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Poster Session 4

Category: Clinical Obstetrics

Poster Session 4

(998) Iron deficiency without anemia in the first trimester: A missed opportunity to prevent anemia?

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Adam K. Lewkowitz, MD, MPHS

Assistant Professor
Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States

Coauthor(s)

NK

Nicole Konecke

Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
TJ

Tracy L. Jackson, PhD

Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
IA

Irving Angeles, MPH

Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
IS

Iman I. Sigman

Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
CW

Crystal F. Ware, RN

Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
AB

Ashley E. Benson, MD

Oregon Health & Science University
Portland, Oregon, United States
JS

Joseph J. Shatzel, MD

Oregon Health & Science University
Portland, Oregon, United States
NR

Nandini Raghuraman, MD, MSCI

Associate Professor
Washington University School of Medicine
St. Louis, Missouri, United States
Molly J. Stout, MD, MS (she/her/hers)

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
Ann M. Bruno, MD, MS (she/her/hers)

Assistant Professor
University of Utah
Salt Lake City, Utah, United States
SF

Steven Fein, MD

Heme On Call
Miami, Florida, United States
Carolyn M. Webster, MD (she/her/hers)

Assistant Professor, Maternal-Fetal Medicine
University of Alabama at Birmingham
Birmingham, Alabama, United States
MA

Michael Auerbach, MD

Clinical Professor, Hematology/Oncology
Georgetown University School of Medicine
Washington DC, District of Columbia, United States
Jamie O. Lo, MD

Associate Professor
Oregon Health & Science University
Oregon Health & Science University, Oregon, United States
MT

Methodius G. Tuuli, MBA, MD, MPH

Chace-Joukowsky Professor of Obstetrics and Gynecology, Chair of Obstetrics and Gynecology
Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, and Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States

Objective:
First-trimester iron deficiency without anemia (IDWA: ferritin < 30 ng/mL with hemoglobin (Hgb) >11 g/dL) may progress to iron deficiency anemia (IDA), which is associated with adverse perinatal outcomes for mother and infant. We aimed to examine the association between first trimester IDWA and development of IDA later in pregnancy.

Study Design:
This was a single center prospective cohort study of individuals with singleton gestations who completed their routine obstetric intake labs—which include CBC and ferritin—in the first trimester from August 2022 to December 2024 Those with first-trimester IDA (ferritin < 30 ng/mL and Hgb< 11 g/dL) were excluded. Individuals with IDWA were compared with non-anemic, non-iron-deficient people (ferritin >30 ng/mL and Hgb > 11). The primary outcome was progression to IDA after 14 weeks’ gestation ( >14wks). Relative risks (RR) were calculated adjusting for receiving iron therapy and race/ethnicity. A subgroup analysis included those in either group who did not receive iron therapy.

Results:
Among 514 eligible individuals, 136 (26%) had first-trimester IDWA. Those with IDWA were more likely to be Hispanic or Native American than those who were non-anemic and non-iron deficient, but age, parity, and body mass index were similar between groups (Table 1). Progression to IDA requiring treatment >14wks was higher among those with IDWA than those who were non-anemic, non-iron deficient (59% versus 33%; p< 0.001). Among those who did not receive iron therapy, people with IDWA were nearly four times more likely to develop IDA >14wks compared with those who were non-anemic, non-iron deficient (16% vs 4%; RR 3.64 (95% CI 1.58, 8.36)) (Table 2).

Conclusion:
First-trimester IDWA is common and associated with high likelihood of requiring IDA treatment prior to delivery, and those who are untreated have a nearly four-fold increased risk of developing IDA compared to non-anemic, non-iron-deficient individuals. These findings suggest that identifying iron deficiency in the first trimester provides an opportunity to prevent overt IDA.