This is a new guideline from BSH on managing iron deficiency in pregnancy. It was published in Oct 19. 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.
What level of Hb is anaemia defined as in pregnancy?
Surprisingly there is a lot of debate about this in the haematology world. Current levels however are:
- Hb < 110 g/l before 12w.
- Hb < 105 g/l after 12w.
- Hb < 100 g/l immediately post-partum.