Review of Prepregnancy Care and Counseling
https://jamanetwork.com/journals/jama/fullarticle/2853067
To the Editor In reading the otherwise comprehensive article by Dr Cooper and colleagues on prepregnancy care and counseling, we were surprised by the lack of discussion about testing for iron deficiency. Iron deficiency, the world’s most common micronutrient deficiency, is epidemic in young women. Studies of healthy reproductive-aged female patients report that iron deficiency is present in approximately 38% using a ferritin cutoff of 30 μg/L. Questioning for the most frequent etiology, heavy menstrual bleeding, is often absent, and symptoms are frequently normalized and marginalized. In a high-resource population of primigravid patients without symptoms or anemia, iron deficiency was reported in 21%, 47%, and 84%, respectively, at 15 weeks’, 20 weeks’, and 33 weeks’ gestation, with the strongest predictor of severe iron deficiency (ferritin <15 μg/L) in the third trimester being a ferritin level of less than 60 μg/L at 15 weeks’ gestation. Also, McCarthy et al used the Bayley Scales of Infant and Toddler Development to determine that a maternal ferritin level of less than 30 μg/L at 15 weeks’ gestation was associated with statistically and clinically significant decrements in language and motor skills in offspring measured at 2 years. Iron deficiency with and without anemia is associated with disorders that negatively affect patients, such as fatigue, restless legs syndrome, pica, and brain fog. Modeling studies have shown that screening for iron deficiency and treating when identified are cost-effective in reproductive-aged female patients. Screening for iron deficiency prior to pregnancy is now recommended by several societies, including the International Federation of Gynecology and Obstetrics, the European Hematology Association, the American Society of Hematology, and the Haematology in Obstetrics & Women’s Health Collaborative (Australia). Counseling young women considering pregnancy options is an ideal time to screen for iron deficiency given its high incidence and morbidity for both mothers and any future children. Therefore, we agree with the increasing number of society recommendations to screen for iron deficiency in all reproductive-aged female patients and all pregnant patients at presentation, irrespective of the presence or absence of anemia.
