Practical Recommendations from Clinical Experts for Optimizing Screening, Diagnosis, and Treatment of Iron Deficiency during Pregnancy in Portugal

Abstract

Iron deficiency is a clinical condition characterized by the depletion of iron stores, potentially affecting up to 95% of pregnant women in Portugal. If not identified and treated early, this condition can progress from fatigue, tiredness and reduced work productivity to anemia, increasing the risk of maternal-fetal complications. Therefore, early detection of iron deficiency during pregnancy is crucial for promptly addressing iron deficits and preventing complications during childbirth and the postpartum period. Scientific evidence and international guidelines recognize serum ferritin as the most reliable marker for detecting iron deficiency. However, in Portugal, its measurement is not currently standardized in the pregnancy monitoring guidelines for any trimester. This lack of formal recommendation leads to a heterogeneous clinical approach, contributing to the underdiagnosis and undertreatment of iron deficiency, with a significant negative impact on maternal and fetal health. To address this gap, the Portuguese Association of Family Medicine, the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, and the Anemia Working Group Portugal established a working group of four clinical experts. This group convened to develop a set of practical guidelines aimed at standardizing serum ferritin measurements across all three trimesters of pregnancy in the national healthcare system. Through these recommendations, experts aim to raise awareness among key stakeholders involved in pregnancy monitoring in Portugal and to urge national health authorities to incorporate this indicator into the digital IT systems used for pregnancy surveillance in primary healthcare. The aim of this initiative is to ensure a more effective approach to gestational iron deficiency and reduce its burden on maternal and fetal health.