Iron Supplementation Guidelines

Introduction to Iron Supplementation

The American College of Obstetricians and Gynecologists recommends that multivitamins with iron should be given routinely to all pregnant women starting when pregnancy is confirmed and continuing for 3 months postpartum, to women of childbearing age who have inadequate dietary iron intake, and to all patients after bariatric surgery 1, 2, 3

All pregnant women should receive iron supplementation regardless of anemia status, as dietary intake alone cannot meet the threefold increased iron demands during the second and third trimesters 2, 4
The standard dose for routine prevention in all pregnant women is 30 mg elemental iron daily 1, 2, 5
A higher dose of 60-100 mg elemental iron daily is recommended for women at increased risk of iron deficiency 5, 6

Iron supplementation should be continued for at least 3 months after delivery in all postpartum women to replenish maternal stores depleted during pregnancy 3
Women at high risk for postpartum anemia should be screened at 4-6 weeks postpartum and may require extended supplementation beyond 3 months 3

Multivitamins with iron are indicated for adolescent girls and women aged 12-49 years, as only one-fourth meet the recommended dietary allowance for iron through diet alone, and 11% have iron deficiency 4

All bariatric surgery patients require lifelong multivitamin supplementation with iron, with specific dosing based on surgical procedure 6, 7
Two adult multivitamin-mineral supplements daily containing iron, folic acid, zinc, copper, selenium, and thiamin (200% of RDA) are recommended after Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion 7

Iron and calcium supplements should be separated by at least 1-2 hours, as calcium inhibits iron absorption 3, 7
During pregnancy, anemia should be screened at the first prenatal visit, again at 24-28 weeks, and in the third trimester 1
Postpartum and breastfeeding women should have their full blood count, serum ferritin, and iron studies checked every 3 months 3
Post-bariatric surgery patients should have their iron studies monitored every 3 months initially, then every 6 months long-term 3
Expect a hemoglobin rise of at least 10 g/L after 2 weeks of daily oral iron therapy, and failure to achieve this response suggests non-compliance, malabsorption, continued bleeding, or concurrent deficiencies requiring investigation 9