Diagnosis and Therapy of Iron Deficiency Anemia During Pregnancy: Recommendation of the Austrian Society for Gynecology and Obstetrics (OEGGG)

Abstract

This overview analyzes the data on the controversial therapy of iron substitution during pregnancy, the diagnosis of iron deficiency anemia and the indication-related therapy, and is the first recommendation issued by the OEGGG on the appropriate therapy. The effects of anemia during pregnancy on postnatal outcomes have been intensively investigated with heterogeneous results. A final scientific conclusion with regards to the “optimal” maternal hemoglobin level is limited by the heterogeneous results of various studies, many of which were conducted in emerging nations (with different dietary habits and structural differences in the respective healthcare systems). The current literature even suggests that there may be a connection between both decreased and increased maternal serum hemoglobin concentrations and unfavorable short-term and long-term neonatal outcomes. In Austria, 67 percent of pregnant women take pharmacological supplements or use a variety of dietary supplements. Clinically, the prevalence of maternal anemia is often overestimated, leading to overtreatment of pregnant women (iron substitution without a medical indication). To obtain a differential diagnosis, a workup of the indications for treatment should be carried out prior to initiating any form of iron substitution during pregnancy. If treatment is medically indicated, oral iron substitution is usually sufficient. Because of the restricted approval and potential side effects, medical indications for intravenous iron substitution should be limited. Intravenous iron substitution without a prior detailed diagnostic workup is an off-label use and should only be used in very limited cases, and women should be advised accordingly.

Key words

pregnancy - anemia - hemoglobin - iron substitution - neonatal outcome

^* Board of the Austrian Society for Gynecology and Obstetrics (OEGGG): Priv. Doz. Dr. Gunda Pristauz-Telsnigg (Graz), Dr. Ingrid Geiss (Lilienfeld), Univ.-Prof. Dr. Karl Tamussino (Graz), Univ.-Prof. Dr. Christian Marth (Innsbruck), Univ.-Prof. Dr. Heinz Kölbl (Vienna), Univ.-Prof. Dr. Thorsten Fischer (Salzburg), Univ.-Prof. Dr. Herbert Kiss (Wien), Univ.-Prof. Dr. Peter Oppelt (Linz), Univ.-Prof. Dr. Bettina Toth (Innsbruck), MR. Dr. Michael Sommergruber (Salzburg), Assoc. Prof. Dr. Philipp Klaritsch (Graz), Priv.-Doz. Dr. Omar Shebl (Linz), Dr. Rainer Heider (Kufstein), Dr. Birgit Volgger (Lienz), Dr. Gerhard Berger (Hartberg), Univ.-Prof. Dr. Alain Zeimet (Innsbruck), Univ.-Prof. Dr. Petra Kohlberger (Vienna), Dr. Alexandra Ciresa-König (Graz), Dr. Thomas Fiedler (Linz), Dr. Karin Windsperger (Vienna), Dr. Brigitte Wiesenthal (Vienna), Univ.-Prof. Dr. Lothar Fuith (Eisenstadt), Univ.-Prof. Dr. George Ralph (Bruck an der Mur), Univ.-Prof. Dr. Dagmar Bancher-Todesca (Vienna), Univ.-Doz. Dr. Walter Neunteufel (Dornbirn), Univ.-Prof. Dr. Ludwig Wildt (Innsbruck)

Publication History

Received: 24 November 2021

Accepted: 30 November 2021

Article published online:
05 April 2022

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