Screening and Supplementation 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

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.

• 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

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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