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Final Research Plan

Screening for Iron Deficiency Anemia in Childhood and Pregnancy


The final Research Plan is used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Report will form the basis of the USPSTF Recommendation Statement on this topic.

This Final Research Plan was available for comment from April 11 until May 8, 2013 at 5:00 p.m., ET. To view the draft Research Plan, click here.


I. Analytic Framework

Routine Iron Supplementation in Children

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Screening for Iron Deficiency Anemia in Children

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Routine Iron Supplementation in Pregnant Women

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Screening for Iron Deficiency Anemia in Pregnant Women

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II. Key Questions to Be Systematically Reviewed

Routine Iron Supplementation in Children

  1. What are the benefits of routine iron supplementation on intermediate and clinical health outcomes in children ages 6 to 24 months?
  2. What are the harms of routine iron supplementation in children ages 6 to 24 months?

Screening for Iron Deficiency Anemia in Children

  1. What are the benefits of screening for iron deficiency anemia on morbidity, mortality, and quality of life in asymptomatic children ages 6 to 24 months?
  2. What are the harms of screening for iron deficiency anemia in children ages 6 to 24 months?
  3. What are the benefits of treatment for iron deficiency anemia on intermediate and clinical health outcomes in children ages 6 to 24 months?
  4. What are the harms of iron treatment in children ages 6 to 24 months?

Routine Iron Supplementation in Pregnant Women

  1. What are the benefits of routine iron supplementation on maternal and infant intermediate and clinical health outcomes in pregnant women?
  2. What are the harms of routine iron supplementation in pregnant women?

Screening for Iron Deficiency Anemia in Pregnant Women

  1. What are the benefits of screening for iron deficiency anemia on maternal and infant morbidity, mortality, and quality of life in asymptomatic pregnant women?
  2. What are the harms of screening for iron deficiency anemia in pregnant women?
  3. What are the benefits of treatment for iron deficiency anemia on maternal and infant intermediate and clinical health outcomes in pregnant women?
  4. What are the harms of iron treatment in pregnant women?

III. Contextual Questions

Contextual questions are not systematically reviewed and are not shown in the Analytic Framework.

Screening for Iron Deficiency Anemia in Children

  1. How well does risk assessment identify children who are at increased risk for iron deficiency anemia?

Screening for Iron Deficiency Anemia in Pregnant Women

  1. How well does risk assessment identify pregnant women who are at increased risk for iron deficiency anemia?
  2. What is the yield (number of new diagnoses) of repeat (periodic) screening in asymptomatic pregnant women? At what timing intervals?

IV. Research Approach

The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Report. Criteria are overarching as well as specific to each of the key questions (KQs).

  Include Exclude
Routine Iron Supplementation in Children
Populations Children ages 6 to 24 months Severely malnourished children who are not representative of those in the United States
Interventions Oral iron supplementation, iron-fortified formulas and foods Injectable forms of iron
Comparators No supplementation  
Outcomes KQ 1: Morbidity (including cognitive, psychomotor, and neurodevelopmental outcomes; developmental delay), mortality, quality of life; incidence of iron deficiency anemia; incidence of iron deficiency; hematologic indices and ferritin levels
KQ 2: More serious harms; discontinuations; accidental overdose
KQ 2: Gastrointestinal outcomes
Settings Primary care relevant  
Timing KQ 1: Long-term
KQ 2: Short- or long-term
 
Study Designs KQ 1: Randomized, controlled trials; controlled cohort studies and other controlled observational studies
KQ 2: Studies from KQ 1 and large uncontrolled observational studies
KQ 1: Uncontrolled studies
Screening for Iron Deficiency Anemia in Children
Populations Asymptomatic children ages 6 to 24 months Severely malnourished children who are not representative of those in the United States; children who are symptomatic for iron deficiency anemia; children ages <6 or >24 months
Interventions KQs 1, 2: Screening for iron deficiency anemia
KQs 3, 4: Oral iron supplementation, iron-fortified formulas and foods
Injectable forms of iron
Comparators KQs 1, 2: No screening for iron deficiency anemia
KQs 3, 4:
No treatment
 
Outcomes KQs 1, 3: Morbidity (including cognitive, psychomotor, and neurodevelopmental outcomes; developmental delay), mortality, quality of life
KQ 2: Overdiagnosis, anxiety, labeling
KQ 3: Incidence of iron deficiency anemia; incidence of iron deficiency; hematologic indices and ferritin levels
KQ 4: More serious harms; discontinuations and overtreatment
KQ 4: Gastrointestinal outcomes
Settings Primary care relevant  
Timing KQs 1, 3: Long-term
KQs 2, 4: Short- or long-term
 
Study Designs KQs 1, 3: Randomized, controlled trials; controlled cohort studies and other controlled observational studies
KQs 2, 4: Studies included from other KQs and large uncontrolled observational studies
KQ 1, 3: Uncontrolled studies
Routine Iron Supplementation in Pregnant Women
Populations Pregnant adolescents and women and their infants Severely malnourished populations that are not representative of those in the United States
Interventions Oral iron supplementation, iron-fortified foods Injectable forms of iron
Comparators No supplementation  
Outcomes KQ 1: Maternal outcomes: Caesarian section rates, preterm delivery, postpartum depression; incidence of iron deficiency anemia; incidence of iron deficiency; hematologic indices and ferritin levels
Infant outcomes: Low birth weight, preterm delivery, perinatal mortality, hematologic indices and ferritin levels
KQ 2: More serious harms; discontinuations; accidental overdose
KQ 2: Gastrointestinal outcomes
Settings Primary care relevant  
Timing KQ 1: Long-term
KQ 2: Short- or long-term
 
Study Designs KQ 1: Randomized, controlled trials; controlled cohort studies and other controlled observational studies
KQ 2: Studies from KQ 1 and large uncontrolled observational studies
KQ 1: Uncontrolled studies
Screening for Iron Deficiency Anemia in Pregnant Women
Populations Pregnant adolescents and women and their infants who are asymptomatic for iron deficiency anemia Severely malnourished populations that are not representative of those in the United States; those who are symptomatic for iron deficiency anemia
Interventions KQs 1, 2: Screening for iron deficiency anemia
KQs 3, 4: Oral iron supplementation, iron-fortified foods
Injectable forms of iron
Comparators KQs 1, 2: No screening for iron deficiency anemia
KQs 3, 4:
No treatment
 
Outcomes KQs 1, 3: Maternal outcomes: Caesarian section rates, preterm delivery, postpartum depression
Infant outcomes: Low birth weight, preterm delivery, perinatal mortality, hematologic indices and ferritin levels
KQ 2: Overdiagnosis, anxiety, labeling.
KQ 3: Maternal outcomes: Incidence of iron deficiency anemia; incidence of iron deficiency; hematologic indices and ferritin levels
KQ 4: More serious harms; discontinuations and overtreatment
KQ 4: Gastrointestinal outcomes
Settings Primary care relevant  
Timing KQs 1, 3: Long-term
KQs 2, 4:
Short- or long-term
 
Study Designs KQs 1, 3: Randomized, controlled trials; controlled cohort studies and other controlled observational studies
KQs 2, 4: Studies included from other KQs and large uncontrolled observational studies
KQ 1, 3: Uncontrolled studies

V. Response to Public Comment

The draft Research Plan was posted for public comment on the U.S. Preventive Services Task Force (USPSTF) Web site from April 11 to May 8, 2013. A few comments requested clarification on the inclusion and exclusion criteria, analytic frameworks, and key questions related to populations, interventions, and outcomes. The Research Plan was revised in response to these comments. Some comments requested that the USPSTF consider assessing iron status and serum transferrin receptor concentration as additional outcomes. Iron status was added as an intermediate outcome in the analytic framework on routine iron supplementation in pregnant women; the other suggested outcome is not routinely used as a screening test in the United States and is therefore not in the scope of this review.

AHRQ Publication No. 13-05187-EF-5
Current as of July 2013


Internet Citation:

U.S. Preventive Services Task Force. Screening for Iron Deficiency Anemia in Childhood and Pregnancy: Final Research Plan. AHRQ Publication No. 13-05187-EF-5. http://www.uspreventiveservicestaskforce.org/uspstf13/anemiachld/anemiafinalresplan.htm



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