USPSTF: Evidence Lacking for Iron Deficiency Screening

Lara C. Pullen, PhD

March 31, 2015

The US Preventive Services Task Force (UPSTF) has released two new draft recommendations: one on screening for iron deficiency anemia (IDA) and routine iron supplementation in pregnant women and one on screening for IDA and routine iron supplementation in young children (ages 6 to 24 months). Both recommendations are given a grade of "I," indicating there is insufficient evidence to determine the balance of benefit against harm.

The USPSTF draft recommendations were published online March 30. The publication of the recommendations coincides with the publication of two supporting review articles, one in the Annals of Internal Medicine and one in Pedatrics. Both draft recommendations are open for comments through April 27, 2015.

Pregnant Women

Amy G. Cantor, MD, MPH, from the Oregon Health & Science University in Portland, and colleagues performed a systematic review for the UPSTF to update evidence on the benefits and harms of routine screening and supplementation for IDA in pregnant women, published online March 30 in the Annals of Internal Medicine. Although they found evidence suggesting supplementation may improve maternal hematologic indices, they found inconclusive evidence that routine prenatal supplementation for IDA improved clinical health outcomes in mothers or infants.

The reviewers identified 12 trials that compared the effects of routine prenatal iron supplementation vs no supplementation. They were unable to find a study that directly compared benefits or harms of screening or not screening pregnant women for IDA.

The strongest evidence to support the benefits of iron supplementation demonstrated improvements in some maternal hematologic parameters when pregnant women at average risk for anemia were given iron supplements. However, the long-term effects of such supplementation are unknown.

The authors called for more research to investigate the long-term clinical health effects of routine iron supplementation during pregnancy.

Young Children

Marian S. McDonagh, PharmD, also from Oregon Health & Science University, and colleagues published the systematic review on supplementation and screening for IDA in young children online March 30 in Pediatrics.

Most physicians who recommend routine iron supplementation do so on the assumption there is long-term benefit from preventing IDA in young children. Unfortunately, Dr McDonagh and colleagues found no high-quality, randomized controlled trials of routine supplementation, screening programs, or treatment of IDA in young children that were able to address this hypothesis.

The authors did find some evidence to suggest that supplementation for IDA in young children improves hematologic values; however, they could not find studies that evaluated clinical outcomes after supplementation. In particular, the reviewers note they were unable to find any evidence about the effects of routine iron supplementation in young children on diagnosis of neurodevelopmental delay, psychomotor delay, or quality of life.

Moreover, the 10 trials that evaluated the effect of iron supplementation reported inconsistent findings regarding the effect of supplementation on incidence of IDA, anemia, or hemoglobin levels. The reviewers note that the inconsistent findings were likely because many of the studies were underpowered to evaluate specific outcomes.

One large study, performed in Chile, supported supplementation for most hematologic values. The study, however, was confounded by a high incidence of hematologic values in the control group.

The reviewers did not find reports of any harm from routine iron supplementation in children.

They concluded their review, as did the authors of the Annals of Internal Medicine review, by calling for studies that specifically address the benefits and harm of routine iron supplementation and screening to prevent IDA in young children.

The authors have disclosed no relevant financial relationships.

Draft recommendation on screening for iron deficiency anemia and routine iron supplementation in pregnant women Full text

Draft recommendation on screening for iron deficiency anemia and routine iron supplementation in young children. Full text

Ann Intern Med. Published online March 30, 2015. Full text

Pediatrics. Published online March 30, 2015. Full text

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