Subscribe to RSS

DOI: 10.1055/a-2628-7308
Recommendations of the AGG (Obstetrics Working Group, Section for Maternal Diseases) for the Management of Anemia in Pregnancy – Part 1 (Iron Deficiency Anemia)
Article in several languages: English | deutsch
Abstract
Objective
These recommendations by the AGG (Committee for Obstetrics, Department of Maternal Diseases) on how to treat iron-deficiency anemia during pregnancy aim to improve the diagnosis and management of iron-deficiency anemia in pregnancy.
Methods
The task force members developed the following recommendations and statements based on the current literature. Recommendations were adopted after the members of the working group achieved consensus.
Recommendations
This article gives an insight into the diagnosis and management of iron-deficiency anemia in pregnancy and provides recommendations on its treatment.
Publication History
Received: 08 May 2025
Accepted after revision: 02 June 2025
Article published online:
12 August 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References/Literatur
- 1 World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Contract No.: WHO/NMH/NHD/MNM/11.1. Geneva: World Health Organization; 2011
- 2 de Haas S, Ghossein-Doha C, van Kuijk SM. et al. Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 49: 177-187
- 3 World Health Organization. The clinical Use of Blood in Medicine, Obstetrics, Paediatrics, Surgery and Anaesthesia, Trauma and Burns. Geneva: World Health Organization; 2001
- 4 World Health Organization. Maternal Health and Safe Motherhood Programme, World Health Organization. Nutrition Programme. The Prevalence of Anaemia in Women: a Tabulation of available Information. 2. Geneva: World Health Organization; 1992
- 5 Pavord S, Daru J, Prasannan N. et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2020; 188: 819-830
- 6 Anemia in Pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol [Anonym]. 2021; 138: e55-e64
- 7 Karami M, Chaleshgar M, Salari N. et al. Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis. Matern Child Health J 2022; 26: 1473-1487
- 8 Hamid K, Ajaz M, Akhter M. et al. Prevalence of anemia in pregnant women. Pak J Phsyiol 2022; 18: 16-19
- 9 Massot C, Vanderpas J. A survey of iron deficiency anaemia during pregnancy in Belgium: analysis of routine hospital laboratory data in Mons. Acta Clin Belg 2003; 58: 169-177
- 10 Tawfik YMK, Billingsley H. et al. Absolute and Functional Iron Deficiency in the US, 2017–2020. JAMA Netw Open 2024; 7: e2433126
- 11 van den Broek N. Anaemia in pregnancy in developing countries. Br J Obstet Gynaecol 1998; 105: 385-390
- 12 Chaparro CM. Setting the stage for child health and development: prevention of iron deficiency in early infancy. J Nutr 2008; 138: 2529-2533
- 13 Fishman SM, Christian P, West KP. The role of vitamins in the prevention and control of anaemia. Public Health Nutr 2000; 3: 125-150
- 14 Hesham MS, Edariah AB, Norhayati M. Intestinal parasitic infections and micronutrient deficiency: a review. Med J Malaysia 2004; 59: 284-293
- 15 Hess SY, King JC. Effects of maternal zinc supplementation on pregnancy and lactation outcomes. Food Nutr Bull 2009; 30 (Suppl. 1) S60-S78
- 16 Mahande AM, Mahande MJ. Prevalence of parasitic infections and associations with pregnancy complications and outcomes in northern Tanzania: a registry-based cross-sectional study. BMC Infect Dis 2016; 16: 78
- 17 Molloy AM, Kirke PN, Brody LC. et al. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull 2008; 29 (Suppl. 2) S101-S111 discussion S112–S115
- 18 Stevens GA, Finucane MM, De-Regil LM. et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health 2013; 1: e16-e25
- 19 World Health Organization. The global Prevalence of Anaemia in 2011. Geneva: World Health Organization; 2015
- 20 IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen. Bundesauswertung: Perinatalmedizin: Geburtshilfe: Erfassungsjahr 2021. 2021 Accessed June 05, 2025 at: https://iqtig.org/downloads/auswertung/2021/pmgebh/DeQS_PM-GEBH_2021_BUAW_V01_2022-06-30.pdf
- 21 Gemeinsamer Bundesausschuss. Richtlinie des Gemeinsamen Bundesausschusses über die ärztliche Betreuung während der Schwangerschaft und nach der Geburt 2023. Accessed June 05, 2025 at: https://www.g-ba.de/downloads/62-492-3335/Mu-RL_2023-09-28_iK-2023-12-19.pdf
- 22 Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep [Anonym]. 1998; 47: 1-29
- 23 World Health Organization. WHO Guidelines approved by the Guidelines Review Committee. WHO Recommendations on antenatal Care for a positive Pregnancy Experience. Geneva: World Health Organization; 2016
- 24 Behnisch W, Muckenthaler M, Kulozik A. Eisenmangelanämie. AWMF Leitlinie 025/021: [S1 Leitlinie]. 2021 Accessed June 05, 2025 at: https://register.awmf.org/assets/guidelines/025-021l_S1_Eisenmangelanaemie_2021-11.pdf
- 25 Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr 2000; 72 (Suppl. 1) 257s-264s
- 26 Auerbach M. Causes and diagnosis of iron deficiency and iron deficiency anemia in adults. UpToDate [online serial]. Waltham, MA: UpToDate; 2024
- 27 Young I, Parker HM, Rangan A. et al. Association between Haem and Non-Haem Iron Intake and Serum Ferritin in Healthy Young Women. Nutrients 2018; 10: 81
- 28 Hwalla N, Al Dhaheri AS, Radwan H. et al. The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions. Nutrients 2017; 9: 229
- 29 Di Santolo M, Stel G, Banfi G. et al. Anemia and iron status in young fertile non-professional female athletes. Eur J Appl Physiol 2008; 102: 703-709
- 30 Scott DE, Pritchard JA. Iron deficiency in healthy young college women. JAMA 1967; 199: 897-900
- 31 Lopez A, Cacoub P, Macdougall IC. et al. Iron deficiency anaemia. Lancet 2016; 387: 907-916
- 32 Matteson KA, Raker CA, Pinto SB. et al. Women presenting to an emergency facility with abnormal uterine bleeding: patient characteristics and prevalence of anemia. J Reprod Med 2012; 57: 17-25
- 33 Shi H, Chen L, Wang Y. et al. Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes. JAMA Netw Open 2022; 5: e2147046
- 34 Smith C, Teng F, Branch E. et al. Maternal and Perinatal Morbidity and Mortality Associated With Anemia in Pregnancy. Obstet Gynecol 2019; 134: 1234-1244
- 35 Harrison RK, Lauhon SR, Colvin ZA. et al. Maternal anemia and severe maternal morbidity in a US cohort. Am J Obstet Gynecol MFM 2021; 3: 100395
- 36 Shao J, Lou J, Rao R. et al. Maternal serum ferritin concentration is positively associated with newborn iron stores in women with low ferritin status in late pregnancy. J Nutr 2012; 142: 2004-2009
- 37 Wiegersma AM, Dalman C, Lee BK. et al. Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders. JAMA Psychiatry 2019; 76: 1294-1304
- 38 Congdon EL, Westerlund A, Algarin CR. et al. Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years. J Pediatr 2012; 160: 1027-1033
- 39 Breymann C. Iron Deficiency Anemia in Pregnancy. Semin Hematol 2015; 52: 339-347
- 40 Kæstel P, Aaby P, Ritz C. et al. Markers of iron status are associated with stage of pregnancy and acute-phase response, but not with parity among pregnant women in Guinea-Bissau. Br J Nutr 2015; 114: 1072-1079
- 41 Krafft A, Huch R, Breymann C. Impact of parturition on iron status in nonanaemic iron deficiency. Eur J Clin Invest 2003; 33: 919-923
- 42 Pavord S, Myers B, Robinson S. et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2012; 156: 588-600
- 43 World Health Organization. WHO Guidelines approved by the Guidelines Review Committee. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization; 2020
- 44 Akesson A, Bjellerup P, Berglund M. et al. Serum transferrin receptor: a specific marker of iron deficiency in pregnancy. Am J Clin Nutr 1998; 68: 1241-1246
- 45 Daru J, Allotey J, Peña-Rosas JP. et al. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfus Med 2017; 27: 167-174
- 46 Chao HX, Zack T, Leavitt AD. Screening Characteristics of Hemoglobin and Mean Corpuscular Volume for Detection of Iron Deficiency in Pregnancy. Obstet Gynecol 2025; 145: 91-94
- 47 McCarthy EK, Schneck D, Basu S. et al. Longitudinal evaluation of iron status during pregnancy: a prospective cohort study in a high-resource setting. Am J Clin Nutr 2024; 120: 1259-1268
- 48 Haider BA, Olofin I, Wang M. et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013; 346: f3443
- 49 Finkelstein JL, Cuthbert A, Weeks J. et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2024; 8 (08) CD004736
- 50 Bundesinstitut für Risikobewertung. Fragen und Antworten zu Eisen in Lebensmitteln. 2008 Accessed June 05, 2025 at: https://www.bfr.bund.de/de/fragen_und_antworten_zu_eisen_in_lebensmitteln-28383.html
- 51 Ortiz R, Toblli JE, Romero JD. et al. Efficacy and safety of oral iron(III) polymaltose complex versus ferrous sulfate in pregnant women with iron-deficiency anemia: a multicenter, randomized, controlled study. J Matern Fetal Neonatal Med 2011; 24: 1347-1352
- 52 Dhanani JV, Ganguly BP, Chauhan LN. Comparison of efficacy and safety of two parenteral iron preparations in pregnant women. J Pharmacol Pharmacother 2012; 3: 314-319
- 53 Van Wyck DB, Martens MG, Seid MH. et al. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstet Gynecol 2007; 110: 267-278
- 54 Lewkowitz AK, Gupta A, Simon L. et al. Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. J Perinatol 2019; 39: 519-532
- 55 Govindappagari S, Burwick RM. Treatment of Iron Deficiency Anemia in Pregnancy with Intravenous versus Oral Iron: Systematic Review and Meta-Analysis. Am J Perinatol 2019; 36: 366-376
- 56 Sultan P, Bampoe S, Shah R. et al. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221: 19-29.e3
- 57 Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM). Roter Hand Brief: Verschärfte Empfehlungen bezüglich des Risiko schwerer Überempfindlichkeitsreaktion auf Eisenpräparate zur intravenösen Applikation. 2013 Accessed June 05, 2025 at: https://www.akdae.de/fileadmin/user_upload/akdae/Arzneimittelsicherheit/RHB/Archiv/2013/20131021.pdf
- 58 Wiesenack C, Meybohm P, Neef V. et al. Current concepts in preoperative anemia management in obstetrics. Curr Opin Anaesthesiol 2023; 36: 255-262
- 59 Benson AE, Shatzel JJ, Ryan KS. et al. The incidence, complications, and treatment of iron deficiency in pregnancy. Eur J Haematol 2022; 109: 633-642
- 60 Neogi SB, Devasenapathy N, Singh R. et al. Safety and effectiveness of intravenous iron sucrose versus standard oral iron therapy in pregnant women with moderate-to-severe anaemia in India: a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Glob Health 2019; 7: e1706-e1716
- 61 Wong L, Smith S, Gilstrop M. et al. Safety and efficacy of rapid (1,000 mg in 1 hr) intravenous iron dextran for treatment of maternal iron deficient anemia of pregnancy. Am J Hematol 2016; 91: 590-593
- 62 Varde KN. TREATMENT OF 300 CASES OF IRON DEFICIENCY OF PREGNANCY BY TOTAL DOSE INFUSION OF IRON-DEXTRAN COMPLEX. J Obstet Gynaecol Br Commonw 1964; 71: 919-922
- 63 Koch TA, Myers J, Goodnough LT. Intravenous Iron Therapy in Patients with Iron Deficiency Anemia: Dosing Considerations. Anemia 2015; 2015: 763576