[Dr.Vad]

Summary of key recommendations
 Anaemia is defined by Hb <110g/l in first trimester, <105g/l in second and
third trimesters and <100g/l in postpartum period
 Full blood count should be assessed at booking and at 28 weeks
 All women should be given dietary information to maximise iron intake and
absorption
 Routine iron supplementation for all women in pregnancy is not
recommended in the UK
 Unselected screening with routine use of serum ferritin is generally not
recommended although individual centres with a particularly high
prevalence of “at risk” women may find this useful
 For anaemic women, a trial of oral iron should be considered as the first
line diagnostic test, whereby an increment demonstrated at two weeks is a
positive result
 Women with known haemoglobinopathy should have serum ferritin
checked and offered oral supplements if their ferritin level is <30 ug/l
 Women with unknown haemoglobinopathy status with a normocytic or
microcytic anaemia, should start a trial of oral iron (1B) and
haemoglobinopathy screening should be commenced without delay in
accordance with the NHS sickle cell and thalassaemia screening
programme
 Non-anaemic women identified to be at increased risk of iron deficiency
should have a serum ferritin checked early in pregnancy and be offered
oral supplements if ferritin is <30 ug/l
 Systems must be in place for rapid review and follow up of blood results
 Women with established iron deficiency anaemia should be given 100-
200mg elemental iron daily. They should be advised on correct
administration to optimise absorption
 Referral to secondary care should be considered if there are significant
symptoms and/or severe anaemia (Hb<70 g/l) or late gestation (>34 weeks)
or if there is failure to respond to a trial of oral iron.
 For nausea and epigastric discomfort, preparations with lower iron content
should be tried. Slow release and enteric coated forms should be avoided
 Once Hb is in the normal range supplementation should continue for three
months and at least until 6 weeks postpartum to replenish iron stores
 Non-anaemic iron deficient women should be offered 65mg elemental iron
daily, with a repeat Hb and serum ferritin test after 8 weeks
 Anaemic women may require additional precautions for delivery, including
delivery in a hospital setting, available intravenous access, blood groupand-
save, active management of the third stage of labour, and plans for
excess bleeding. Suggested Hb cut-offs are <100g/l for delivery in hospital
and <95g/l for delivery in an obstetrician-led unit
 Women with Hb <100g/l in the postpartum period should be given 100-
200mg elemental iron for 3 months
 Parenteral iron should be considered from the 2nd trimester onwards and
during the postpartum period for women with confirmed iron deficiency
who fail to respond to or are intolerant of oral iron
 Blood transfusion should be reserved for those with risk of further
bleeding, imminent cardiac compromise or symptoms requiring immediate
attention. This should be backed up by local guidelines and effective
patient information

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