This cross-sectional study was conducted at the MCB service center of the Styrian Health Insurance Fund in Graz, Austria, where women come to perform oral glucose tolerance tests and provide a second blood sample for anemia screening and other tests. As hemoglobin data were available for a limited group of women, the hemoglobin status during pregnancy and associated consumption of iron-containing medications were also recorded. In addition to how often pregnant women take iron and iron-containing multivitamin supplements during pregnancy, the aim of this study was to determine when they began taking them and on whose recommendation. The results of the whole project will be reported to the panel of experts to enable them to develop appropriate recommendations for a new MCB program to be implemented by 2019. The second package, which is described in this article, investigated how often and why women took iron and iron-containing multivitamin supplements during pregnancy. To determine the prevalence of anemia during pregnancy, the first package involves retrospective cohort analyses of hemoglobin levels measured in week ≤ 16 and between weeks 25–28 in pregnant women who had both tests at the MCB service center of the Styrian Health Insurance Fund (Steiermärkische Gebietskrankenkasse). A project consisting of two work packages has therefore been initiated.

Currently, these screening tests check blood hemoglobin and the number of erythrocytes but not the level of ferritin. During a structured assessment of existing guidelines and discussions by a panel of experts, the question arose whether the two blood samples (before week 16 and in weeks 25–28) that are currently required during pregnancy are actually necessary. As a result of new developments in research, this program is now under review by the Austrian Ministry of Health. Since 1974, the Austrian government has required certain test results for mothers and their newborns to be entered into a so-called Mutter-Kind-Pass (mother-child booklet MCB) until the child is 62 months old. This study is part of a project dealing with the usefulness of repeated anemia screening during pregnancy. Iron supplementation leads to a fall in the prevalence of maternal anemia at delivery however, it is unclear if iron supplementation in well-nourished non-anemic pregnant women affects perinatal outcomes. For women living in a region where anemia is a severe public health problem, the daily intake of 60 mg of elemental iron is recommended, beginning as early as possible. In contrast, the WHO recommends that all pregnant women take 30–60 mg iron daily. Guidelines from other developed countries do not recommend routine iron supplementation at all. In the UK, an individualized approach is taken based on the results of blood count screening and the identification of women at increased risk due to previously confirmed anemia, multiple pregnancies, pregnancies within 1 year of one another and vegetarianism. There are also huge differences in recommendations whether to take iron supplements.ĭuring pregnancy, the American Congress of Obstetricians and Gynecology (ACOG) recommends taking 27 mg of dietary ferrous iron daily, whereas the UK guidelines do not routinely recommend iron supplementation. Due to a paucity of evidence, one guideline does not recommend anemia screening at all. Several international guidelines recommend regular anemia screening, while two guidelines only recommend screening in the case of an existing indication. The definition of anemia varies during the course of pregnancy and is defined as a hemoglobin level < 11.0 mg/dl in the first trimester, 10.5 mg/dl in the second trimester and again 11 mg/dl in the third trimester. During a singleton gestation, the blood volume expands by approximately 50% and total red blood cell mass by around 25%. According to the World Health Organization (WHO), its prevalence during pregnancy is approximately 15.5% in Austria. Iron deficiency anemia is the most common form of anemia in pregnancy and is usually hypochromic and microcytic and associated with a low level of ferritin.

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