This is a new guideline from BSH on managing iron deficiency in pregnancy. It was published in Oct 2019.
There were quite a few points in here that I found interesting and was not aware of. It will certainly make me think a bit more carefully about those requests from the midwife to prescribe iron. I will list the things I learnt from this guideline then do a more general summary.
What did I learn from this guideline?
There is a lot of uncertainty about managing anaemia and iron deficiency in pregnancy. A lot of what we do is based on consensus, rather than on evidence.
- Ferritin should be checked in women with a haemoglobinopathy before starting iron treatment to ensure that they do not become iron overloaded.
- How should iron tablets be taken? To maximise absorption it should be taken on an empty stomach with either water or a juice containing vitamin C. It should not be taken with other medications, food or vitamins.
- After starting iron tablets, recheck the haemoglobin (Hb) at 2-3w. This is to ensure the patient is responding. If they aren’t, consider other causes of anaemia.
- Aim to give the equivalent of 40 – 80mg of iron a day (see below). If the patient gets side-effects, give a lower dose, or try alternate day dosing. There is good evidence that lower doses and alternate day dosing is effective.
- Some women are at higher risk of anaemia due to low pre-pregnancy iron stores (see below). These women should be screened for at booking. You can either start them on empirical iron, or check ferritin first.