Iron supplements for all pregnant patients, regardless of race, can help prevent anemia

Iron supplementation is recommended for all patients at the beginning of their pregnancy, regardless of a patient’s race.

Iron supplementation is recommended for all patients at the beginning of their pregnancy, regardless of a patient’s race, and all obstetricians at Norton Healthcare should follow this guidance.

Updated guidance for anemia in pregnancy

In 2021, the American College of Obstetricians and Gynecologists (ACOG) changed its protocol for treating anemia by standardizing anemia values for all patients. The former protocol, which used a race-based standard that defined anemia differently for Black women, was related to population-based studies that showed Black women naturally have lower levels of hemoglobin.

ACOG recognized that this race-based standard can lead to undertreatment of anemia in pregnant Black patients and create a higher risk of maternal-fetal complications, need for transfusion and higher rates of mortality.

According to ACOG, the following levels are considered anemic for all patients:

Hemoglobin (g/dL) Hematocrit (%)
First trimester: <11 g/dL <33%
Second trimester: <10.5 g/dL <32%
Third trimester: <11 g/dL <33%


Black people are nearly three times more likely to die of pregnancy-related complications than white people, and the alarming rate of maternal mortality and the racial gap in pregnancy loss and pregnancy-related deaths are nationwide public health concerns. Various initiatives and programs are in place to reduce maternal morbidity and mortality rates and help improve health outcomes for Norton Healthcare patients.

How iron supplements can reduce the risks

Iron supplements can help prevent anemia during pregnancy.

“Iron creates blood that supplies oxygen for the baby, so it is of utmost importance to help prevent iron deficiency anemia and related complications among our pregnant patients,” said Gigi L. Girard, M.D., OB/GYN with Norton Women’s Care.

During pregnancy, anemia is usually caused by iron deficiency or blood loss. Pregnant women need higher levels of iron, and failing to maintain sufficient iron levels can lead to complications. Iron deficiency anemia during pregnancy increases the risk of premature birth (prior to 37 weeks), low birth weight and postpartum depression. It also increases the risk for child mortality.

While prenatal vitamins usually contain iron, an additional iron supplement can help ensure pregnant patients receive the necessary 27 milligrams of iron a day.

Refer a patient

To refer a patient to Norton Women’s Care, visit Norton EpicLink and choose EpicLink referral to Obstetrics/Gynecology.

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