U.S. Preventive Services Task Force
Release Date: May 2006
Summary of Screening Recommendations / Summary
of Supplementation Recommendations / Supporting Documents
Screening Children and Pregnant Women for Iron Deficiency Anemia
- The U.S. Preventive Services Task Force (USPSTF) concludes that evidence is insufficient to recommend for or against routine screening for iron deficiency anemia in asymptomatic children aged 6 to 12 months.
Rating: "I" statement
- The USPSTF recommends routine screening for iron deficiency anemia in asymptomatic pregnant women.
Rating: "B" recommendation
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Rationale:
Importance: Iron deficiency
anemia is associated with psychomotor and cognitive abnormalities in children.
Iron deficiency anemia during pregnancy has been associated with increased
risk for low birth weight, preterm delivery, and perinatal mortality. The
prevalence of iron-deficiency anemia has remained stable over the last decade
in the general U.S. population and continues to be highest among
minority and poor children. Recent studies suggest that maternal
iron deficiency anemia may be associated with postpartum depression and poor
performance on mental and psychomotor tests in offspring.
Detection: There is good evidence that hemoglobin is
a sensitive test for iron deficiency anemia, but it has low specificity because
the majority of anemias in childhood are not caused by iron deficiency. The USPSTF
found insufficient evidence (no studies) that specifically addressed the
accuracy of screening tests in asymptomatic pregnant women.
Benefits of detection and early intervention: The USPSTF
found no evidence that universal or selective screening for iron deficiency
anemia in asymptomatic children results in improved health outcomes. The USPSTF found poor evidence (conflicting studies) of the effectiveness
of interventions that demonstrate improved health outcomes, such as developmental
status, in asymptomatic children. The USPSTF found fair evidence that treating asymptomatic pregnant women
who have iron deficiency anemia results in moderate benefits in health outcomes.
Harms of detection and early treatment: The USPSTF
found no evidence addressing the harms of screening either children or pregnant
women for iron deficiency anemia. Potential harms include false-positive
results, anxiety, and cost; the small potential harms of treatment with oral
iron include gastrointestinal symptoms and unintentional overdose.
USPSTF assessment: The USPSTF
was unable to determine the balance between the benefits and harms of routine
screening for iron deficiency anemia in asymptomatic children aged 6 to 12
months. The USPSTF concludes that the benefits
of routine screening for iron deficiency anemia in asymptomatic pregnant
women outweigh the potential harms.
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Iron Supplementation for Children and Pregnant Women
- The U.S. Preventive Services Task Force (USPSTF) recommends routine iron supplementation for asymptomatic children aged 6 to 12 months who are at increased risk for iron deficiency anemia (go to Clinical Considerations for a discussion of increased risk).
Rating: "B" recommendation
- The USPSTF concludes that evidence is insufficient to recommend for or against routine iron supplementation for asymptomatic children aged 6 to 12 months who are at average risk for iron deficiency anemia.
Rating: "I" statement
- The USPSTF concludes that evidence is insufficient to recommend for or against routine iron supplementation for non-anemic pregnant women.
Rating: "I" statement
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Rationale:
Importance: Iron deficiency anemia is associated with
psychomotor and cognitive abnormalities in children. Iron deficiency anemia
in pregnancy has been associated with increased risk for low birth weight,
preterm delivery, and perinatal mortality. Recent studies suggest that maternal
iron deficiency anemia may be associated with postpartum depression and poor
performance on mental and psychomotor tests in offspring. The
prevalence of iron-deficiency anemia has remained stable over the last decade
in the general U.S. population
and continues to be greatest among minority and poor children.
Recognition of risk status: A validated
risk assessment tool to guide primary care physicians in identifying individuals
who would benefit from iron supplementation has not been developed.
Benefits of risk assessment and preventive medication: The USPSTF found fair evidence that iron supplementation (e.g., iron-fortified
formula or iron supplements) may improve neurodevelopmental outcomes in children
at increased risk for iron deficiency anemia. The USPSTF
found poor evidence (poor quality and conflicting studies) that iron–fortified
formula or supplementation improves neurodevelopmental outcomes in children
aged 6 to 12 months if they are not at increased risk for iron deficiency
anemia. The USPSTF found poor evidence (poor quality
studies) that iron supplementation may improve health outcomes in non-anemic
pregnant women.
Harms of risk assessment and preventive medication: The USPSTF
found fair evidence that oral iron supplementation increases the risk for
unintentional overdose and gastrointestinal symptoms. Given appropriate protection
against overdose, these harms are small. There is poor evidence (poor quality
studies) that iron supplementation for non-anemic pregnant women results
an increased risk for harms.
USPSTF Assessment: The USPSTF
concludes that the moderate benefits of iron supplementation in asymptomatic
children aged 6 to 12 months who are at increased risk for iron deficiency
anemia outweigh the potential harms. The USPSTF
was unable to determine the balance between the benefits and harms of iron
supplementation in children aged 6 to 12 months who are at average risk for
iron deficiency anemia, and of iron supplementation in non-anemic
pregnant women.
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Supporting Documents
Screening for Iron Deficiency Anemia, May 2006
Recommendation Statement (PDF File, 80 KB; PDF Help)
Evidence Synthesis (PDF
File, 350 KB; PDF Help)
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Current as of May 2006
Internet Citation:
Screening for Iron Deficiency Anemia, Topic Page. May 2006 U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspsiron.htm