Identification and treatment of iron-deficiency anemia in pregnancy and postpartum: A systematic review and quality appraisal of guidelines using AGREE II.
clinical practice guidelines
iron-deficiency anemia
postpartum
pregnancy
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
09 Jul 2023
09 Jul 2023
Historique:
revised:
02
06
2023
received:
21
04
2023
accepted:
10
06
2023
medline:
10
7
2023
pubmed:
10
7
2023
entrez:
10
7
2023
Statut:
aheadofprint
Résumé
Several international guidelines provide recommendations for the optimal management of iron-deficiency anemia (IDA) in the pregnant and postpartum populations. To review the quality of guidelines containing recommendations for the identification and treatment of IDA in pregnancy and postpartum using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and to summarize their recommendations. PubMed, Medline, and Embase databases were searched from inception to August 2, 2021. A web engine search was also performed. Clinical practice guidelines that focused on the management of IDA in pregnancy and/or postpartum populations were included. Included guidelines were appraised using AGREE II independently by two reviewers. Domain scores greater than 70% were considered high-quality. Overall scores of six or seven (out of a possible seven) were considered high-quality guidelines. Recommendations on IDA management were extracted and summarized. Of 2887 citations, 16 guidelines were included. Only six (37.5%) guidelines were deemed high-quality and were recommended by the reviewers. All 16 (100%) guidelines discussed the management of IDA in pregnancy, and 10 (62.5%) also included information on the management of IDA in the postpartum period. The complex interplay of racial, ethnic, and socioeconomic disparities was rarely addressed, which limits the generalizability of the recommendations. In addition, many guidelines failed to identify barriers to implementation, strategies to improve uptake or iron treatment, and resource and cost implications of clinical recommendations. These findings highlight important areas to target future work.
Sections du résumé
BACKGROUND
BACKGROUND
Several international guidelines provide recommendations for the optimal management of iron-deficiency anemia (IDA) in the pregnant and postpartum populations.
OBJECTIVES
OBJECTIVE
To review the quality of guidelines containing recommendations for the identification and treatment of IDA in pregnancy and postpartum using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and to summarize their recommendations.
SEARCH STRATEGY
METHODS
PubMed, Medline, and Embase databases were searched from inception to August 2, 2021. A web engine search was also performed.
SELECTION CRITERIA
METHODS
Clinical practice guidelines that focused on the management of IDA in pregnancy and/or postpartum populations were included.
DATA COLLECTION AND ANALYSIS
METHODS
Included guidelines were appraised using AGREE II independently by two reviewers. Domain scores greater than 70% were considered high-quality. Overall scores of six or seven (out of a possible seven) were considered high-quality guidelines. Recommendations on IDA management were extracted and summarized.
MAIN RESULTS
RESULTS
Of 2887 citations, 16 guidelines were included. Only six (37.5%) guidelines were deemed high-quality and were recommended by the reviewers. All 16 (100%) guidelines discussed the management of IDA in pregnancy, and 10 (62.5%) also included information on the management of IDA in the postpartum period.
CONCLUSIONS
CONCLUSIONS
The complex interplay of racial, ethnic, and socioeconomic disparities was rarely addressed, which limits the generalizability of the recommendations. In addition, many guidelines failed to identify barriers to implementation, strategies to improve uptake or iron treatment, and resource and cost implications of clinical recommendations. These findings highlight important areas to target future work.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Sinai Health Clinicians in Quality Improvement Award
Informations de copyright
© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Références
WHO. Health topics: anaemia. 2021. Accessed June 26, 2021. https://www.who.int/health-topics/anaemia#tab=tab_1
WHO. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. World Health Organization; 2011.
Hytten F. Blood volume changes in normal pregnancy. Clin Haematol. 1985;14(3):601-612.
De Haas S, Ghossein-Doha C, van Kuijk SM, van Drongelen J, Spaanderman MEA. Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis. Ultrasound Obs Gynecol. 2017;49(2):177-877.
McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993-2005. Public Health Nutr. 2009;12(4):444-454.
Smith C, Teng F, Branch M, Chu S, Joseph KS. Maternal and perinatal morbidity and mortality associated with anemia in pregnancy. Obstet Gynecol. 2019;134(6):1234-1244.
Rahman MM, Abe SK, Rahman MS, et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr. 2016;103(2):495-504.
Georgieff MK. Iron deficiency in pregnancy. Am J Obstet Gynecol. 2020;223(4):516-524.
Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N. Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand. 1999;78(9):749-757.
Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child's health. Saudi Med J. 2015;36(2):146-149.
Tolkein Z, Stecher L, Mander AP, Pereira DIA, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015;10(2):e0117383.
Butwick AJ, Aleshi P, Fontaine M, Riley ET, Goodnough LT. Retrospective analysis of transfusion outcomes in pregnant patients at a tertiary obstetric center. Int J Obstet Anesth. 2009;18(4):302-308.
Covidence systematic review software. Veritas Health Innovation. Accessed July 2, 2021. www.covidence.org
Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):839-842.
Roper JC, Amber N, Wan OYK, Sultan AH, Thakar R. Review of available national guidelines for obstetric anal sphincter injury. Int Urogynecol J. 2020;31(11):2247-2259.
Tran K, McCormack S. Screening and treatment of obstetric anemia: a review of clinical effectiveness, cost-effectiveness, and guidelines. Can. Agency Drugs Technol. Heal. CADTH Rapid Response Reports. 2019 Dec:1-25.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med. 2012;22(3):276-282.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 223: Anemia in pregnancy. Obstet Gynecol. 2021;138(2):55-64.
Breymann C, Bian X, Blanco-Capita LR, Chong C, Mahmud G, Rehman R. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med. 2011;39(2):113-121.
Guidelines & Protocols Advisory Committee. Iron deficiency-diagnosis and mangement. BC Guidelines 2019 Apr;1-16.
Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep. 1998;47(3):1-36.
Danish Society of Obstetrics and Gynecology. Anaemia and iron deficiency in pregnancy and postpartum. Nord Fed Soc Obstet Gynecolody. 2016. Accessed July 4, 2023. https://static1.squarespace.com/static/5467abcce4b056d72594db79/t/5714ea13a3360cab668161e3/1460988440726/Guideline+for+an%C3%A6mi_final.pdf
Romero JM, Morales EC, Castro EV, et al. Review by expert group in the diagnosis and treatment of anemia in pregnant women. Ginecol Obstet Mex. 2012;80(9):563-580.
Di Renzo GC, Fonseca E, Gratacos E, et al. Good clinical practice advice: iron deficiency anemia in pregnancy. Int J Gynecol Obstet. 2019;144(3):322-324.
Kripalani A, Sharma A, Radhika AG, et al. FOGSI General Clinical Practice Recommendations Management of Iron Deficiency Anemia in Pregnancy. The Federarion of Obstetric and Gynecological Societies of India; 2017.
Muñoz M, Peña-Rosas JP, Robinson S, et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018;28(1):22-39.
National Collaborating Centre for Women's and Children's Health. Antenatal care: routine care for the healthy pregnant woman. RCOG Press; 2008.
South Australian Maternal & Neonatal Comminity of Practice. Policy clinical guideline: anemia in pregnancy. South Austuralian perinatal practice guidelines. 2019.
Breymann C, Honegger C, Hosli I, Surbek D. Diagnosis and treatment of iron-deficiency anaemia in pregnancy and postpartum. Arch Gynecol Obstet. 2017;296(6):1229-1234.
Albinaab N, Angelillo-Scherrer A, Betticher D, et al. Swiss delphi study on iron deficiency. Swiss Med Wkly. 2019;149:w20097.
Pavord S, Daru J, Prasannan N, Robinson S, Standworth GJ, et al. UK guidelines on the maagement of iron deficiency in pregnancy. BJH. 2019;188(6):819-830.
Siu AL, Bibbins-Domingo K, Grossman D, et al. Screening for iron deficiency anemia and iron supplementation in pregnant women to improve maternal health and birth outcomes: U.S. preventive services task force recommendation statement. Ann Intern Med. 2015;163(7):529-536.
WHO. WHO recommendations on antenatal care for a positive pregnancy experience. 2016.
Rioux FM, LeBlanc CP. Iron supplementation during pregnancy: what are the risks and benefits of current practices? Appl Physiol Nutr Metab. 2007;32(2):282-288.
Malinowski AK, Murji A. Iron deficiency and iron deficiency anemia in pregnancy. Can Med Assoc J. 2021;193(29):1137-1138.
Cochrane KM, Hutcheon JA, Karakochuk CD. Iron-deficiency prevalence and supplementation practices among pregnant women: a secondary data analysis from a clinical trial in Vancouver. Canada J Nutr. 2022;152(10):2238-2244.
van den Broek NR, Letsky EA, White SA, Shenkin A. Iron status in pregnant women: which measurements are valid? Br J Haematol. 1998;103(3):817-824.
Dignass A, Farrag K, Stein J. Limitations of serum ferritin in diagnosing iron deficiency in inflammatory conditions. Int J Chronic Dis. 2018;2018:9394060-71.
Carsley S, Fu R, Borkhoff CM, et al. Iron deficiency screening for children at 18 months: a cost-utility analysis. CMAJ Open. 2019;7(4):689-698.
Rogozinska E, Daru J, Nicolaides M, et al. Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis. Lancet Haematol. 2021;8(7):503-512.
Juul SE, Derman RJ, Auerbach M. Perinatal iron deficiency: implications for mothers and infants. Neonatology. 2019;115(3):269-274.
Thurn L, Wikman A, Westgren M, Lindqvist PG. Incidence and risk factors of transfusion reactions in postpartum blood transfusions. Blood Adv. 2019;3(15):2298-2306.
Barton JC, Wiener HH, Acton RT, et al. Prevalence of iron deficiency in 62,685 women of seven race/ethnicity groups: the HEIRS study. PLoS One. 2020;15(4):e0232125.
Kanu FA, Hamner HC, Scanlon KS, Sharma AJ. Anemia among pregnant women participating in the special supplemental nutrition program for women, infants, and children-United States, 2008-2018. MMWR Morb Mortal Wkly Rep. 2022;71(25):813-819.
Teichman J, Nisenbaum R, Lausman A, Sholzberg M. Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting. Blood Adv. 2021;5(22):4666-4673.
ACC/SCN. Fourth Report on the World Nutrition Situation-Nutrition throughout the Life Cycle. Geneva ACC/SCN Collab with IFPRI; 2000.
Elmore C, Ellis J. Screening, treatment, and monitoring of iron deficiency anemia in pregnancy and postpartum. J Midwifery Womens Health. 2022;67(3):321-331.
Aranda N, Ribot B, Garcia E, Viteri FE, Arija V. Pre-pregnancy iron reserves, iron supplementation during pregnancy, and birth weight. Early Hum Dev. 2011;87(12):791-797.
Ronnenberg AG, Wood RJ, Wang RJ, et al. Preconception hemoglobin and ferritin concentrations are associated with pregnancy outcome in a prospective cohort of Chinese women. J Nutr. 2004;134(10):2586-2591.
Wirawan F, Nurrika D. Maternal pre-pregnancy anemia and child anemia in Indonesia: risk assessment based on a population-based prospective longitudinal study. Epidemiol Health. 2022;44:e2022100.
Nguyen PH, Young M, Gonzalez-Casanova I, et al. Impact of preconception micronutrient supplementation on anemia and iron status during pregnancy and postpartum: a randomized controlled trial in rural Vietnam. PLoS One. 2016;11(12):e0167416.
Georgieff MK. The role of iron in neurodevelopment: fetal iron deficiency and the developing hippocampus. Biochem Soc Trans. 2008;36(6):1267-1271.
Congdon EL, Westerlund A, Algarin CR, et al. Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years. J Pediatr. 2012;160(6):1027-1033.
Karakoc G, Orgul G, Sahin D, Yucel A. Is every other day iron supplementation effective for the treatment of the iron deficiency anemia in pregnancy? J Matern Fetal Neonatal Med. 2022;35(5):832-836.