ACOG Practice Bulletin no. Anemia in pregnancy. Article type [CB]. Practice Guidelines. Citation [CB]. Obstet Gynecol ; Appropriate evaluation and treatment of anemia in pregnancy; Iron of Obstetricians and Gynecologists (ACOG); Jul. 7 p. (ACOG practice bulletin; no. 95). Anemia, the most common hematologic abnormality, is a reduction in the concentration of erythrocytes or hemoglobin in blood. The two most common causes of.

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BrannonChristine Lewis Taylor Nutrients The use of intravenous iron was not assessed. In addition, no new studies that would be applicable to the current U.

Rates may be higher in low-income and minority populations 1, 2. Natural food sources of iron include certain fruits, vegetables, meat, and poultry. Clinical Preventive Services for Women: Description of Implementation Strategy An implementation strategy was not provided. Although the USPSTF found adequate evidence on harms and deemed them to be small to none, it found inadequate evidence on benefits.

Older observational studies suggest an association between adverse outcomes in infants and anemia in the early stages of pregnancy but not during the third trimester 2. Committee members conducted a literature search with the assistance from the ACOG Resource Center staff who routinely perform the Practice Bulletin literature searches. The primary screening test for anemia is to measure serum hemoglobin or hematocrit levels. Food and Drug Administration advisory on Dexferrum iron dextran injection.

Topics Discussed in This Paper. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence. The USPSTF has published separate recommendation statements on screening for iron deficiency anemia in young children and folic acid supplementation during pregnancy available at www.

Serum ferritin, which is often used to measure iron status, may have limited use during pregnancy because its concentration often decreases in late pregnancy despite adequate iron stores in the bone marrow. All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.


To aid practitioners in making decisions about appropriate obstetric and gynecologic care To provide a brief overview of the causes of anemia in pregnancy and review iron requirements To provide recommendations for screening and clinical management of anemia during pregnancy.

The NCBI database was searched from to Effectiveness of screening for anemia during pregnancy Effectiveness of anemia prophylaxis during pregnancy. The Institute of Medicine recommends screening for anemia in each trimester of pregnancy Iron deficiency anemia results when iron stores become so low that hemoglobin synthesis is impaired, which causes anemia.

Given the inconsistent findings and lack of adequately powered studies on the effect of supplementation on maternal and infant health outcomes, the USPSTF did not find sufficient evidence to determine the balance of benefits and harms of supplementation and thus cannot make a recommendation in favor of or against iron supplementation.

ACOG Practice Bulletin No. anemia in pregnancy. – Semantic Scholar

Overall, the USPSTF found inadequate evidence on the effect of routine iron supplementation during pregnancy practtice maternal health or birth outcomes, such as maternal iron deficiency anemia, cesarean delivery, preterm delivery, infant mortality, or low birthweight.

Potential Benefits Appropriate evaluation and treatment of anemia in pregnancy Iron supplementation decreases the prevalence of maternal anemia at delivery Potential Harms There is little evidence that iron supplementation results in morbidity beyond gastrointestinal symptoms, except in patients with hemochromatosis or certain other genetic disorders.

Members of the U. A formal cost analysis was not performed and published cost analyses were not reviewed.

Intravenous iron treatment is also used during pregnancy. Nutrient content of the U.

ACOG Practice Bulletin no. 95. Anemia in pregnancy

The USPSTF found adequate evidence that routine iron supplementation during pregnancy has no effects on the length of gestation and infant Apgar scores at 1 and 5 minutes. When reliable research was not available, expert opinions from obstetrician—gynecologists were used. According to the Institute of Medicine, the Recommended Dietary Allowance for iron in pregnant women is 27 mg per day. Consistent with the USPSTF, the American Academy of Family Physicians concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant xcog to prevent adverse maternal health and birth outcomes Centers for Disease Control and Prevention.


See the No95 Considerations section for suggestions for practice regarding the I statements.

In its review of the evidence to update the recommendation, the USPSTF found no good- or fair-quality studies on the benefits or harms of screening that would be applicable to the current U. Of the 7 studies 13—19 reporting serum ferritin levels at term or delivery, 5 13, 15, 17—19 reported a significantly higher ferritin level in the supplemented versus control groups Department of Health and Human Services.

All pregnant women should be screened for anemia, and those with iron deficiency anemia should be treated with supplemental iron, in addition to prenatal vitamins. The USPSTF commissioned a systematic evidence review to update its recommendation on screening for iron deficiency anemia.

The document was then reviewed by the committee and the committee agreed that it is current and accurate. However, given the hemodilution and physiologic anemia that normally occurs during pregnancy, using hemoglobin or hematocrit measurement alone to determine iron deficiency status can be imprecise, and its sensitivity and specificity for detecting iron deficiency anemia in pregnant women are unknown.

The USPSTF also found inadequate evidence on the treatment of iron deficiency anemia in pregnant women because none of the recent studies on treatment were generalizable to the general U.

A committee member reviewed the document and new literature on the topic. The currency of the guideline was reaffirmed by the developer in and this summary was updated by ECRI Institute on March 7, Citations Publications citing this paper.