Program

Nurse-Midwifery M.S.

Number of Pages

32

Year Approved

2024

First Advisor

Douglas, Taneesha

Second Reader

Katrina Wu

Abstract

Introduction: With increased iron demand in pregnancy, accurate and timely diagnosis of iron deficiency is especially important since its symptoms are life-limiting or life-threatening. Screening for ferritin, an indicator of iron storage, could lead to early diagnoses of nonanemic iron deficiency (NAID), though there is currently no consensus on universal ferritin screening in pregnancy. The purpose of this review was to identify the incidence of NAID, the current evidence and guidelines for ferritin screening in pregnancy, to determine if ferritin is the most appropriate test, and if so, what cutoff level has the highest specificity and sensitivity. Methods: Using the Whittemore and Knafl methodology design, we searched PubMed, Scopus, CINAHL, Google Scholar, and Science Direct using the keywords ferritin AND iron deficiency AND screening AND pregnant women OR pregnancy. We restricted the search to full-text publications available in English, published in the last 10 years. We excluded studies featuring multi-fetal gestations, severe malnutrition, chronic severe disease, or high-risk pregnancies. This method yielded 23 articles from 16 countries, which we assessed for quality and then synthesized. Results: Studies represented 51,411 pregnant women and used different ferritin cutoff values to define NAID. Ferritin of 30 mcg/L had higher specificity and sensitivity for identifying iron deficiency. Ferritin concentrations were affected by inflammation. Ferritin was lowest in the second trimester due to hemodilution and increased iron demand. In the first trimester more participants had NAID (20.2%-70%) than anemia (1.9%-16%). NAID was associated with multiple risk factors and hemoglobin was insufficient to screen for it. Discussion: The studies in this review found that screening ferritin in the first trimester identifies NAID and provides time to intervene before delivery. Current screening methods detect iron deficiency anemia (IDA), the end-stage of iron deficiency. Guidelines are needed to identify and treat NAID. More research is needed regarding the relationship of inflammation to ferritin.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis

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