Routine Iron Supplementation for Anemia Prevention
For this healthy 20-week pregnant woman with normal BMI, blood pressure, and no risk factors, the most appropriate health promotion intervention is advising iron supplements to prevent anemia (Option C).
Rationale for Iron Supplementation
Iron supplementation is the evidence-based preventive intervention indicated for this low-risk pregnancy. 1
- Among fertile women, only 20% have adequate iron reserves (>500 mg) needed for pregnancy, while 40% have virtually no iron stores 1
- Iron demand increases dramatically from 0.8 mg/day in early pregnancy to 7.5 mg/day in late pregnancy 1
- Without supplementation, 20% of pregnant women develop iron deficiency anemia 1
- An iron supplement of 65 mg/day from 20 weeks of gestation is adequate to prevent iron deficiency anemia 1
- Iron-treated pregnant women maintain higher hemoglobin levels and greater iron reserves both during pregnancy and postpartum compared to placebo-treated women 1
- Children born to iron-treated mothers have higher serum ferritin levels than those born to placebo-treated mothers 1
Why Other Options Are Not Indicated
Early Glucose Tolerance Test (Option A)
This patient has no indication for early glucose screening. 2, 3
- Early glucose testing (before 20 weeks) is only recommended for women at increased risk for undiagnosed type 2 diabetes 3
- Risk factors requiring early screening include: history of GDM/pre-diabetes, previous macrosomia (>4500g), obesity, metabolic syndrome, age >35 years, vascular disease, or high-risk ethnicity 3
- This 20-year-old patient with BMI 24 (normal weight) and no personal or family history of gestational diabetes has none of these risk factors 3
- Standard screening occurs at 24-28 weeks gestation for low-risk women 3, 4, 5
24-Hour Urine Protein (Option B)
Proteinuria screening is not indicated in normotensive pregnant women without hypertension. 2, 6, 7
- Proteinuria assessment is performed when evaluating for preeclampsia, which requires hypertension (≥140/90 mmHg) as a prerequisite 2, 6
- This patient's blood pressure is 110/70 mmHg, which is completely normal 2
- Preeclampsia is defined as gestational hypertension (≥140/90 mmHg developing after 20 weeks) plus significant proteinuria (≥0.3 g/day) 6, 7
- Without hypertension, proteinuria screening has no clinical utility for preeclampsia detection 2
Low-Dose Aspirin for Preeclampsia Prevention (Option D)
Aspirin prophylaxis is only indicated for women with specific high-risk factors, which this patient lacks. 2, 7
- Low-dose aspirin (75-100 mg/day) is recommended prophylactically only in women with history of early-onset preeclampsia (<28 weeks gestation) 2, 7
- It should be started before 16 weeks gestation in high-risk women 7
- This patient has no personal history of preeclampsia, normal blood pressure, and normal BMI 2
- General prophylactic aspirin for all pregnant women is not recommended based on guideline evidence 2
Clinical Implementation
Prescribe elemental iron 65 mg daily starting now (at 20 weeks). 1