Key takeaways:
- A multidisciplinary quality improvement initiative led to a 6-fold increase in iron deficiency screening during pregnancy.
- Use of intravenous iron therapy increased 20-fold following implementation of standardized screening and treatment pathways.
- Nearly two-thirds of pregnant patients screened were found to have iron deficiency, highlighting a common and underrecognized condition.
- Hemoglobin levels improved and blood transfusion rates declined after expanded screening and treatment.
- Findings suggest current pregnancy screening guidelines may miss iron deficiency in the absence of anemia.
Screening rates and treatment for iron deficiency are significantly increased by a multidisciplinary project designed for improved screening and treatment, according to a recent study presented at the American Society of Hematology 2025 Annual Meeting.1
The data indicated a 6-fold increase in screening rates for iron deficiency, alongside a 20-fold increase in the number of intravenous (IV) iron infusions. The team hopes to conduct further research to determine how this improves the quality of life by making patients feel better, experience reduced postpartum depression, and return to work sooner.1
“Screening rates went from 10% to over 60% within a year,” said Richard Godby, MD, lead author and hematologist at the Mayo Clinic. “Two-thirds of pregnant patients screened were found to be iron-deficient, indicating that this is a very common, but readily fixable problem.”1
Standardized screening and education across specialties
The study was conducted to address the unmet need of screening for iron deficiency in pregnancy, as current guidelines only recommend screening when the patient presents with anemia.2 The multidisciplinary team included representatives from hematology, obstetrics, anesthesiology, and patient blood management.
This team standardized an approach to iron deficiency screening and treatment through a quality improvement (QI) initiative. Patient and provider handouts, alongside divisional presentations, were used to provide information about the standardized care pathway.2
Following education, obstetric providers optimized logistics by pairing ferritin testing with 2 standard hemoglobin assessments. The first assessment was performed in early pregnancy, defined as 8 to 12 weeks’ gestation, followed by late pregnancy, defined as 24 to 28 weeks’ gestation.2
Iron deficiency was defined as ferritin under 50 mcg/L, and anemia was defined as hemoglobin under 11 g/dL. Patients with iron deficiency in early pregnancy were offered oral iron supplementation, while those with iron deficiency in late pregnancy were offered an IV iron infusion. These offers were made regardless of anemia status.2
Ferritin screening rises substantially after intervention
The pre-intervention period was defined as January 2023 to February 2024, while the post-intervention period was defined as March 2024 to June 2025. During these periods, 2097 and 2429 pregnancies, respectively, were assessed. A significant increase in ferritin screening rates was reported in the latter cohort, at 63% vs 10% in the former group.2
In the pre-intervention cohort, 66% of ferritin tests were positive for iron deficiency, vs 69% in the post-intervention cohort. Anemia rates were 25% in both groups, though 92% of patients from each group had documented prenatal vitamin (PNV) consumption.2
An increase in the prevalence of iron dextran infusion was also reported, from 0.9% to 21%. Documentation of both PNV and additional oral iron supplementations was reported in 29% of patients receiving IV iron dextran.
Improvements observed in hemoglobin levels and transfusion rates
Median hemoglobin also improved between the pre-intervention and post-intervention periods in patients receiving IV iron dextran, from 10.7 to 11.8 g/dL. In those without anemia, this increase was from 12 to 12.8, vs 11.2 to 12.1 g/dL with ferritin 30 to 50 mcg/L following IV iron. The need for a blood transfusion declined from 3.1% to 2.7%.2
Overall, the results indicated significant improvements in screening and treatment for iron deficiency following implementation of a multidisciplinary QI initiative. Investigators recommended additional studies to better characterize iron deficiency in pregnancy.2
“These findings suggest reassessing the threshold for diagnosing anemia and screening for iron deficiency in pregnancy,” said Godby.1
References
- Quality improvement project results in increased screening and treatment for iron deficiency in pregnancy. American Society of Hematology. December 6, 2025. Accessed December 18, 2025. https://www.eurekalert.org/news-releases/1108767
- Godby R, Wick M, Liu M, et al. Implementation of a multidisciplinary quality improvement project standardizing an approach to screening and treating iron deficiency in pregnancy. Presented at: American Society of Hematology 2025 Annual Meeting. December 12-15, 2025. New Orleans, Louisiana.
