Table 1.
Summary of key recommendations from the 2019 UK guidelines on the management of iron deficiency anaemia.
| Recommendation | Grade of recommendation |
|---|---|
| Antenatal | |
| Healthcare professionals should be aware that iron deficiency anaemia in pregnancy is common and associated with increased risk of maternal morbidity and mortality | 1B |
| Healthcare professionals should be aware that iron deficiency anaemia in pregnancy is associated with increased risk of perinatal morbidity and mortality, with implications for infant neurocognitive development | 2B |
| Haemoglobin should be routinely measured at booking and at around 28 weeks’ gestation | 1D |
| If anaemia without an obvious other cause is detected, a diagnostic trial of oral iron should be given without delay, with a repeat full blood count in 2–3 weeks | 1D |
| Non-anaemic women at risk of iron deficiency should be identified and either started on prophylactic iron empirically or have serum ferritin checked first | 1D |
| A serum ferritin level of less than 30 μg/L in pregnancy is indicative of iron deficiency. Levels higher than this do not rule out iron deficiency or depletion | 2C |
| The optimal dose of elemental oral iron of 40–80 mg every morning is suggested, checking haemoglobin at 2–3 weeks to ensure an adequate response. Further research is warranted. | 2C |
| For nausea and epigastric discomfort, alternate day dosing or preparations with lower iron content should be tried. | 1A |
| Once the Hb is in the normal range, replacement should continue for 3 months and until at least 6 weeks postpartum to replenish iron stores | 1D |
| If response to oral iron is poor, compliance should be checked, and consideration given to alternative causes of anaemia | 1A |
| Intravenous iron should be considered in women who present after 34 weeks’ gestation with confirmed iron deficiency anaemia and an Hb of less than 100 g/L | 1C |
| Intrapartum and postpartum | |
| Women with iron deficiency anaemia with an Hb of less than 100 g/L should deliver in an obstetrician-led unit and should have active management of the third stage of labour | 1D |
| After delivery, women with blood loss greater than 500 mL, those with uncorrected anaemia detected in the antenatal period or those with symptoms suggestive of anaemia postnatally should have their Hb checked within 48 h of delivery | 2A |
| Women with Hb less than 100 g/L within 48 h of delivery, who are haemodynamically stable, asymptomatic or mildly symptomatic, should be offered oral elemental iron 40–80 mg daily for at least 3 months | 2A |
| Use of intravenous iron postpartum should be considered in women who are previously intolerant of, or do not respond to, oral iron and/or where the severity of symptoms of anaemia requires prompt management | 2B |
Hb: haemoglobin.