Iron Supplementation in Pregnancy

Recommended Approach by Trimester

• The USPSTF and CDC recommend low-dose oral iron supplementation (30 mg/day) starting at the first prenatal visit for all pregnant women as primary prevention 1, 2
• Oral iron is the treatment of choice for iron deficiency anemia during the first trimester, with doses of 60-120 mg/day of elemental iron taken between meals 1

Diagnostic Confirmation Before Treatment

• Confirm iron deficiency anemia with hemoglobin/hematocrit appropriate for gestational age (Hb <11.0 g/dL in first and third trimesters, <10.5 g/dL in second trimester) plus ferritin <30 μg/L 1, 2
• Serum ferritin is an acute phase reactant and may be falsely elevated during inflammation, potentially masking true iron deficiency 3, 2

Evidence Quality Note

• The USPSTF explicitly states that "the use of intravenous iron was not assessed" in their systematic review of iron supplementation in pregnancy 3, 4, 5