatory authority but their
recommendations are often influential in guiding policy and
practice.
The task force released two draft recommendations on screening
for iron deficiency on 1 April, one on screening pregnant women
and a second on screening children aged 6 to 24 months.1 2 These
recommendations were based on two systematic reviews,
published in the Annals of Internal Medicine and Pediatrics,
respectively.3 4
In the case of screening asymptomatic pregnant women for iron
deficiency anemia, the task force panel found no studies that
evaluated the direct effects of routine screening on maternal
health or birth outcomes. It found inadequate evidence to support
the treatment of iron deficiency in pregnant women in the United
States because the most recent studies were done abroad, and
the panel considered their results not generalizable to the US
population.
It is estimated that 18.6% of pregnant women in the US have
iron deficiency and about 16.2% of those have anemia. The
rates of screening and supplementation in pregnant women are
not well documented. However, based on anecdotal evidence,
it is likely quite common, the panel said.
Overall the panel found that there was not enough evidence to
demonstrate a benefit from routine iron supplementation during
pregnancy on maternal health or birth outcomes, including
maternal iron deficiency anemia, cesarean delivery, preterm
delivery, infant mortality, or low birth weight.
The panel did find adequate evidence that routine iron
supplementation during pregnancy improved maternal
hematological indexes, such as ferritin and hemoglobin, but
found no studies that directly assessed the association between
change of iron status as the result of treatment or
supplementation and improvement in maternal or infant health
outcomes.
The panel noted that the US Centers for Disease Control and
Prevention currently recommends anemia screening and the
initiation of low dose iron supplementation at the first prenatal
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care visit for all pregnant women; the Institute of Medicine
recommends anemia screening in each trimester of pregnancy;
and the American Congress of Obstetricians and Gynecologists
recommends screening all pregnant women for anemia and
treating those with iron deficiency anemia with supplemental
iron.
In the case of children aged 6 to 24 months, the panel found
inadequate evidence that routine screening for iron deficiency
anemia improved growth or cognitive, psychomotor, or
neurodevelopmental outcomes. The panel found no studies that
evaluated the direct effect of routine screening on child health
outcomes, nor did they find studies that directly assessed the
association between change in iron status as the result of
intervention and a change in health outcomes.
The prevalence of iron deficiency anemia in children aged 12
to 35 months in the US is estimated to be 2.1%. Although some
observational studies have shown that iron deficiency anemia
in early childhood was associated with neurodevelopmental and
behavioral delays, the panel said, it was difficult to conclude
that there was a direct causal link between the two because of
the methodological flaws in those studies and potential
confounding due to nutritional and socioeconomic differences
between groups.
The panel noted that its recommendations did not apply to
children younger than 6 months or older than 24 months, to
children who were severely malnourished, children born
prematurely, or those who had symptoms of iron deficiency or
anemia.
The draft recommendations were posted online and are open
for comment until 27 April.
1 US Preventive Services Task Force. Draft recommendation statement. Iron deficiency
anemia in pregnant women: screening and supplementation. Mar 2015. www.
uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/iron-
deficiency-anemia-in-pregnant-women-screening-and-supplementation.
2 US Preventive Services Task Force. Draft recommendation statement. Iron deficiency
anemia in young children: screening and supplementation. Mar 2015. www.
uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/iron-
deficiency-anemia-in-young-children-screening-and-supplementation.
3 Cantor AG, Bougatsos C, Dana T, Blazina I, McDonagh M. Routine iron supplementation
and screening for iron deficiency anemia in pregnancy: a systematic review for the US
Preventive Services Task Force. Ann Intern Med 30 Mar 2015, doi:10.7326/M14-2932.
4 McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C. Screening and routine
supplementation for iron deficiency anemia: a systematic review. Pediatrics
2015;135;723-3.
Cite this as: BMJ 2015;350:h1841
BMJ Publishing Group Ltd 2015
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