What is the recommended dose of iron supplementation for a pregnant individual with iron deficiency anemia?

Iron Dosing in Pregnancy

For routine prophylaxis in early pregnancy, prescribe 30 mg of elemental iron daily; for women at higher risk of iron deficiency anemia, prescribe 60-100 mg daily; and for treatment of established iron deficiency anemia, prescribe 60-120 mg of elemental iron daily. 1, 2

Dosing Algorithm Based on Clinical Scenario

Routine Prophylaxis (Low-Risk Women)

• 30 mg elemental iron daily is the standard dose prescribed in early pregnancy for women without risk factors 1, 2
• This dose is typically included in prenatal vitamins and meets the Institute of Medicine's recommended dietary allowance of 27 mg per day 1, 2
• Most pregnant women (77%) use multivitamin supplements containing approximately 48 mg of iron, which is adequate for prophylaxis 1

Higher-Risk Populations

• 60-100 mg elemental iron daily should be prescribed for women at increased risk of iron deficiency anemia 1, 2
• Risk factors include: Non-Hispanic Black or Mexican American ethnicity, vegetarian diet, gastrointestinal disease or medications that decrease iron absorption (such as antacids), short interval between pregnancies, and parity of 2 or more 1, 2
• Vegetarian women may require almost twice as much iron since nonheme iron from plant sources is less well absorbed than heme iron from animal sources 1, 2

Treatment of Established Iron Deficiency Anemia

• 60-120 mg elemental iron daily is the therapeutic dose for treating diagnosed iron deficiency anemia in pregnancy 1, 3
• This dose should be started immediately upon diagnosis without waiting for additional confirmatory testing 3
• Treatment should continue throughout pregnancy and the postpartum period to prevent recurrence 3
• Monitor response with repeat hemoglobin/hematocrit testing after 4 weeks of treatment, expecting an increase of ≥1 g/dL 3

Optimizing Iron Absorption and Tolerability

Timing and Administration

• Take iron at bedtime to reduce gastrointestinal side effects 2, 3
• Take iron between meals for optimal absorption 4
• Avoid concurrent calcium supplements and antacids, which decrease iron absorption; take these at different times of day 2, 3

Common Side Effects

• Gastrointestinal symptoms (nausea, constipation) are the most common adverse effects 1
• Darkening color of urine or stool is expected and harmless 1, 2
• Staining of teeth and gums can occur 1, 2
• Side effects increase with higher doses but are generally comparable between 60-120 mg doses 5

When to Consider Intravenous Iron

• Consider IV iron if no response to oral iron after 4 weeks despite compliance 3
• Before switching to IV iron, confirm compliance and rule out other causes of anemia such as thalassemia minor or sickle cell trait 3
• Ferric carboxymaltose is the preferred IV formulation due to rapid effectiveness and better tolerability 3
• IV iron administration should be performed in settings with resuscitation facilities available due to rare but serious allergic reactions 3

Critical Pitfalls to Avoid

• Do not prescribe doses higher than 120 mg daily for routine supplementation, as higher dosages have potential negative effects on mineral absorption, oxidative pathways, and adverse gastrointestinal symptoms without additional benefit 6
• Do not fail to identify high-risk women who need increased supplementation beyond the standard 30 mg dose 2
• Do not continue routine supplementation postpartum in breastfeeding women without documented anemia or risk factors 7

Note: The answer options provided (1000,2000,3000,4000) appear to be in milligrams and are all incorrect. The correct doses are 30-120 mg of elemental iron daily depending on the clinical scenario, not thousands of milligrams. 1, 2, 3