Did you know?

the global voice for

women’s health

Statement in September 2023

Iron deficiency and anaemia in women and girls

Anaemia is an under-recognised and undertreated chronic state that adversely impacts more than 2 billion people worldwide, predominantly women, the fetus and children. Iron deficiency is the most common micronutrient deficiency worldwide and is the most frequent cause of anaemia. It is prevalent in women in all socioeconomic strata.

Reference: WHO. The Global Prevalence of Anaemia in 2011. WHO.

FIGO Recommendations

All reproductive-aged girls and women should be regularly tested for Iron Deficiency starting from menarche and throughout their life, preferably by measuring serum ferritin.

Iron deficiency anaemia is a significant, global, public health issue

To see the full statement, visit FIGO.

*Some Hematologists may be available via Telemedicine for your convenience.

Did you know?

What you need to know about

Iron deficiency

in Pregnancy

Iron deficiency is associated with symptoms such as fatigue, shortness of breath and ice chewing for the pregnant mother.

There are also risks for the baby including: autism, intellectual disability, and attention deficit hyperactivity disorder, among others.

The only way to know, is to get iron testing (Ferritin).

As many as 50% of non-anemic pregnant women have iron deficiency in the first trimester, and don’t know it! This only gets worse throughout pregnancy as the babies iron needs increase.

A simple iron infusion could help you and your baby feel their best in no time!

Did you know?

What you need to know about

Iron deficiency

after weight loss surgery

Iron deficiency is a side effect that may result from a bariatric surgery. Most of the iron from foods is absorbed in the first part of your small intestine (duodenum). But after a bariatric surgery, food bypasses the duodenum. This can lead to iron deficiency and other nutrition problems.

• You are at risk for iron deficiency and anemia years/decades after bariatric surgery.
• You will need to monitor your level of iron and other nutrients for the rest of your life.
• You will likely need intravenous iron infusions to improve your symptoms.

What you need to know about

As many as 75% of teenage girls have iron deficiency, and

don’t know it!

Iron deficiency

in Teenage Girls

The only way to know,

is to get iron testing (Ferritin).

Iron deficiency affects a persons ability to perform their best in school and athletics.

A simple iron infusion could help you feel your best in no time!

Common Symptoms

of Iron Deficiency include:

• Lack of energy or tiredness (fatigue)
• Cold intolerance
• Dizziness
• Weakness
• Headache
• Hair loss
• Brittle nails
• Craving to chew ice or clay

• Rapid heartbeat
• Shortness of breath
• Chest pain
• Strange pounding sensation in your ears
• Irritability
• Poor concentration

Other Relevant Articles referenced in FIGO Statement

1. WHO. The Global Prevalence of Anaemia in 2011. WHO. Accessed July 1, 2019. https://www.who.int/nutrition/publications/micronutrients/global_prevalence_anaemia_2011/en/.

2. Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet. Jan 16 2021;397(10270):233-248. doi:10.1016/S0140-6736(20)32594-0

3. Scott DE, Pritchard JA. Iron deficiency in healthy young college women. JAMA. Mar 20 1967;199(12):897-900.

4. Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood. Apr 4 2013;121(14):2607-17. doi:10.1182/blood-2012-09-453522

5. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. Jan 30 2014;123(5):615-24. doi:10.1182/blood-2013-06-508325

6. Milman N, Taylor CL, Merkel J, Brannon PM. Iron status in pregnant women and women of reproductive age in Europe. Am J Clin Nutr. Dec 2017;106(Suppl 6):1655S-1662S. doi:10.3945/ajcn.117.156000

7. Teichman J, Nisenbaum R, Lausman A, Sholzberg M. Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting. Blood Adv. Nov 23 2021;5(22):4666-4673. doi:10.1182/bloodadvances.2021004352

8. Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. Mar 2015;128(3):196-200. doi:10.1016/j.ijgo.2014.09.027

9. Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. Am J Obstet Gynecol. Jun 2019;220(6):569 e1-569 e7. doi:10.1016/j.ajog.2019.02.048

10. Henry C, Ekeroma A, Filoche S. Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research. BMC Womens Health. Jun 12 2020;20(1):123. doi:10.1186/s12905-020-00986-8

11. Henry C, Filoche S. Reflections on access to care for heavy menstrual bleeding: Past, present, and in times of the COVID-19 pandemic. Int J Gynaecol Obstet. Aug 2023;162 Suppl 2:23-28. doi:10.1002/ijgo.14945

12. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middleincome countries. Ann N Y Acad Sci. Aug 2019;1450(1):15-31. doi:10.1111/nyas.14092

13. Richards T, Musallam KM, Nassif J, et al. Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery. PLoS One. 2015;10(7):e0130861. doi:10.1371/journal.pone.0130861

14. Murji A, Lam M, Allen B, et al. Risks of preoperative anemia in women undergoing elective hysterectomy and myomectomy. Am J Obstet Gynecol. Dec 2019;221(6):629 e1-629 e18. doi:10.1016/j.ajog.2019.07.018

15. Goddard AF, James MW, McIntyre AS, Scott BB, British Society of G. Guidelines for the management of iron deficiency anaemia. Gut. Oct 2011;60(10):1309-16. doi:10.1136/gut.2010.228874

16. Hamm RF, Wang EY, Levine LD, Speranza RJ, Srinivas SK. Implementation of a protocol for management of antepartum iron deficiency anemia: a prospective cohort study. Am J Obstet Gynecol MFM. Mar 2022;4(2):100533. doi:10.1016/j.ajogmf.2021.100533

17. Rahmati S, Azami M, Badfar G, Parizad N, Sayehmiri K. The relationship between maternal anemia during pregnancy with preterm birth: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. Aug 2020;33(15):2679-2689. doi:10.1080/14767058.2018.1555811

18. Omotayo MO, Abioye AI, Kuyebi M, Eke AC. Prenatal anemia and postpartum hemorrhage risk: A systematic review and meta-analysis. J Obstet Gynaecol Res. Aug 2021;47(8):2565-2576. doi:10.1111/jog.14834

19. Daru J, Zamora J, Fernandez-Felix BM, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health. May 2018;6(5):e548-e554. doi:10.1016/S2214-109X(18)30078-0

20. Auerbach M, Abernathy J, Juul S, Short V, Derman R. Prevalence of iron deficiency in first trimester, nonanemic pregnant women. J Matern Fetal Neonatal Med. Mar 2021;34(6):1002-1005. doi:10.1080/14767058.2019.1619690

21. Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol. Sep 2006;13(3):158-65. doi:10.1016/j.spen.2006.08.004

22. Georgieff M. The importance of iiron deficiency in pregnancy on fetal, neonatal, and infant neurodevelopmental outcomes. Int J Gynecol Obstet. 2023;

23. Georgieff MK. The importance of iron deficiency in pregnancy on fetal, neonatal, and infant neurodevelopmental outcomes. Int J Gynaecol Obstet. Aug 2023;162 Suppl 2:83-88. doi:10.1002/ijgo.14951

24. Wiegersma AM, Dalman C, Lee BK, Karlsson H, Gardner RM. Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders. JAMA Psychiatry. Sep 18 2019:1-12. doi:10.1001/jamapsychiatry.2019.2309

25. Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol. Nov 2011;90(11):1247-53. doi:10.1007/s00277-011-1279-z

26. Azami M, Badfar G, Khalighi Z, et al. The association between anemia and postpartum depression: A systematic review and meta-analysis. Caspian J Intern Med. Spring 2019;10(2):115-124. doi:10.22088/cjim.10.2.115

27. Butwick AJ, McDonnell N. Antepartum and postpartum anemia: a narrative review. Int J Obstet Anesth. Aug 2021;47:102985. doi:10.1016/j.ijoa.2021.102985

28. WHO. Nutrition: maternal, infant and young child nutrition: draft comprehensive implementation plan. 2012. A65-11. Accessed August 18, 2023. https://apps.who.int/iris/handle/10665/78899

29. Awomolo AM, McWhirter A, Sadler LC, Coppola LM, Hill MG. Neonatal outcomes from a randomized controlled trial of maternal treatment of iron deficiency anemia with intravenous ferumoxytol vs oral ferrous sulfate. Am J Obstet Gynecol MFM. Jun 20 2023:101063. doi:10.1016/j.ajogmf.2023.101063