Pregnancy
More than 80% of women iron deficient by third trimester of pregnancy
A new study and accompanying editorial has argued for routine iron screening for all pregnant women after research results revealed that more than 80 per cent of women are iron deficient by the third trimester of pregnancy.
When a woman becomes pregnant, her iron requirements increase almost tenfold to support foetal development as well as her own increased iron needs. Her ability to meet these increased iron needs depends on her iron stores at the beginning of the pregnancy as well as the physiological adaptations that enhance iron absorption as pregnancy progresses.
These physiological adaptations, however, are not always enough to support a pregnant woman’s iron needs, especially among the estimated 50 per cent of women who begin pregnancy with depleted iron stores. While often thought of as a problem in low-resource settings, recent studies have documented iron deficiency rates of 33 to 42 per cent among pregnant women in high-resource settings.
Iron deficiency can lead to anaemia, a condition in which the body can’t produce sufficient haemoglobin, which, in turn, limits the red blood cells’ ability to carry oxygenated blood throughout the body.
Anaemia during pregnancy is associated with a higher risk of both adverse maternal outcomes and adverse infant outcomes, including postpartum depression, postpartum haemorrhage, preterm birth, low birth weight, and small-for-gestational age birth. Even without the presence of anaemia, maternal iron deficiency can result in long-term neurodevelopmental challenges for the child.
At the moment, screening for iron deficiency during pregnancy is not universally routine. Moreover, there is no generally agreed upon diagnostic criteria for iron deficiency during pregnancy.
The most recent draft recommendation from the US Preventive Services Task Force, for example, states that “the current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anaemia in pregnant women.”
In contrast, the International Federation of Gynecology and Obstetrics and European Hematology Society recommend all pregnant women in their first trimester irrespective of the presence or absence of anaemia be screened for iron deficiency.
Moreover, they also recommend that all women of reproductive age irrespective of the presence or absence of anaemia be screened for iron deficiency.
Even when screening is conducted, it may be insufficient to detect iron deficiency. In clinical practice, for example, haemoglobin is frequently the only benchmark used to evaluate iron status among pregnant women. Haemoglobin, however only provides an indication of anaemia. As a result, poor maternal and infant health outcomes that may develop before iron deficiency advances to anaemia may arise undetected.
Unfortunately, well-designed studies of the changes in iron status during the course of pregnancy are limited.
In response, the authors of a new study evaluated the changes in iron biomarkers throughout pregnancy, established the prevalence of iron deficiency, and proposed iron status benchmarks in early pregnancy that predict iron deficiency in the third trimester.
The authors, Elaine K. McCarthy et al., also sought to determine how common risk factors for iron deficiency such as obesity and smoking affected iron status throughout pregnancy. The study is one of the largest studies ever to document the changes in iron status during pregnancy.
To conduct their research, the authors worked with data collected from 641 women in Ireland who were pregnant and had a successful delivery for the first time and who participated in the IMproved PRegnancy Outcomes via Early Detection (IMPROvED) consortium project.
Samples were taken from the women at 15 weeks, 20 weeks and 33 weeks of pregnancy to determine iron status. Within 72 hours following delivery, information about the pregnancy, delivery, and the baby were obtained from the mother via an interview with a research midwife.
Information pertaining to clinical outcomes and complications during pregnancy and delivery were confirmed by reviewing medical records.
“In this high-resource setting,” the authors found that “iron deficiency defined by a variety of biomarkers and thresholds, was very common during pregnancy, despite the cohort profile as generally healthy.”
Interestingly, none of the study participants were anaemic in the first trimester, yet more than 80 per cent of the women were iron deficient by the third trimester.
In particular, the authors noted that “our cohort had higher rates of deficiency in the third trimester than even some low-resource settings.”
In this study, almost three-quarters of the participants took an iron-containing supplement that contained the Irish/European recommended daily iron allowance of 15 to 17mg. The authors did note that “iron-containing supplements (mainly multivitamins) taken pre/early pregnancy were associated with a reduced risk of deficiency throughout pregnancy, including the third trimester.”
According to the authors, these findings draw attention to “the benefit of screening for iron deficiency with haemoglobin and ferritin in defined low-risk populations.”
Moreover, based on their findings, the authors proposed a threshold for ferritin, a protein that stores iron, of 60µg per litre or less at 15 weeks of pregnancy that predicted the presence of iron deficiency at 33 weeks of pregnancy, defined as 15µg of ferritin per litre or less.
The authors noted that: “This has previously been identified as the inflection point at which foetal iron accretion is compromised, leading to poorer neurocognitive function and earlier onset of postnatal iron deficiency in the offspring.”
In an accompanying editorial to this study, authors Michael Auerbach and Helain Landy bluntly labelled the medical community’s approach to women, including the lack of screening and treating iron deficiency and anaemia among pregnant women, as “misogyny.”
Given the study’s findings, the editorial calls upon the American College of Obstetricians and Gynecologists and the United States Preventive Services Taskforce to “change their approach to diagnosis to screen all pregnant women for iron deficiency, irrespective of the presence or absence of anaemia, and recommend supplementation when present for the most frequent nutrient deficiency disorder that we encounter.”
Looking to the future, the authors believe that “further good-quality, large-scale longitudinal studies of iron status, with concurrent inflammatory status, are needed to provide the evidence base to help establish much-needed consensus. Moreover, the use of early pregnancy iron biomarkers and thresholds should be instituted in better alignment with clinically meaningful health outcomes.”
The study and editorial have been published in The American Journal of Clinical Nutrition.
A high-powered ultrasound treatment could help identical twins affected by a rare and serious condition during early pregnancy, an initial study suggests.
Twin-to-twin transfusion syndrome, or TTTS, causes uneven blood flow between identical twins who share a placenta.
The imbalance can leave one baby dangerously small and the other too large, putting both babies’ survival at risk.
Brioney Garrett’s daughters were in danger before doctors used the world-first treatment to seal the blood vessels causing the problem without an operation.
Nancy and Margo were born healthy and, now aged four, are due to start school.
Researchers from Queen Charlotte’s and Chelsea Hospital tested the non-invasive procedure in 10 women from the UK and elsewhere in Europe after scans detected TTTS during early pregnancy.
Five women needed further treatment, while 12 of the 20 babies survived following the procedure.
The researchers described having a treatment that did not require a needle or telescope to be inserted into the mother’s abdomen as “extremely exciting”.
However, they said larger studies involving more pregnant women were needed before the procedure could be offered more widely.
Garrett described her daughters as “my miracle twins”.
She said: “We were in a very dire situation and I don’t forget that.
“It stays with me always how things could have been. Every day I still count my blessings.”
TTTS affects between 10 and 15 per cent of identical twins who share a placenta, representing around 300 to 400 pregnancies in the UK each year.
The uneven blood flow causes excess fluid to build up around the larger recipient baby, while leaving dangerously little fluid around the smaller donor baby.
Treatment usually involves inserting a needle into the womb to drain some of the fluid or using a laser to seal the connecting blood vessels.
Garrett’s procedure took about 20 minutes. She lay flat while a specially designed machine directed high-powered ultrasound waves at small blood vessels in her placenta.
She said: “It was very quick and pretty painless.”
Christoph Lees, head of fetal medicine at Imperial College Healthcare NHS Trust and professor of obstetrics at Imperial College London, described the research as “very promising”.
He said: “If this could work in a fully-fledged study, it could give hope to a lot of women who otherwise might have to have quite invasive treatment.”
Ultrasound is commonly used during medical scans to produce images of the body, but this procedure uses much more focused waves.
Heat generated by the waves can seal blood vessels about 2mm in diameter and located around 5cm to 6cm beneath the skin.
The procedure blocked blood flow in 90 per cent of the vessels treated during the study, with no unwanted side-effects reported.
Twins Trust, which supported the study, said the approach could make a significant difference for families affected by TTTS.
Helen Peck, head of healthcare engagement and research, said: “Any procedure that is non-invasive and can potentially identify TTTS earlier and improve outcomes for our families with this life-threatening condition could be a turning point.”
Scans carried out weeks after Garrett’s procedure showed that blood flow between the babies had been rebalanced, although other problems developed during the pregnancy.
Garrett said Margo, who had too little fluid around her, “was in a much better position” and that “the strain on Nancy’s heart had eased”.
Nancy and Margo were born at nearly 34 weeks, weighing 3lb 7oz and 3lb 3oz respectively.
Garrett said: “They were both healthy, and Margo wasn’t as small as we worried she was going to be.”
The twins are due to start primary school in September.
Garrett said: “They’re funny, smart, energetic little girls that just fit right in with their age group.”
A new reporting tool built specifically for obstetrics and maternal-fetal medicine has launched, aimed at teams managing increasingly complex pregnancies with limited time and resources.
Trice Imaging has released Trice Workspace Reporting, which connects imaging, reporting and longitudinal patient data in a single workflow to support faster clinical decision making.
Birth rates are falling worldwide, but pregnancies are getting more complicated. Advanced maternal age, IVF-assisted pregnancies, rising obesity rates and a higher prevalence of hypertension and diabetes mean more cases now require specialist monitoring, advanced imaging and multidisciplinary care.
At the same time, clinical teams are stretched and facing growing administrative demands.
Trice Workspace Reporting brings together customisable reporting, dynamic pregnancy dating and longitudinal patient history with an AI-ready, EHR-interoperable infrastructure, all inside the company’s Tricefy image management platform.
The company says it aims to accelerate standardised and synchronised report turnaround, support timely clinical decisions and improve operational efficiency for fetal medicine services.
“Maternal fetal medicine teams are managing increasingly complex pregnancies while being asked to do more with limited time and resources,” said Mark A. Samii, chief revenue officer at Trice Imaging.
“Trice Workspace Reporting is designed to remove unnecessary friction from reporting by creating a structured digital foundation that supports today’s need for connected clinical workflows.
“It also provides a digital foundation as practices prepare for tomorrow and the evolution of AI-enabled fetal assessment, anomaly detection and outcome prediction technologies.”
Trice Imaging describes its mission as transforming the women’s health journey by connecting physicians, patients and healthcare systems. From independent practices to large hospital ecosystems, it aims to reach the entire women’s health continuum, spanning IVF and reproductive health, maternal-fetal medicine and OB/GYN, and onwards to lifelong women’s health.
For more than 17 years the firm has worked on cloud-based storage, retrieval, display, organisation and exchange of ultrasound medical images and associated information across health environments.
Its wider platform now extends to dynamic clinical reporting, AI-driven workflow optimisation, data analytics and secure patient engagement.
Trice Imaging holds regulatory and data protection clearances in 40 countries. It has offices in Miami and Stockholm, alongside a growing network of global distributors.
By Dr Fran Conti-Ramsden, clinician at Guy’s and St Thomas’ NHS Foundation Trust, academic at King’s College London, and chief medical officer of MEGI Health.
A woman gives birth. A few days later she goes home, often with a bag of medication for her blood pressure, and then, very often, very little structured follow-up for her heart (cardiovascular) health.
In my clinical work, and through our collaboration with Action on Pre-eclampsia, I see and hear about this postnatal cliff edge again and again, and it still shocks me.
We invest a lot of medical care and attention whilst a woman or birthing individual is pregnant, then, at the very moment emerging evidence suggests we have a window of opportunity to modify long-term health, the support falls away.
That cliff edge is a symptom of a deeper issue: we have come to treat “women’s health” as a synonym for reproductive health. Pregnancy, periods and fertility, important as they are, have crowded out everything else.
Yet the conditions that do most to shorten and limit women’s lives are not reproductive at all.
Cardiovascular disease is the leading cause of death in women worldwide, and it is still too readily thought of as a man’s problem.
Heart disease in women is more likely to be missed and under-treated, in part because for decades women were under-represented in the research that built our knowledge.
Pregnancy makes this vivid.
Conditions such as pre-eclampsia are not only risks to be managed for nine months; they are early warnings about a woman’s future, markers that she is more likely to develop heart disease and high blood pressure in the years to come.
We have the knowledge to act on that. What we mostly do instead is discharge her and look away.
This is exactly the kind of problem better tools should help us solve: spotting risk earlier, supporting women and their clinicians through the vulnerable postnatal window, and providing continuity where the system currently provides a drop due to lack of capacity.
Artificial intelligence and digital health have real potential here; in risk prediction, in monitoring blood pressure at home, and in helping stretched clinicians know who needs attention and when.
And yet this is not where most of the energy is going.
It is far easier to build, fund and scale an app that tracks a cycle than a tool that changes the trajectory of a woman’s heart.
So, innovation clusters at the lighter, lower-risk end of innovation, while the conditions that actually kill and disable women, and moments like the postnatal cliff, stay under-served.
Closing the women’s health gap could add at least a trillion dollars to the global economy each year, the World Economic Forum estimates, but the bigger prize is women living longer, healthier lives.
None of this means technology is a cure in itself. It is a tool, and a tool built carelessly can do harm.
Because women have been under-represented in medical data, systems trained on that data can quietly carry the same blind spots forward, deepening inequalities rather than closing them.
Responsible innovation, with clinical-grade evidence, privacy and equity designed in from the start, and tools built around real clinical pathways rather than bolted on afterwards, is not a brake on progress.
It is the only version of progress worth having.
I am optimistic, because a serious community is forming around exactly these questions and the appetite to get it right is real.
It is why, at MEGI, we are bringing clinicians, researchers, founders, regulators and investors together for our AI × Women’s Health summit on 25 June.
If we keep our focus on the conditions that matter most to women’s lives, and build the tools to meet them responsibly, the postnatal cliff edge could become something else entirely: the moment the system finally catches her and delivers preventative healthcare.
AI × Women’s Health: Innovation, Challenges and Opportunities summit is taking place on Thursday 25 June 2026 at the London Institute for Healthcare Engineering. The event is free and is fully booked and operating a waiting list. Join the waiting list here.
About Dr Fran Conti-Ramsden
Dr Fran Conti-Ramsden is a UK Obstetrics and Gynaecology registrar and Chadburn Clinical Lecturer at KCL passionate about transforming women’s health through technology and innovation.
Combining NHS clinical experience with an MRC-funded PhD, recent NHS Clinical AI fellowship and commercial role as Chief Medical Officer at Megi health, she works at the intersection of clinical medicine, data science, technology and AI.
Her current programme of research focuses on the intersection of healthcare and technology; leveraging advances such as smartphone based vital signs capture and large language models to drive forward scalable innovation in maternal cardiovascular care.
She has published over 20 peer-reviewed manuscripts (See gScholar, h-index 12), including award-winning work recognized by Hypertension Journal.
She was awarded an AI visionary award in 2025 by Health Innovation KSS was the recipient of the 2024 International Society for the Study of Hypertension in Pregnancy Zuspan prize.
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