A quality improvement project at the Mayo Clinic has led to a significant increase in screening and treatment for iron deficiency among pregnant patients. Within one year of implementation, the project resulted in a sixfold rise in screening rates and a 20-fold increase in intravenous (IV) iron infusions.
Women of child-bearing age are particularly vulnerable to iron deficiency due to factors such as menstruation, low intake of iron-rich foods, and certain medications that can inhibit iron absorption, according to Dr. Richard Godby of the Mayo Clinic. The need for iron increases during pregnancy, and deficiencies have been linked to complications including fetal growth restriction, premature birth, low birth weight, and impaired brain development.
Current guidelines from the American College of Obstetricians and Gynecologists recommend screening only for pregnant women with anemia—defined as hemoglobin levels below 11 g/dL during the first or third trimester. However, Dr. Godby’s team sought to standardize broader screening by adding ferritin testing—a measure of stored iron—to routine lab work at both eight to twelve weeks and again at twenty-four to twenty-eight weeks of pregnancy.
Patients found to have low ferritin early in pregnancy were offered oral supplements; those with low levels later were offered IV iron dextran infusions. The study compared two groups: one before the project (2,097 pregnancies) and one after (2,429 pregnancies).
The results showed that ferritin testing increased from 10% before implementation to 63% after. Among those tested, about two-thirds were found to be iron deficient in both groups. IV iron infusions rose from less than 1% before the project to 21% afterward.
Median hemoglobin levels improved among patients who received IV infusions—from 10.7 g/dL before treatment to 11.8 g/dL after. Patients whose initial hemoglobin was above the anemia threshold also saw increases. "These findings suggest reassessing the threshold for diagnosing anemia and screening for iron deficiency in pregnancy," said Dr. Godby.
The proportion of pregnancies requiring blood transfusion during delivery dropped slightly from 3.1% before the project to 2.7% after; most who needed transfusions had not been screened for iron deficiency.
Dr. Godby noted that nearly all patients took prenatal vitamins—usually purchased over-the-counter—but these supplements are not regulated for content or dosage by authorities.
As a next step, researchers plan to investigate whether treating iron deficiency improves outcomes such as postpartum depression recovery time and overall quality of life.
Dr. Godby will present these findings on December 7, 2025, at noon Eastern time at the Orange County Convention Center.
