O&G · Antenatal care — haematological disorders
Anaemia in pregnancy
Also known as Iron deficiency anaemia in pregnancy · Anaemia in pregnancy · Physiological anaemia of pregnancy · Maternal anaemia · Ferric carboxymaltose in pregnancy
FRANZCOG fellowship reference on anaemia in pregnancy: FIGO 2025 screening and haemoglobin cutoffs, the ferritin-below-30 diagnosis of iron deficiency, oral iron 60 to 120 mg elemental iron daily first-line, the indications for parenteral iron and transfusion, folic acid dosing, and the Khalafallah, FER-ASAP, Froessler, FRIDA and Daru evidence.
Checked against its sources on 23 Oct 2026
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Target exams
FRANZCOGMRCOGABOGFRCSCMRCPI
Red flags
- Severe anaemia (haemoglobin under 70 g/L) was associated with maternal death in the WHO Multicountry Survey, adjusted odds ratio 2.36
- Iron deficiency anaemia within 4 to 6 weeks of anticipated childbirth is an indication for parenteral iron (FIGO 2025)
- Haemoglobinopathy: give iron only with laboratory evidence of iron deficiency (ferritin under 30 micrograms per L)
- Parenteral iron is not advised in the first trimester owing to a lack of safety data
- Transfuse for severe anaemia close to childbirth, acute severe bleeding, or symptomatic anaemia with haemodynamic or cardiac compromise
Scenario
You are reviewing the 28-week bloods of a woman who feels constantly tired: haemoglobin 92 g/L, mean cell volume 76 fL, ferritin 9 micrograms per L. The examiner wants four things from you: which cutoff defines anaemia, which test proves iron deficiency, which route and dose of iron, and when blood is justified.
References18ShowHide
- [1]American College of Obstetricians and Gynecologists Anemia in Pregnancy: ACOG Practice Bulletin, Number 233 Obstet Gynecol, 2021.PMID 34293770
- [2]Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, Tunçalp Ö, Torloni MR, Mittal S, Jayaratne K, Lumbiganon P, Togoobaatar G, Thangaratinam S, Khan KS Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis Lancet Glob Health, 2018.PMID 29571592
- [3]Rogozińska E, Daru J, Nicolaides M, Amezcua-Prieto C, Robinson S, Wang R, Godolphin PJ, Saborido CM, Zamora J, Khan KS, Thangaratinam S Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis Lancet Haematol, 2021.PMID 34171281
- [4]Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T Daily oral iron supplementation during pregnancy Cochrane Database Syst Rev, 2015.PMID 26198451
- [5]Breymann C, Milman N, Mezzacasa A, et al. Ferric carboxymaltose vs. oral iron in the treatment of pregnant women with iron deficiency anemia: an international, open-label, randomized controlled trial (FER-ASAP) J Perinat Med, 2017.PMID 27278921
- [6]Khalafallah AA, Hyppa A, Chuang A, Hanna F, Wilson E, Kwok C, Yan C, Gray Z, Mathew R, Falloon P, Dennis A, Pavlov T, Allen JC A Prospective Randomised Controlled Trial of a Single Intravenous Infusion of Ferric Carboxymaltose vs Single Intravenous Iron Polymaltose or Daily Oral Ferrous Sulphate in the Treatment of Iron Deficiency Anaemia in Pregnancy Semin Hematol, 2018.PMID 30502851
- [7]Froessler B, Schubert KO, Palm P, Church R, Aboustate N, Kelly TL, Dekker GA, Hodyl NA Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial BJOG, 2023.PMID 36047598
- [8]Radhika AG, Sharma AK, Perumal V, Sinha A, Sriganesh V, Kulshreshtha V, Kriplani A Parenteral Versus Oral Iron for Treatment of Iron Deficiency Anaemia During Pregnancy and post-partum: A Systematic Review J Obstet Gynaecol India, 2019.PMID 30814805
- [9]Camaschella C Iron deficiency Blood, 2019.PMID 30401704
- [10]Markova V, Hansen R, Thomsen LL, Pinborg A, Moos T, Holm C Intravenous iron isomaltoside versus oral iron supplementation for treatment of iron deficiency in pregnancy: protocol for a randomised, comparative, open-label trial Trials, 2020.PMID 32843079
- [11]Daniilidis A, Panteleris N, Vlachaki E, Breymann C, Assimakopoulos E Safety and efficacy of intravenous iron administration for uterine bleeding or postpartum anaemia: a narrative review J Obstet Gynaecol, 2018.PMID 29057687
- [12]Oteng-Ntim E, Pavord S, Howard R, et al. Management of sickle cell disease in pregnancy. A British Society for Haematology Guideline Br J Haematol, 2021.PMID 34409598
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- [14]Drakesmith H, Pasricha SR, Cabantchik I, Hershko C, Weiss G, Girelli D, Stoffel N, Muckenthaler MU, Nemeth E, Camaschella C, Klenerman P, Zimmermann MB Vaccine efficacy and iron deficiency: an intertwined pair? Lancet Haematol, 2021.PMID 34450104
- [15]Ubom AE, Begum F, Ramasauskaite D, Nieto-Calvache AJ, Oguttu M, Nunes I, Malel ZJ, Beyeza-Kashesya J, Wright A; FIGO Committee on Childbirth and Postpartum Hemorrhage FIGO good practice recommendations on anemia in pregnancy, to reduce the incidence and impact of postpartum hemorrhage (PPH) Int J Gynaecol Obstet, 2025.PMID 41031541
- [16]Stoffel NU, Cercamondi CI, Brittenham G, Zeder C, Geurts-Moespot AJ, Swinkels DW, Moretti D, Zimmermann MB Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials Lancet Haematol, 2017.PMID 29032957
- [17]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.Source
- [18]Bamrah D, Nautiyal R, Kala M, Bhat K, Garg S Screening for β-Thalassemia Trait in Pregnant Women With Microcytic Hypochromic Anemia and Its Impact on Pregnancy Outcomes Cureus, 2026.PMID 42245877