What is the treatment for iron deficiency anemia in pregnancy?

Treatment for Iron Deficiency Anemia in Pregnancy

The primary treatment for iron deficiency anemia in pregnancy is oral iron supplementation at a dose of 60-120 mg/day, along with dietary counseling to increase iron-rich foods. 1

Diagnosis and Initial Management

• Screen for anemia at the first prenatal visit using hemoglobin or hematocrit measurements appropriate for the specific stage of pregnancy 1
• Confirm positive screening results with repeat hemoglobin or hematocrit testing 1
• If the pregnant woman is not acutely ill, a presumptive diagnosis of iron deficiency anemia can be made and treatment initiated 1

Treatment Algorithm

First-line Treatment:

• Oral iron supplementation at 60-120 mg/day of elemental iron 1
• Counsel patients about consuming iron-rich foods and foods that enhance iron absorption 1
• Monitor response to treatment after 4 weeks 1

Response Assessment:

• Adequate response: Hemoglobin increase of ≥1 g/dL or hematocrit increase of ≥3% after 4 weeks 1
• When hemoglobin/hematocrit normalizes for gestational age, decrease iron dose to 30 mg/day 1

Inadequate Response:

• If after 4 weeks there is no improvement despite compliance, further evaluate with additional tests including MCV, RDW, and serum ferritin 1
• Consider alternative diagnoses such as thalassemia minor or sickle cell trait, particularly in women of African, Mediterranean, or Southeast Asian ancestry 1

Severe Anemia:

• If hemoglobin is <9.0 g/dL or hematocrit is <27.0%, refer to a physician experienced in managing anemia during pregnancy 1
• Consider intravenous iron therapy for severe anemia or when oral iron is not tolerated 1, 2

Special Considerations

• Gastrointestinal side effects are common with oral iron and may affect compliance 3, 4
• Recent research shows intravenous iron (such as ferumoxytol) produces superior increases in hemoglobin, hematocrit, iron, and ferritin levels compared to oral iron 2
• For pregnant women with severe anemia, intravenous iron may be more effective at rapidly correcting anemia 5, 2

Monitoring and Follow-up

• Continue monitoring hemoglobin/hematocrit levels throughout pregnancy 1
• During the second or third trimester, if hemoglobin is >15.0 g/dL or hematocrit is >45.0%, evaluate for potential pregnancy complications related to poor blood volume expansion 1
• For women with risk factors (anemia in third trimester, excessive blood loss during delivery, multiple birth), screen for anemia at 4-6 weeks postpartum 1
• If no risk factors for anemia are present, supplemental iron should be stopped at delivery 1

Preventive Measures

• All pregnant women should receive low-dose (30 mg/day) iron supplements starting at the first prenatal visit, even without anemia 1
• The Recommended Dietary Allowance for iron in pregnant women is 27 mg per day 1
• Encourage consumption of iron-rich foods including meat, poultry, certain fruits and vegetables, and iron-fortified grain products 1