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.