Multidisciplinary Initiative Dramatically Increases Iron Deficiency Screening in pregnancy
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A new quality improvement initiative has lead to a sixfold increase in iron deficiency screening and a 20-fold increase in IV iron infusions for pregnant women, potentially establishing a framework for better maternal and fetal outcomes. The findings, presented at the ASH Annual Meeting and Exposition in Orlando in December 2025, demonstrate a notable improvement in identifying and addressing a frequently underrecognized condition.
“Iron deficiency in pregnancy is underrecognized and undertreated,” said Richard C. Godby, MD, a hematologist and assistant professor at Mayo Clinic in Rochester, minnesota. “This is one approach, but this is not necessarily the only approach. Every institution is different, but showing peopel that this can be done, and that it works, hopefully provides some momentum that leads to better recognition and treatment.”
Addressing a ‘Gap in Care’
Iron plays a vital role in hemoglobin production and overall bodily functions. Existing data suggests a considerable portion of adolescents and young women in the U.S. may experience iron deficiency, with more than half still exhibiting low iron levels three years after diagnosis.During pregnancy, the demand for iron increases to support fetal and placental advancement, making prompt identification and treatment crucial to prevent complications like low birth weight, neurodevelopmental disorders, preterm birth, mood disorders, fatigue, and postpartum hemorrhage.
Despite the prevalence of iron deficiency and the availability of ferritin as a biomarker for iron stores, current guidelines typically recommend screening only when anemia is diagnosed. Standard screening in the U.S. assesses hemoglobin levels early (8-12 weeks gestation) and late (24-28 weeks gestation) in pregnancy. However, ferritin screening – a more direct measure of iron deficiency – is not routinely recommended, with prenatal vitamins often prescribed.
the intervention, the rate of ferritin screening increased dramatically, from 10% to 63%. A comparable proportion of tests revealed iron deficiency in both periods (66% vs. 69%), despite widespread use of prenatal vitamins (92% in both eras) and oral iron supplementation (26% pre-intervention vs. 30% post-intervention).
Notably, the rate of iron dextran infusions surged from 0.9% to 21% after implementation. Over one-third (39%) of those receiving IV iron dextran were already taking prenatal vitamins and oral iron supplements.
Among women who received IV iron dextran, median hemoglobin levels increased from 10.7 g/dL to 11.8 g/dL. Hemoglobin levels improved irrespective of initial hemoglobin and ferritin levels, suggesting a broad benefit from the intervention. “No matter how you define iron deficiency,and even if someone was not anemic by conventional definitions,hemoglobin levels still rose after IV iron,” Godby stated.
Furthermore,the percentage of pregnancies requiring blood transfusions during admission for delivery decreased from 3.1% to 2.7%.
Implications for Future Guidelines
The researchers concluded that this standardized approach to iron deficiency screening and treatment is reproducible across different healthcare settings. The findings highlight the need to reassess current guidelines and reference ranges for iron deficiency and anemia in pregnancy.
The U.S. Preventive Services Task Force (USPSTF) has indicated that current evidence is insufficient to recommend for or against routine screening or supplementation for asymptomatic pregnant individuals. “The USPSTF could not make a recommendation because no data truly exist,” godby explained. “If more people start to approach this in a standardized way, hopefully there will be more data that can allow for more formal recommendations.”
For more information, Richard C.Godby,MD,can be reached at [email protected].
Source: Godby R, et al.Abstract 595. Presented at: ASH Annual Meeting and Exposition; Dec. 6-9, 2025; Orlando.
Disclosures: Godby reports a consulting role with johnson & Johnson. please see the study for all other authors’ relevant financial disclosures.
