School of Medicine, Georgetown University, Washington, DC, USA.
Department of Obstetrics and Gynecology, Davenport University, Grand Rapids, MI, USA.
J Matern Fetal Neonatal Med. 2021 Mar;34(6):1002-1005. doi: 10.1080/14767058.2019.1619690. Epub 2019 Jun 3.
Despite a high frequency of iron deficiency in pregnancy, the United States Preventative Services Task Force (USPSTF) stated: "there is inconclusive evidence routine supplementation for iron deficiency anemia improves maternal or infant clinical health outcomes." In contradistinction, high-quality epidemiologic studies report long lasting deficits in infants diagnosed with iron deficiency in the first 6 months of life compared with infants who were not, with specific deficits in cognition, memory, executive function and electrophysiology documented up to 19 years of age. Infants are not routinely screened for iron deficiency. United Kingdom guidelines differ and recommend screening high-risk infants who are preterm, of diabetic, underweight, obese, or vegetarian mothers, those born to anemic or iron deficient mothers, of smokers, those with inflammatory bowel disease or abnormal uterine bleeding, and from pregnancies in which the intergravid period is <6 months. Iron parameters are not routinely drawn unless anemia is present and in some cases only if microcytic. In that iron deficiency precedes the development of anemia, and waiting for its development misses a large number of overtly iron deficient gravidas. Iron parameters were measured in 102 consecutive, nonselected, nonanemic, first trimester women presenting to their obstetricians. Using standard cutoffs of percent transferrin saturation and/or serum ferritin, 42% were observed to be iron deficient. Given the lack of harm of testing for iron deficiency, it appears prudent to err on the side of caution and screen all presenting pregnant mothers until properly powered outcome data become available. The current recommendations of the USPSTF may need to be revisited.
尽管孕期缺铁的发生率很高，但美国预防服务工作组（USPSTF）指出：“常规补充铁剂治疗缺铁性贫血是否能改善母婴临床健康结局，尚无定论证据。”相比之下，高质量的流行病学研究报告称，与未被诊断为缺铁的婴儿相比，在生命的前 6 个月被诊断为缺铁的婴儿会出现长期的缺铁，并且在认知、记忆、执行功能和电生理学方面存在特定的缺陷，这些缺陷的记录时间长达 19 年。婴儿并没有被常规筛查缺铁。英国的指南则有所不同，建议对有早产、糖尿病、体重不足、肥胖或素食母亲、母亲贫血或缺铁、吸烟者、有炎症性肠病或异常子宫出血、以及在妊娠期间间隔<6 个月的高危婴儿进行筛查。除非出现贫血，否则不会常规抽取铁参数，在某些情况下，只有出现小细胞性贫血时才会抽取。由于缺铁先于贫血的发展，等待其发展会错过大量明显缺铁的孕妇。在向产科医生就诊的 102 名连续、非选择性、非贫血的初孕妇中测量了铁参数。使用转铁蛋白饱和度和/或血清铁蛋白的标准截断值，观察到 42%的孕妇缺铁。鉴于检测缺铁无害，似乎谨慎起见进行筛查所有就诊的孕妇是合理的，直到获得适当的、有说服力的结果数据。目前 USPSTF 的建议可能需要重新考虑。
