No. 469 Iron Deficiency and Iron Deficiency Anemia in Obstetrics and Gynaecology

The purpose of this guideline is to provide an evidence-based framework for healthcare professionals to recognize, manage, and prevent iron deficiency and iron deficiency anemia across the lifecycle of women, with particular emphasis on time periods of vulnerability, such as pregnancy, menstruation, and perioperatively.

This clinical practice guideline seeks to improve the lives of women at all reproductive life stages, from menarche to menopause, with iron deficiency and iron deficiency anemia in the context of obstetrical and gynaecologic care.

This guideline reviews the available options for the prevention, assessment, and treatment of iron deficiency and iron deficiency anemia. While the focus of this guideline pertains to oral and intravenous iron replacement therapy, the importance of reducing menstrual blood loss is also emphasized.

By consolidating the best evidence to date with expert opinion across the disciplines of obstetrics and gynaecology, hematology, and anaesthesiology, we provide recommendations and treatment algorithms to guide the diagnosis and treatment of iron deficiency and iron deficiency anemia for patients within our specialty.

The prevention, early identification, and treatment of iron deficiency and iron deficiency anemia is assessed to be a cost-effective strategy to improve the health and well-being of women of reproductive age. This proactive approach to iron deficiency and iron deficiency anemia has also been shown to reduce the need for blood transfusion, along with the associated harms and costs of transfusion. The potential costs of iron infusion therapy must be assessed in the context of the profound adverse impacts on quality of life, reduced work performance and decreased economic productivity of patients with iron deficiency and iron deficiency anemia.

Using relevant MeSH headings and keywords (related to concepts of anemia, iron deficiency, blood management, blood conservation, transfusion, obstetrics, pregnancy, postpartum, and gynaecology), published literature was retrieved through searches of PubMed and Cochrane Systematic Reviews from January 2015 to December 2025. Grey literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies.

This guideline was developed through consensus by a multidisciplinary team of authors with representation from obstetrics, gynaecology, anaesthesiology, and hematology. The content and recommendations were drafted and agreed upon by the authors. The SOGC's Clinical Obstetrics and Gynaecology Committee reviewed the guideline and the Guideline Management and Oversight Committee approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. See online Appendix A (Tables A1 for definitions and A2 for interpretations). A national panel of patient partners was gathered to provide feedback and perspective on the recommendations and summary statements for this guideline. Community partners were purposefully selected to ensure representation of Canadian geographic regions, lived experience with iron deficiency or iron deficiency anemia, as well as obstetrical or gynaecologic care received.