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Within a year of initiation, a multidisciplinary project to improve screening and treatment for iron deficiency in pregnancy resulted in a sixfold rise in screening rates for iron deficiency in pregnant patients, a 20-fold rise in the number of intravenous (IV) iron infusions, and a significant improvement in median hemoglobin levels.

Screening rates went from 10% to over 60% within a year. Two-thirds of pregnant patients screened were found to be iron deficient, indicating that this is a very common, but readily fixable problem.”

Richard Godby, MD, lead author, hematologist at the Mayo Clinic in Rochester, Minnesota

Women of child-bearing age are at high risk for iron deficiency. Menstruation and low intake of iron-rich foods are some of the most common causes of iron deficiency among women in this age group, Dr. Godby said. In addition, some commonly used medications, such as proton pump inhibitors, can inhibit the body’s ability to absorb iron.

The body needs more iron during pregnancy. Iron deficiency and anemia during pregnancy have been associated with adverse outcomes such as fetal growth restriction, premature birth, low birth weight, and compromised development of the fetus’s brain and nervous system. 

Iron deficiency can be diagnosed with a blood test for ferritin, a protein that enables the body to store iron. However, guidelines from the American College of Obstetrics and Gynecology – the professional society that represents most U.S. doctors in this specialty – currently recommend iron deficiency screening only for pregnant women with anemia, which they define as a hemoglobin level below 11 g/dL in the first or third trimester.

Dr. Godby and his colleagues worked with a multidisciplinary team at the Mayo Clinic to develop and implement a quality improvement project aimed at standardizing the screening and treatment of iron deficiency in pregnancy. They added ferritin testing to the list of recommended lab tests that patients typically undergo at eight to 12 weeks of pregnancy and again at 24 to 28 weeks. If patients had low ferritin levels at eight to 12 weeks, their teams offered to prescribe oral iron supplements. If patients’ ferritin was low at 24 to 28 weeks, the teams offered them an IV infusion of iron dextran.

To measure the project’s results, the research team compared changes after project implementation between the two cohorts of patients – one treated before implementation (2,097 pregnancies; the Before cohort) and one treated a year later, after implementation (2,429 pregnancies; the After cohort).

Results showed that, in the Before cohort, just 10% of patients underwent ferritin testing, compared with 63% in the After cohort. Among those tested, 66% in the Before cohort and 69% in the After cohort were iron deficient. Just 0.9% of patients in the Before cohort received IV iron dextran infusions, compared with 21% in the After cohort.

Among patients who received IV iron infusions, the median hemoglobin level improved from 10.7 to 11.8 g/dL. Patients whose hemoglobin level was 12 g/dL at study entry (above the cutoff of 11 g/dL to be considered anemic according to current guidelines from the American College of Obstetricians and Gynecologists) saw an increase to 12.8 g/dL. “These findings suggest reassessing the threshold for diagnosing anemia and screening for iron deficiency in pregnancy,” Dr. Godby said. 

Before the project, 3.1% of pregnancies required a blood transfusion during hospitalization for delivery, compared with 2.7% after the project’s implementation. Most patients who needed blood transfusions had not been tested for iron deficiency. While this difference was not statistically significant, Dr. Godby said, it suggests that a reduction in the need for post-partum blood transfusions could be an additional benefit of treating iron deficiency during pregnancy.

Dr. Godby noted that nearly all of the patients in both the Before and After cohorts took prenatal vitamins, which are recommended during pregnancy and supposed to contain iron. However, these supplements were usually purchased over the counter rather than prescribed by the health care team. Over-the-counter dietary supplements are not regulated to ensure they contain the ingredients and amounts of ingredients claimed by the manufacturers, he said.

As a next step, the team hopes to analyze whether treating iron deficiency in pregnancy improves patients’ quality of life by enabling them to feel better, experience less post-partum depression, return to work sooner, and more.

Richard Godby, MD, of the Mayo Clinic, will present this study on Sunday, December 7, 2025, at 12:00 noon Eastern time in W304A-D of the Orange County Convention Center.