Insufficient evidence for iron screening in kids

“Insufficient evidence” exists to recommend for or against screening for iron-deficiency anemia in asymptomatic children aged 6 to 24 months, the US Preventive Services Task Force (USPSTF) states in a draft recommendation.

A second draft recommendation cites insufficient evidence to recommend for or against screening for iron-deficiency anemia and routine iron supplementation in pregnant women who aren’t anemic. Both drafts are open for public comment until April 27, 2015, on the USPSTF website.

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The drafts update the USPSTF’s 2006 recommendations on screening and supplementation. The 2006 recommendations for children said that there wasn’t enough evidence to assess the benefits and harms of screening infants aged 6 to 12 months but recommended routine iron supplementation for high-risk babies. The USPSTF is no longer issuing a supplementation recommendation because of the ready availability of iron-fortified foods in the United States.

For pregnant women, the 2006 statement, unlike the present draft, recommended routine screening for iron-deficiency anemia. However, it agreed with the current draft statement in citing insufficient evidence to recommend for or against routine iron supplementation, which the Institute of Medicine and the American College of Obstetricians and Gynecologists support.

The task force based its recommendations on 2 evidence reviews for young children and pregnant women, published in Pediatrics and the Annals of Internal Medicine.

The pediatric systematic review found no studies examining the benefits or harms of screening for iron-deficiency anemia and none that assessed the relationship between improvement in blood iron levels and clinical outcomes. The review also found some evidence for increases in hematologic values with iron supplementation but not improvements in clinical outcomes. The researchers note that the studies they looked at “may have been underpowered” and had varying control factors that could have affected the results. No randomized, controlled screening trials have been done.

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The systematic review of screening and supplementation in pregnancy found no studies that directly compared screening or not screening with regard to harms and clinical outcomes. No controlled observational studies met criteria for inclusion in the review. Evidence that routine prenatal iron supplementation has benefits for mothers or infants was inconclusive, although some studies suggested that supplementation might improve maternal hematologic values.

Limitations of the studies included lack of generalizability, differences in methodology, and small size.