A new study shows that identifying and treating iron deficiency during the second trimester of pregnancy is cost-effective at a threshold of <30 μg/L ferritin, as compared to a lower threshold of <15 μg/L or no screening.
“These results fill a critical gap in maternofetal medicine and may help inform the forthcoming American Society of Hematology Clinical Practice Guidelines on the Diagnosis and Treatment of Iron Deficiency,” wrote the authors, led by Daniel Wang of Yale School of Medicine in New Haven, Connecticut.
The researchers undertook the project because iron deficiency is among the five leading causes of years lived with disability in women of reproductive age worldwide. It affects more than half of pregnancies, with poor outcomes including postpartum hemorrhage, impaired fetal neurocognitive development, preterm labor, and maternal mortality.
However, the U.S. currently has no guidelines for universal screening of iron deficiency in pregnancy. In addition, thresholds for diagnosis (<15 μg/L ferritin in all trimesters according to the Centers for Disease Control and Prevention and <15μg/L ferritin in first trimester according to the World Health Organization) “fall below more sensitive physiologically based thresholds of no less than 20 to 25 μg/L ferritin in pregnancy,” the authors wrote. “As such, iron-deficiency screening and treatment represents an enormous gap in the health of expectant mothers.”
Therefore, they designed a model and performed an analysis to assess the cost-effectiveness of screening ferritin thresholds to diagnose and treat iron deficiency in pregnancy.
Women entered the model at age 15 and were screened or not screened during the second or third trimester of each pregnancy in their lifetime. Those found to be iron deficient received a single dose of 1 g intravenous iron dextran.
There were three groups:
- Ferritin threshold <30 μg/L
- Ferritin threshold <15 μg/L
- No screening
The analysis considered quality-adjusted-life-years (QALYs), wages lost to infusion time to take into account societal factors, and incremental cost-effectiveness ratio (ICER).
Screening with a ferritin threshold of 30 μg/L versus 15 μg/L versus no screening accrued $213,000, $212,800, and $212,400 and 25.12, 25.11, and 25.09 QALYs per individual, respectively. The authors determined that screening at a ferritin threshold of 30 μg/L was the cost-effective strategy due to ICER of $23,000/QALY. Screening at 30 μg/L also was most cost-effective per societal factors, with ICER of $33,000/QALY.
Reference
Wang D, Sra M, Ito S, et al. Raising the bar in maternofetal hematology: Cost-effectiveness of iron deficiency screening in pregnancy across ferritin-based thresholds. Abstract 598. Presented at: the 67th American Society of Hematology Annual Meeting and Exposition, Dec. 6-9, 2025, Orlando, FL.
