Draft Research Plan
Iron Deficiency and Iron Deficiency Anemia During Pregnancy: Screening and Supplementation
April 07, 2022
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
- What are the benefits of routine iron supplementation during pregnancy on maternal and infant health outcomes?
- What are the harms of routine iron supplementation during pregnancy?
- In pregnant persons with or without anemia, what is the association between change in maternal iron status (including changes in ferritin or hemoglobin level) and improvement in newborn and peripartum outcomes in U.S.-relevant populations?
- What are the benefits of screening for iron deficiency anemia in asymptomatic pregnant persons on maternal and infant health outcomes?
- What are the harms of screening for iron deficiency anemia in pregnant persons?
- What are the benefits of treatment of iron deficiency anemia during pregnancy on maternal and infant health outcomes?
- What are the harms of iron treatment in pregnant persons?
- In pregnant persons with iron deficiency, with or without anemia, what is the association between change in maternal iron status (including changes in ferritin or hemoglobin level) and improvement in newborn and peripartum outcomes in U.S.-relevant populations?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What are the current practices in identifying pregnant persons with iron deficiency anemia? Do current practices of identification differ by race and ethnicity, age, socioeconomic status, cultural factors, educational attainment, or health literacy level?
- What are current practices for the use of iron supplementation during pregnancy? Do current practices differ by race and ethnicity, age, socioeconomic status, cultural factors, educational attainment, or health literacy level?
- How well do risk assessment tools identify pregnant persons at increased risk for iron deficiency anemia?
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).
Category | Included | Excluded |
---|---|---|
Populations | Asymptomatic adolescents (ages 13 to <18 years) and adults (age ≥18 years), regardless of iron status, who are pregnant and their infants | Nonpregnant persons; persons with underlying diagnosis or symptoms of anemia; and severely malnourished populations not representative of those in the United States |
Interventions | Oral iron supplementation and iron-fortified foods | Nonoral forms of iron |
Comparators | All KQs: No supplementation
KQ 3: Change in maternal iron deficiency, iron deficiency anemia status, or both |
|
Outcomes | KQ 1: Maternal health outcomes: Mortality; health-related quality of life; preeclampsia (severe); postpartum hemorrhage; blood transfusion; and postpartum depression Maternal intermediate outcomes: Incidence of iron deficiency anemia; incidence of iron deficiency; hematologic indices and ferritin levels; and Caesarean delivery rates Infant health outcomes: Perinatal mortality, respiratory distress, and neonatal intensive care unit admission Infant intermediate outcomes: Hematologic indices and ferritin levels; low birth weight, small for gestational age size, and preterm delivery KQ 2: More serious harms; harms leading to discontinuation; and accidental overdose |
|
Settings | U.S. primary care–relevant settings | |
Timing | KQ 1: Long-term outcomes
KQ 2: Short- or long-term outcomes |
|
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 |
Abbreviation: KQ=key question.
Category | Included | Excluded |
---|---|---|
Populations | KQs 1 and 2: Pregnant adolescents and adults asymptomatic for iron deficiency anemia and their infants
KQs 3 and 4: Pregnant adolescents and adults with iron deficiency anemia and their infants KQ 5: Pregnant persons with iron deficiency, with or without anemia, and their infants |
Severely malnourished populations not representative of those in the United States; persons symptomatic for iron deficiency anemia |
Interventions |
KQs 1 and 2: Screening for iron deficiency anemia KQs 3 and 4: Oral or intravenous iron supplementation and iron-fortified foods |
Nonoral and nonintravenous forms of iron |
Comparators | KQs 1 and 2: No screening for iron deficiency anemia
KQs 3 and 4: No treatment KQ 5: A change in maternal iron deficiency, iron deficiency anemia status, or both |
|
Outcomes | KQs 1, 3, 5: Maternal health outcomes: Mortality; health-related quality of life; preeclampsia (severe); postpartum hemorrhage; blood transfusion; and postpartum depression Maternal intermediate outcomes: Caesarean delivery rates; incidence of iron deficiency anemia; incidence of iron deficiency; hematologic indices and ferritin levels Infant health outcomes: Perinatal mortality, morbidity (neonatal intensive care unit admission, respiratory distress) Infant intermediate outcomes: Hematologic indices and ferritin levels; low birth weight, small for gestational age size, and preterm delivery KQ 2: Overdiagnosis, anxiety, and labeling KQ 4: More serious harms; harms leading to discontinuations; and overtreatment |
|
Settings | U.S. primary care–relevant | |
Timing | KQs 1 and 3: Long-term outcomes
KQs 2 and 4: Short- or long-term outcomes |
|
Study designs | KQs 1 and 3: Randomized, controlled trials; controlled cohort studies; and other controlled observational studies
KQs 2 and 4: Studies included from other KQs and large uncontrolled observational studies KQ 5: Association studies |
KQ 1 and 3: Uncontrolled studies |
Abbreviation: KQ=key question.