Feature Article

Iron deficiency anaemia in pregnancy. How best to treat, and why

KATHRYN AUSTIN, Giselle Kidson-Gerber, Antonia Shand


© STocK_coLorS/ ISTocKpHoTo.com modeL USed for ILLUSTraTIVe pUrpoSeS onLy
© STocK_coLorS/ ISTocKpHoTo.com modeL USed for ILLUSTraTIVe pUrpoSeS onLy


Pregnant women with iron deficiency anaemia (IDA) are at greater risk of blood transfusion, life-threatening bleeding, fetal growth restriction, preterm birth and perinatal death. Pregnancy-related IDA can usually be managed in a primary care setting with oral iron supplements, although sometimes intravenous iron is required. New maternity guidelines and clinical resources are available.

Key Points

  • Iron deficiency anaemia (IDA) is a common condition in pregnancy that can have significant adverse effects on the health of the mother and baby.
  • Iron deficiency alone is defined by a haemoglobin level that is within normal limits with a serum ferritin level below 30 mcg/L and is a precursor to IDA.
  • Routine screening for IDA by measuring haemoglobin level +/- ferritin level should occur at the first antenatal appointment and at 28 weeks’ gestation.
  • A haemoglobin level of less than 110 g/L before 20 weeks’ gestation or less than 105 g/L at or after 20 weeks’ gestation is considered abnormal.
  • First-line treatment for IDA is oral iron supplementation. Intravenous iron supplementation should only be considered when oral iron therapy has failed, is not tolerated or rapid replacement is required to optimise iron stores and haemoglobin level.
  • GPs are in a unique situation to identify, treat and monitor adherence to IDA treatment in pregnancy and postpartum to improve outcomes for the mother and baby.
  • Excellent resources for clinicians and women are available from the Australian Red Cross Blood Service Toolkit for Maternity Blood Management (www.transfusion.com.au/maternity).