The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.
Department of Family Medicine, Oregon Health & Science University, Portland.
JAMA. 2024 Sep 17;332(11):914-928. doi: 10.1001/jama.2024.13546.
IMPORTANCE: In 2015 the US Preventive Services Task Force (USPSTF) found insufficient evidence to assess the balance of benefits and harms of routine screening and supplementation for iron deficiency anemia during pregnancy. OBJECTIVE: To update the 2015 review on screening for iron deficiency anemia, in addition to iron deficiency during pregnancy, to inform the USPSTF. DATA SOURCES: Ovid MEDLINE and Cochrane databases through May 24, 2023; surveillance through May 24, 2024. STUDY SELECTION: Randomized clinical trials of iron supplementation, screening effectiveness, treatment, and harms; observational studies of screening. DATA EXTRACTION AND SYNTHESIS: Dual review of abstracts, full-text articles, study quality, and data abstraction. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES: Maternal and infant clinical outcomes, hematologic indices, and harms. RESULTS: Seventeen trials (N = 24 023) on maternal iron supplementation were included. Iron supplementation was associated with decreased risk of maternal iron deficiency anemia at term (4 trials, n = 2230; 8.6% vs 19.8%; relative risk, 0.40 [95% CI, 0.26-0.61]; I2 = 20.5%) and maternal iron deficiency at term (6 trials, n = 2361; 46% vs 70%; relative risk, 0.47 [95% CI, 0.33-0.67]; I2 = 81.9%) compared with placebo or no iron supplement. There were no statistically significant differences in maternal quality of life, rates of gestational diabetes, maternal hemorrhage, hypertensive disorders of pregnancy, cesarean delivery, preterm birth, infant low birth weight, or infants small for gestational age for maternal iron supplementation compared with placebo or no supplementation. Harms of iron supplementation included transient gastrointestinal adverse effects. No studies evaluated the benefits or harms of screening for iron deficiency or iron deficiency anemia during pregnancy. Data on the association between iron status and health outcomes, such as hypertensive disorders of pregnancy and preterm birth, were very limited. CONCLUSIONS AND RELEVANCE: Routine prenatal iron supplementation reduces the incidence of iron deficiency and iron deficiency anemia during pregnancy, but evidence on health outcomes is limited or indicates no benefit. No studies addressed screening for iron deficiency or iron deficiency anemia during pregnancy. Research is needed to understand the association between changes in maternal iron status measures and health outcomes.
重要性：2015 年，美国预防服务工作组（USPSTF）发现，没有足够的证据来评估常规筛查和补充铁缺乏症在怀孕期间的益处和危害之间的平衡。
目的：更新 2015 年关于铁缺乏症筛查的审查，以及怀孕期间除铁缺乏症以外的其他内容，为 USPSTF 提供信息。
数据来源：通过 2023 年 5 月 24 日的 Ovid MEDLINE 和 Cochrane 数据库进行检索；通过 2024 年 5 月 24 日进行监测。
研究选择：铁补充剂、筛查效果、治疗和危害的随机临床试验；筛查的观察性研究。
数据提取和综合：对摘要、全文文章、研究质量和数据提取进行双重审查。使用随机效应模型对数据进行汇总。
主要结果和措施：母婴临床结局、血液学指标和危害。
结果：纳入了 17 项关于孕产妇铁补充的试验（N=24023）。铁补充与足月时产妇缺铁性贫血风险降低相关（4 项试验，n=2230；8.6% vs 19.8%；相对风险，0.40[95%CI，0.26-0.61]；I2=20.5%）和足月时产妇缺铁性贫血相关（6 项试验，n=2361；46% vs 70%；相对风险，0.47[95%CI，0.33-0.67]；I2=81.9%）与安慰剂或无铁补充剂相比。与安慰剂或无补充剂相比，铁补充剂对孕产妇生活质量、妊娠期糖尿病、孕产妇出血、妊娠高血压疾病、剖宫产、早产、婴儿低出生体重或小于胎龄儿的发生率没有统计学意义。铁补充剂的危害包括短暂的胃肠道不良反应。没有研究评估筛查孕妇缺铁或缺铁性贫血的益处或危害。关于铁状况与妊娠高血压疾病和早产等健康结局之间关系的数据非常有限。
结论和相关性：常规产前铁补充可降低怀孕期间铁缺乏和缺铁性贫血的发生率，但健康结局的证据有限或表明无益处。没有研究涉及筛查孕妇缺铁或缺铁性贫血。需要研究了解孕产妇铁状况测量值与健康结局之间的关系。
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