New Data: Screen Maternal Ferritin with Prenatal Care?

Summary

---

Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: New Data: Screen Maternal Ferritin with Prenatal Care?
Date: February 21, 2026
Host: Dr. Chapa

---

Episode Overview

Main Theme:
Dr. Chapa explores the emerging evidence and ongoing debate about whether routine screening of maternal ferritin (an indicator of iron stores) should be incorporated into standard prenatal care, rather than waiting to screen for iron deficiency anemia alone.

Purpose:
To present logical, evidence-based arguments for why screening for iron deficiency (via ferritin) in pregnancy may be beneficial, review current guidelines and gaps, and discuss new international data influencing this evolving clinical question.

---

Key Discussion Points & Insights

1. Iron Deficiency Anemia vs. Iron Deficiency in Pregnancy

• Iron deficiency anemia is known to be detrimental—linked to low birth weight, preterm delivery, perinatal mortality, postpartum depression, and impaired mental/psychomotor development in children.

  • [02:03] “Iron deficiency anemia has been linked to low birth weight, preterm delivery, perinatal mortality... postpartum depression and poor mental and psychomotor performance in the offspring.” (Dr. Chapa)

• Iron deficiency (without anemia) is a precursor and can be prevalent early in pregnancy.

  • [03:33] “Based on population studies, anywhere from 19 up to 42% of non-anemic pregnant women... have iron deficiency.” (Dr. Chapa)

• The typical progression is depletion of iron stores (ferritin falls) before anemia is detectable on CBC.

2. Current Guidelines: What Do Major Societies Say?

• CDC, SMFM, ACOG: All recommend screening for iron deficiency anemia in pregnancy (CBC, indices) but do not advise universal ferritin testing for iron deficiency.

  • [04:46] “ACOG says we should screen for iron deficiency anemia with a CBC... Those who fall below the level... then you can consider serum ferritin...” (Dr. Chapa)
  • Refers to ACOG Practice Bulletin No. 233.

• Gaps in Guidance:

  • US Preventive Services Task Force (USPSTF): “Insufficient evidence” for recommending maternal ferritin screening.
    • [11:27] “The U.S. Preventative Service Task Force actually has this as an insufficient statement... It’s like, I don’t know. It’s insufficient.” (Dr. Chapa)

3. International Perspective

• Australia (HOW Collaborative, 2025):

  • Recommends routine ferritin screening at initial prenatal visit, at 24–28 weeks, and at 36 weeks if indicated.
    • [12:45] “They recommend... routine ferritin screening in all pregnant women at initial enrollment and then again at 24 to 28 weeks, and then again at 36 weeks if clinically indicated. Wow.” (Dr. Chapa)

• Guideline Review:

  • A 2024 systematic review found only 5 of 14 international guidelines recommend ferritin as part of prenatal screening.

4. Pathophysiology: Early Detection & Intervention

• Ferritin as an Early Marker:

  • Ferritin <30 μg/L is diagnostic for iron deficiency in pregnancy.
  • Early detection may allow for targeted oral or IV supplementation, potentially averting progression to anemia.
    • [14:59] “30 is a cutoff for ferritin in pregnancy.”

• Analogy to TXA in Hemorrhage:

  • Dr. Chapa compares waiting for anemia to “waiting for postpartum hemorrhage to start TXA”, arguing proactive management is logical.

5. Practical Clinical Scenario & New Research

• Faculty Group Discussion:

  • Resident checks ferritin in a non-anemic patient. Attending questions whether intervention is needed.
    • [07:06] “A resident checked out to me and said this patient has low ferritin iron deficient... the faculty said, but she’s not anemic. So who was right here?” (Dr. Chapa)

• Landmark Trial (Lancet Hematology, Jan 2026):

  • Randomized controlled trial on intravenous iron therapy in non-anemic, iron-deficient pregnant women (Pakistan, multicenter, n>1000).

    • IV iron significantly improved hemoglobin before delivery vs. oral iron.

    • [19:20] Quote:
      “Among non-anemic iron deficient pregnant women, intravenous iron therapy significantly improved maternal hemoglobin before delivery compared with oral iron prophylaxis.”
      — [19:20] Dr. Chapa, quoting the study

    • Study conclusion:
      [20:29] Quote:
      “Ferritin screening should be considered in early pregnancy as intravenous iron therapy is effective in those tested positive for non-anemic iron deficiency.”
      — [20:29] Dr. Chapa, quoting the authors

• Real-World Takeaway:

  • IV iron overcomes GI side effects/compliance issues with oral supplementation.
  • No major adverse outcomes reported; some possible side effects with IV, but rare.

6. Potential Broader Benefits

• Speculative Benefits:

  • Some studies suggest early correction of iron deficiency (even without anemia) may reduce risk of preeclampsia, preterm birth, or postpartum depression—but data not definitive; study design concerns noted.
    • [21:38] “Some studies... correcting iron deficiency even without anemia possibly could help with preeclampsia and preterm birth... but those studies did have some methodological issues.” (Dr. Chapa)

• No Evidence of Harm:

  • No studies show adverse outcomes from correcting iron deficiency itself (besides rare IV side effects).
    • [22:13] “No study has shown adverse outcomes outside of maybe some side effects from iron transfusion... Most show benefit especially in correction of the indices.” (Dr. Chapa)

7. Big Picture and Dr. Chapa’s Position

• Clinical Logic:
  • “It’s pretty darn logical” to screen and treat iron deficiency early, even if US guidance hasn’t yet fully endorsed this.
  • Encourages listeners to consider practice change, initiate discussions, or use material for journal clubs.
    • [23:01] “Should we screen for ferritin in pregnancy? Now the ACOG answer is, well, we screen for iron deficiency anemia, right? Thank God we do. But why don’t we get to the root cause of that so the patient doesn’t actually develop iron deficiency anemia by checking for iron deficiency?” (Dr. Chapa)

---

Notable Quotes & Memorable Moments

• [01:06] “The more that we study, the more that we know, the more questions are generated... that is by definition, the process of science.” (Dr. Chapa)
• [03:33] “Anywhere from 19 up to 42% of non-anemic patients that enter into prenatal care have iron deficiency.” (Dr. Chapa)
• [12:48] “Thankful for the HOW... for being very forward thinking… I’m a fan of this.” (Dr. Chapa)
• [19:20] “Among non anemic iron deficient pregnant women, intravenous iron therapy significantly improved maternal hemoglobin before delivery compared with oral iron prophylaxis.” (Lancet Hematology, via Dr. Chapa)
• [20:29] “Ferritin screening should be considered in early pregnancy as intravenous iron therapy is effective in those tested positive...” (Lancet Hematology, via Dr. Chapa)
• [22:13] “No study has shown adverse outcomes outside of maybe some... side effects from iron transfusion... Most show benefit.” (Dr. Chapa)
• Throughout: Running “logical”/Spock-themed commentary adding a light, nerdy tone.

---

Timestamps for Key Segments

• Iron Deficiency Anemia: Risks, Definitions: [01:06] – [04:46]
• Guideline Review, Ferritin vs. Anemia: [04:46] – [07:06]
• Faculty Debate/Resident Story: [07:06] – [09:22]
• Gaps in US Guidance, USPSTF, GDM Analogy: [09:22] – [12:45]
• Australian Guidance & Int’l Systematic Review: [12:45] – [14:59]
• Lancet 2026 RCT (IV Iron in Non-anemic Women): [14:59] – [19:20]
• Practical Implications, Recommendations: [19:20] – [23:01]
• Big Picture & Closing Thoughts: [23:01] – [25:00]

---

Final Thoughts

Summary Statement:

• Current US guidance stops at screening/treating iron deficiency anemia; evidence and international guidelines support a move toward early ferritin screening to identify and treat iron deficiency prior to anemia. New data from a strong RCT support the benefit of IV iron in non-anemic, iron-deficient pregnancies for optimizing maternal health.
• Dr. Chapa strongly advocates for this shift, emphasizing logic, patient safety, and the ever-evolving nature of evidence-based practice.

---

Useful For:

• Medical students, residents, and practicing clinicians seeking to optimize prenatal screening protocols.
• Journal clubs and those interested in practice-changing OB/GYN research or international guideline differences.
• Anyone seeking a lively, evidence-based summary on iron in pregnancy.

---

Tone:
Engaging, energetic, and accessible—peppered with science enthusiasm, Spock/“logical” jokes, and clinical practicality.

---

Transcript

[A]

The world moves fast. Your workday even faster. Pitching products, Drafting reports analyzing data Microsoft 365 Copilot is your AI assistant for work built into Word, Excel, PowerPoint, and other Microsoft 365 apps you use, helping you quickly write, analyze, create, and summarize so you can cut through clutter and clear a path to your best work. Learn [e-mail] M365Copilot this episode is brought

[B]

to you by Indeed. Stop waiting around for the perfect candidate. Instead, use Indeed Sponsored Jobs to find the right people with the right skills fast. It's a simple way to make sure your listing is the first candidate. C According to Indeed Data, Sponsored Jobs have four times more applicants than non sponsored jobs. So go build your dream team today with Indeed. Get a $75 sponsored job credit at Indeed.com podcast terms and conditions apply.

[C]

You know, it's one of those things. The more that we study, the more that we know, the more questions are generated. Isn't that great? I mean, that is by definition, the process of science. I mean, you make a hypothesis, you test a hypothesis, you generate more questions. You're like, oh, great, now I'm going in five different directions. You test those hypotheses. Onward and onward. That's the way it is. We've known for a long time that iron deficiency anemia during pregnancy is associated with some bad things. I mean, iron deficiency anemia has been linked to low birth weight, preterm delivery, perinatal mortality. It's been linked in some studies to postpartum depression and poor mental and psychomotor performance in the offspring. Now notice what I said and notice what I stressed there. Iron deficiency anemia. Now here's the catch, okay? Iron deficiency anemia in pregnancy is bad. Of course, it also increases the risk of blood transfusion at time of birth. However, if iron deficiency anemia is bad. So let's think one step back. Shouldn't we take care of iron deficiency first before the patient becomes anemic? Remember that there's two different tests here, guys. There's serum ferritin, which has high sensitivity and specificity for iron deficiency. And in pregnancy in general, that has been marked as a ferritin serum level of under 30 as evidence of iron deficiency in pregnancy. So you have ferritin level which is iron deficient. And then you have anemia, which is a low hematocrit or hemoglobin. Now, with time, iron deficiency, what sets up first that comes first will eventually show up as iron deficiency anemia. Mind blowing, right? I Mean, how's that for high quality data right here? I mean, that just makes sense, right? That's a normal pathophysiology of iron deficiency anemia. Nobody wakes up one morning and goes, well, I wasn't iron deficient anemic yesterday, but somehow I am today. It's a process where iron first gets depleted in body stores as ferritin, then manifests as iron deficiency anemia. Now, of course, the CDC says and ACOG say, look, we should really screen for iron deficiency anemia because of those complications that we've already discussed that are associated with iron anemia in pregnancy. However, here's the catch, and it's controversial. Okay, well, rather than waiting for the patient to have iron deficiency anemia, why don't we check first to make sure the patient is not iron deficient? In other words, should we be including serum ferritin in the prenatal labs? Okay, now let me. Let me just be very clear here. Some of you already do that. I do. We do. We include serum ferritin in there because it's part of fine tuning micronutrients to correct any micronutrient depletion. And we're going to get into this in this episode because there is evidence, guys, that outside of low H and Hs, okay, outside of anemia, iron deficiency is super prevalent. At least it is in the US and it depends on who you read. But in general, look at these numbers. In general, based on population studies, anywhere from 19 up to 42% of non anemic pregnant women. Did y' all get that, guys? All right, so this is the. The H and H is still okay. It hasn't even dipped yet. But according to some evidence, anywhere from 19 up to 42% of non anemic patients that enter into prenatal care have iron deficiency. So here's where I'm getting at. If iron deficiency is bad and eventually will manifest as iron deficiency anemia, should we be including this? Now, I know what your first question is. Well, what does ACOG say? Well, ACOG says we should screen for iron deficiency anemia with a CBC and of course, use indices. And then those who fall below the level of anemia diagnosis in pregnancy, then you can consider serum ferritin as well as things like troll iron binding capacity. All of this is in ACOG's guidance, which is practice bulletin number 23 3. But this is very similar, guys, to TXA. Remember, the original endorsement of translate acid at time of delivery by ACOG was for established postpartum hemorrhage meaning 1000mls of blood loss or more, or signs or symptoms of hypovolemia based on the woman trial. Then came all of the other data that said, you know, rather than waiting for the patient to have postpartum hemorrhage, why not give that prophylactically? Especially when the patient has additional risk factors at an EBL or QBL of 500 or. And again, the data is a little controversial. We've covered all of the data on TXA before. But the whole point is rather than waiting for the patient to actually have a condition which is now morbid, like postpartum hemorrhage, where you then give txa. The same can be said here for interventions early to identify iron deficiency before the patient has iron deficiency anemia. Okay, so I'm going to be very clear. Yes, both cdc, SMFM, and acog. I guess not both. That's three of them. So all three of the major organizations say we should screen for iron deficiency anemia. No question. However, since iron deficiency anemia is one thing and iron deficiency is another, and there's data that women enter prenatal care already iron deficient, anywhere from 19 to 42%. Doesn't it make sense to include maternal serum ferritin, an initiation of prenatal care? I'm going to go through the data, and then again, you do what you do. Maybe have a journal club about it. I'll put the references, of course, in our show notes. But this is something that actually came up in our own faculty group discussion where somebody said, hey, a resident checked out to me and said, this patient has LO ferritin iron deficient and was asking about IV iron transfusion, maybe because a patient couldn't tolerate PO iron, but the patient's H and H was normal. So the faculty said, but she's not anemic. So who was right here? And so I very quickly defended the resident because in this case it needed to be defended, which is, hey, guys, even without iron deficiency anemia, iron deficiency by itself is bad. And there is data. Here it is, guys. Is there any evidence that fixing iron deficiency even without anemia, is there any evidence that that is beneficial? Because if there is no evidence that is beneficial, then it's just opinion. But there is evidence that fixing iron deficiency even before the patient gets anemic actually has some benefit in pregnancy. I'm gonna give you that data when we come back right now after this intro.

[D]

This time of year, everyone talks about going dry, but at Athletic Brewing Company, we're skipping that because we prefer going athletic, which isn't dry at all. From crisp goldens to hoppy IPAs and limited releases in between, you'll find something that fits your style. Every single non alcoholic brew is packed with flavor and the same craft experience you love. So yeah, you could call it dry, but there's really nothing dry about it. Find your new favorite near [e-mail] Athletic Brewing Company fit for all times right now get up to 20% off select online storage solutions put heavy duty HDX totes to good use, protecting what's important to you. The solid, impact resistant design prevents cracking and the clear base and sides make items easy to find even when the totes are stacked. Find select online shelving and tote storage up to 20% off at the Home Depot. To organize every room in your home from your garage to your attic, visit homedepot.com how doers get more done.

[C]

This this is Dr. Chapa's obgyn clinical pearls no spin podcast. So to briefly review the hypothesis here, the logical argument well, we know that iron deficiency anemia is bad and also increases the risk, of course, of maternal transfusion at delivery. Okay, iron deficiency anemia is bad and iron deficiency anemia is a late manifestation of iron deficiency. Okay, wouldn't it be logical then to screen for iron deficiency in pregnancy? Logical? Yep. It is, as Spock would say, pretty darn logical. Logical. However, that's not what most professional societies actually endorse. It's kind of weird. It is kind of a gap. Just like there's a gap with what to do when a patient presents after 28 weeks for gestational diabetes. I mean, the rules are you do the screen between 24 to 28 weeks. That is the ACOG cap. It's up to 28. It's not 24 and infinity, as some say. Like the World Health Organization says, hey, just check them whenever. We'd rather just check them the not. But that's coming from a world health perspective versus a country that has resources and population like we do. So screening for GDM 24 to 28. If you miss the 28 week mark because you come in later, you just kind of missed it. That's a gap in the guidance now. Doesn't mean you ignore it, but you can perhaps do something else. Check a hemoglobin A1C, even though we know that's limited. Do a fasting finger stick, have them check our own sugars, whatever. Do something. But technically the cap is 24 to 28, so there is a gap with what to do with GDM in the third trimester for diagnosis. And we've covered that twice, twice on this podcast. You can go back and screen that. Okay. One of it was like, screen for GDM after 28 weeks. Yay or nay. And we did that not long ago. My point is, there's gaps sometimes in the guidance. It's weird, but it is. Right now, there is this gap in the clinical guidance regarding screening for ferritin. Even though we know that iron deficiency anemia is bad, the U.S. preventative Service Task Force actually has this as an insufficient statement. In other words, it's a level I. They're like, ah, I don't know. Maybe we should. Maybe we shouldn't. I don't know. It's insufficient. So it doesn't mean not to. But it stops short of saying we should. It's like, I don't know. It's insufficient. And the reason it's insufficient is because most of the data has not been clear if it reduces some adverse immediate maternal and neonatal outcomes. We don't know that. We know that supplemental iron, either oral or iv, increases hematological indices. And that's what I'm advocating for here. Guys, I want to be very clear. I'm not saying that correcting micronutrient depletions like ferritin is going to fix all the pregnancy issues. However, it's definitely not gonna hurt. I mean, if a patient has a micronutrient that we can correct and ferritin is one of them from iron deficiency, because iron is a micronutrient, we can tune her up to get her ready for delivery. So I am a big fan. I am. Of checking for ferritin, because that is different. Iron deficiency doesn't always show up as iron deficiency anemia. There is a gap in time. So we're waiting for a patient to be quote, end quote, ill before we do something. Same with our analogy of TXA and postpartum hemorrhage that we had earlier. Okay? Now, what is interesting is that Australia, okay? So Australia. I've got a good friend in Australia, Steve. You know, I got to reach out to him. I haven't talked to him in a while. Anyway, he's OB GYN in Australia, and they actually do have a recent consensus statement from a collaborative group called the HOW. Not the WHO, not the World Health Organization, but the HOW. H O W. That is hematology in obstetrics and women's health. The HOW collaborative. This came out in 2025, and they recommend. Here it is, guys. Listen to this routine ferritin screening in all pregnant women at initial enrollment and then again at 24 to 28 weeks, and then again at 36 weeks if clinically indicated. Wow. Okay. So thankful for the how the Hematology and Obstetrics and Women's Health from Australia for being very forward thinking here. I'm a fan of this. I think this is an easy thing to correct. It gives patient extra buy in to go. Look, I get not to want to take a prenatal vitamin with extra iron. I get that iron gives you burp back. You get constipated, you feel kind of nauseous. I get it. But if we fix this, your body will be tuned up for delivery because it will manifest in your red blood cells and you'll have less anemia. Now remember. Remember what we talked about at the beginning, what iron deficiency anemia has been linked to? It's been linked to some bad things. Not just need for transfusion, but in some studies, preeclampsia. In some studies, altered growth. In some studies, poor motor and neurodevelopmental issues in the child, and even softer data on postpartum depression. The point is, why wouldn't we want to treat this? Isn't that interesting. Nonetheless, a 2024 systematic review of 14 international guidelines found that only five guidelines recommended screening with ferritin in addition to a CBC during pregnancy. Is that odd or what? So we all get iron deficiency anemia is bad. Well, why don't we fix the iron deficiency? And people go, I don't know, that's kind of a good idea. It seems logical to do that. Yet right now we don't have an acol guidance for that. We screen for iron deficiency anemia, but not the root cause, which is iron deficiency. Logical. Yep. As Spock would say, that would be logical. So just throwing this out there for your benefit. Now, here's a question, here's a question. Is there any evidence that if we screen for this and we find it, can that improve some outcomes? Well, in terms of H and H indices, absolutely. That's obviously why we give iron supplementation either oral or iv. So, yes, we do have that data. That. That's a no brainer. And that just came out of the Lancet January 2026. So. Guys, let me just explain why I'm covering this topic, okay? Remember that, as I said earlier, it was in our faculty chat, a resident checked ferritin despite the fact that the patient had normal H and H. And I'm like, yes, good for that resident. He's Forward thinking he's ahead of his time. Giving him the medal. There's no metal. Give him a medal or her the medal. Because he's thinking patient protection and micronutrient correction. I got no problem with that. Even though, even though. Guys, here it is. The patient was non anemic in the Lancet Hematology in January of 2026. The title of this two arm randomized control trial which was multi center was quote, intravenous iron for non anemic iron deficiency in pregnancy. A multicenter 2 arm randomized control trial. End quote. So did you all get this? So these are patients who had ferritin checked and they were not anemic. Sound familiar? Just like my resident's case. And said okay, well let's just see if these patients, if we have getting on top of this is going to prevent anemia. Now in this case, to get away from the compliance issue, these patients had intravenous iron.

[B]

Eczema is unpredictable, but you can flare less with Epglis, a once monthly treatment for moderate to severe eczema after an initial four month or longer dosing phase. About four in 10 people taking Eglis achieved itch relief and clear or almost clear skin at 16 weeks. And most of those people maintain skin that's still more clear at one year with monthly dosing.

[A]

MGLIS Lebricizumab LBKZ, a 250mg injection, is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema, also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBGLIS can be used with or without topical corticosteroids. Don't use if you're allergic to Ebglis. Allergic reactions can occur that can be severe eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with Eglis before starting Ebglis. Tell your doctor if you have a parasitic infection.

[B]

Ask your doctor about eglis and visit eglis.lilly.com or call 1-800-lilyrx or 1-800-545-5979.

[C]

So good, so good, so good.

[B]

New spring arrivals are at Nordstrom Rack stores now. Get ready to save big with up to 60% off rag and bone. Marc Jacobs Free people and more.

[C]

How did I not know Rack has Adidas. Cause there's always something new.

[B]

Join the Nordy Club to unlock exclusive discounts. Shop new arrivals first and more. Plus, buy online and pick up at your favorite Rack store for free. Great brands, great prices. That's why you rack

[C]

now. Duh. What do you think, guys? Do you think this actually helped the iron indices? Of course it did. No brainer. Again, as Spock would say, it's pretty logical. Logical? Are we gonna do that? Michael? Logical. Thank you. Man, you're kind of. Are you falling asleep? What's going on? You're not picking up my cues. Yes, I forgive you. Oh, okay. Sure. One more time. Come on, let's go. Logical. Jeez. So the Lancet hematology intravenous iron for non anemic iron deficiency in pregnancy. This is out of Pakistan, so I get it that there's different patient populations. Nonetheless, I want to just read you their main finding and their interpretation here because it applies directly what we're doing here. The take home message is this. You do what you want to do. Of course get a cbc, of course get a ferritin, especially if it falls below the cutoff level. For first, second or third trimester anemia, you got to do that along with. You can do total iron binding capacity. We don't do that. We just go straight to the ferritin because that's the most sensitive and specific. But assess the patient somehow. My point is, rather than waiting for her to actually become anemic, and in this case, just anemia from iron deficiency. Though I get there's a lot of other causes of anemia like folate deficiency, which is usually macrocytic or other hemoglobinopathies. I get that. I'm not talking about that. I'm talking about ferritin for iron deficiency. Why not try to fix that? So according to this study that just came out of Lancet Hematology, quote, Among non anemic iron deficient pregnant women, and of course they use the iron cutoff just like we do. That's the universal of 30 micrograms per liter. So 30 is a cutoff for ferritin in pregnancy. Quote. Among non anemic iron deficient pregnant women, intravenous iron therapy significantly improved maternal hemoglobin before delivery compared with oral iron prophylaxis. So they did have an oral group, but this makes the case that IV iron. Okay. Is the way to go, probably because you avoid the compliance issues with the GI side effects and the nausea. So there is a push. Remember, these patients have normal H and hs. So just like my resident said, maybe I want to send her for IV iron or ahead of his time. Amazing. Amazing. So it's a no brainer. The question was I wonder if this is going to give him better H&H's. Of course it does because you take away the compliance issue and then you're giving them IV iron. So here's where they leave this. And again, talk amongst yourselves. But I'm very thankful for this group. They are not a sponsor, but they actually state very clearly what I have been endorsing to our residents and have been endorsing for the past 10 years. Quote, Here it is. Ferritin screening should be considered in early pregnancy as intravenous iron therapy is effective in those tested positive for non anemic iron deficiency. End quote. Duh. I mean, so my point, and again, I don't want to minimize that, but gee, if you're iron deficient and you give somebody IV iron, I think it's going to work. That's pretty logical. Logical, yeah. Thank you, Spock. So that's all I'm trying to say. The question that we're getting here, the main focus of this episode is should we screen for ferritin in pregnancy? Now the ACOG answer is, well, we screen for iron deficiency anemia, right? Thank God we do. But why don't we get to the root cause of that so the patient doesn't actually develop iron deficiency anemia by checking for iron deficiency. Now I'll be very clear cause. I don't want somebody to send me a message. There is actually some studies that have shown or suggested that correcting iron deficiency, even without anemia, potentially, potentially could help with like a preeclampsia and preterm birth. I know that. I realize that those studies are out there. However, I don't want to get into that because those studies did have some methodological issues. I'm not real sure you know about their study design, but yes, I am aware of that. The point is, no study has shown adverse outcomes outside of maybe some, you know, some side effects from iron transfusion and rarely a true allergic response. Most show benefit, especially in correction of the indices. So I thought this was fascinating. Consider this for a journal club. The question that our podcast asked and the question that our title is for this episode is New Data Screen Maternal Ferritin with Prenatal Care. Why not? So it's not just screening for anemia. We're already doing that. And that's a separate issue on hemoglobinopathies, whether you do the maternal carrier screen, which looks at a genetic level, or if you do a CBC with indices, which looks for different types of anemia. I'm a big fan, of course, for checking for hemoglobinopathies with molecular testing over a gel, because even electrophoresis can miss some thalassemias. All right, Some alpha thalassemias can be missed by electrophoresis. So I go straight to the cause and do a molecular genetic test for hemoglobinopathies. So, yes, we do screen for anemia, but rather than waiting for the patient to become anemic. And since up to 42% of pregnant women who start prenatal care are iron deficient from poor nutrition and or other reasons, then why not get on top of the issue Again? It's a gap in the guidance. Fascinating. A gap in the guidance, but thankful for the how from Australia, who's very forward thinking and said, now, man, we, we got. We gotta do this and do this potentially three times at enrollment at 24 to 28 weeks and then again late in the third trimester at 36 as necessary. Podcast family, I hope you found this interesting, that it's, it's amazing. The more that we know, the more questions are generated and that is how science should be. Again, that is a logical part of scientific investigation. Logical. Thank you, Spock. All right, Podcast family, I think we've done what we're supposed to do. Now that we've done all that. Michael, wake up again. Come on, let's take it home. This is Dr. Chapas, obgyn clinical pearls. No spin. Podcast.