Fighting anemia: 50% of Ontario pregnancies impacted by low iron levels amid insufficient testing rates

31 Aug 2021 --- Canadian researchers are calling for greater awareness of iron levels during pregnancy, following the revelation that 40 percent of pregnant women in Ontario never had their iron levels checked. Half of the women who did have a simple blood test had low iron levels, demonstrating the ubiquity of this issue.

“Despite the very high prevalence of iron deficiency in pregnancy, and how easy it is to treat, we are not doing a very good job of checking for it,” says lead study author Dr. Jennifer Teichman of the University of Toronto.

She explains that it’s not top of mind, in part, because of inconsistent recommendations for ferritin testing across clinical guidelines. The researchers sought to provide more robust data about the prevalence and severity of iron deficiency among pregnant women. 

Testing and supplementation come forward
The researchers underscore the need to revisit clinical guidelines to ensure that ferritin testing, the standard measure of iron deficiency, is included as a routine part of maternal care and pregnancy health screenings.

Currently, the US Preventative Services Task Force does not recommend universal screening for iron deficiency in pregnancy, citing existing studies as “insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women.” 

However, Teichman argues there is now sufficient data showing the harms of iron deficiency and anemia in pregnancy, such that it would be unethical to conduct a study in which iron-deficient women are not given supplementation. Conversely, there are no conceivable harms to iron screening, she explains.

Teichman also notes that iron deficiencies are completely correctable with iron supplements, although standard prenatal vitamins by themselves cannot treat iron deficiency.

“Prenatal vitamins contain only a sprinkling of iron, and many combine iron with calcium, which can inhibit the absorption of iron. The way to address the problem is by identifying iron deficiency early on and then supplementing women with therapeutic doses of iron, which has ten times the amount found in most prenatal vitamins.”

Re-evaluating iron
The study, now published in Blood Advances, included 44,552 women who received prenatal testing at community laboratories. 

Altogether, about 60 percent of patients got a ferritin test during pregnancy. Most tests were ordered by general practitioners (48 percent) and obstetricians/gynecologists (32 percent). 

The vast majority of ferritin testing (71 percent) occurred at or around the time of the first prenatal visit, when the risk of iron deficiency is lowest and, often, patients’ iron levels were only checked once during their pregnancy.

“Iron deficiency becomes more common as women progress through pregnancy,” says Teichman. “If we don’t re-evaluate iron stores later in pregnancy, we miss a lot of women who are becoming iron deficient in later trimesters.”Teichman urges women to ask about their iron levels before and during their pregnancy.

Socioeconomic differences
Another key finding was that women of lower socioeconomic status were less likely to be tested for iron deficiency, which underscores differences in access to care and how clinicians may treat these patients differently.

This difference is especially notable as Canada has a publicly funded health care system, which means patients don’t incur the cost of ferritin testing. 

However, all pregnant people need high levels of iron to support the developing fetus, the growing placenta and the increased blood supply needed to sustain the pregnancy.

Iron deficiency is the most common cause of anemia (low hemoglobin or red blood cell count) during pregnancy, which has been linked to poorer outcomes for both mother and baby, including a higher risk of premature delivery, low birth weight, postpartum depression and even maternal death. 

Anemia early in pregnancy has also been associated with neurodevelopmental delays in the offspring, even as the child approaches school age and beyond, which points to potentially long-lasting effects. Low levels of iron alone can cause pregnant women to experience fatigue, weakness and brain fog.

Alternative ways to target iron levels
Considering how widespread anemia is, it is unsurprising that it has been a major focus for the nutrition industry.

Late last year, Hofseth BioCare launched what it says is the first and only product without iron in the US market to maintain healthy ferritin and hemoglobin levels.

Meanwhile, Probi’s LP299V bacterial strain can help improve iron absorption, likely due to an increase in iron bioavailability. 

Last winter, a study found that iron infusion could be more effective than common iron supplements to treat women with iron-deficiency anemia after childbirth in low-income settings in sub-Saharan Africa. 

Edited by Katherine Durrell