Suboptimal Screening and Correction of Maternal Iron Deficiency Anaemia in the General Population and in Inherited Bleeding Disorders: A Population-Based Cohort Study

Iron deficiency anaemia (IDA) is associated with adverse pregnancy outcomes globally. Women with inherited bleeding disorders are at increased risk, with scarce data on rates of IDA screening and correction during pregnancy. The impact of correction on outcomes is unclear. To assess the frequency of IDA screening, the frequency of IDA in pregnancies with and without bleeding disorders and the impact of correction on outcomes. This retrospective population-based cohort study includes all hospitalized pregnancies using the Alberta Pregnancy Birth Cohort. IDA was defined as haemoglobin <110 g/L in first/third trimester, <105 g/L in second trimester and ferritin <30 μg/L. Logistic regression was performed to assess the association between IDA, corrected IDA and pregnancy outcomes. 36 500/207 355 (18%) pregnancies and 14/58 (24%) pregnancies in the bleeding disorder subgroup had anaemia. Only one of three pregnancies with anaemia had a concurrent ferritin test, and over 80% demonstrated IDA. Ferritin screening was performed in 60% of the overall cohort and 79% in bleeding disorders. Young maternal age, multiparity, lower socioeconomic status and mothers from African and Asian countries significantly predict IDA. Despite the increased risk for adverse outcomes, only 43 (8%) first-trimester and 96 (9%) third-trimester IDA were corrected. IDA screening and correction remained suboptimal among pregnant women. Updated screening guidelines may promote better identification and outcomes.