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Recording available 2/16-5/2

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Poster Session 2

Category: Clinical Obstetrics

Poster Session 2

(398) Iron Deficiency Without Anemia Is Highly Prevalent at 24–28 Weeks’ Gestation: A Prospective Cohort

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Abbey P. Donahue, MD, MPH

Fellow
Wake Forest University
Winston-Salem, North Carolina, United States

Coauthor(s)

AW

Angelina H. Wiater, BA

Medical Student
Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States
MW

Mackenzie Wood, MS

Wake Forest University
Winston-Salem, North Carolina, United States
LF

Lexi Frankel

Wake Forest University
Winston-Salem, North Carolina, United States
MZ

Matthew Zuber, MD

Wake Forest University School of Medicine
Winston Salem, North Carolina, United States
MK

Melissa Kozakiewicz, MD

Wake Forest School of Medicine
Winston-Salem, North Carolina, United States
CG

Chad Grotegut, MBA, MD

Division Director
Wake Forest University
Winston-Salem, North Carolina, United States

Objective:
To determine the prevalence of iron deficiency without anemia (IDWA) at 24–28 weeks’ gestation among non-anemic pregnant patients.

Study Design:
We conducted a prospective cohort study of pregnant patients with hemoglobin ≥ 11 g/dL at their initial prenatal visit who underwent ferritin testing between 24w0d–28w6d across three outpatient clinics. Patients with prior anemia, known iron deficiency, malabsorptive disorders, or multifetal gestation were excluded. Ferritin results were blinded to providers and not used to guide clinical care. IDWA was defined as ferritin < 30 µg/L in the setting of normal hemoglobin (Hgb ≥ 11 g/dL). Baseline characteristics were compared between patients with and without IDWA.

Results:
Among 321 patients with ferritin levels drawn during the study period, 66 (20%) were anemic (Hgb < 11 g/dL) and excluded. Of the remaining 251 non-anemic patients, 94% (N=240) met criteria for IDWA (Figure 1). Baseline characteristics were largely similar between ferritin groups. Patients with ferritin ≥ 30 µg/L trended toward higher rates of nulliparity (53% vs 34%, p = 0.13) and tobacco use during pregnancy (13% vs 5%, p = 0.2), though these differences were not statistically significant. Maternal age, hemoglobin and MCV values, and rates of hypertensive disorders were comparable between groups (Table 1).

Conclusion:
Iron deficiency in pregnancy is exceedingly common, even among those with normal hemoglobin levels based on current ferritin criteria. These findings suggest that routine screening or empiric iron supplementation may be warranted to prevent the later development of anemia. An updated ferritin cutoff to define IDWA in pregnancy may be warranted given the distribution we observed. Once the cohort has completed delivery, we plan to evaluate associations between midtrimester ferritin levels and delivery outcomes; specifically whether midtrimester ferritin levels can predict hemoglobin at birth admission and other perinatal outcomes.