Hidden in plain sight

When I tell other physicians my area of research is anemia in pregnancy, I am met with a puzzled look. “But it’s common,’’ “It’s treatable” and “Why is more research needed?” are comments I frequently receive.

These responses underscore the importance of the research. Despite being easily treated, anemia — the condition of having too few fully functional red blood cells — is a global problem for pregnant women. Typically caused by iron deficiency, about 40% of pregnant women worldwide experience anemia and are at increased risk of life-threatening repercussions.

Anemia rates are also high for pregnant people in the U.S., and they’re highest for those who are Black, 21% of whom experience anemia — twice the rate of those who are white. Among those who are Black, the condition contributes to nearly a quarter of the severe medical conditions that arise during pregnancy, including sepsis, kidney failure, the need for blood transfusions and cardiac complications such as heart failure.

Some common causes of iron deficiency are a lack of iron-rich foods and heavy menstrual bleeding, and it can usually be treated by diet and supplementing with iron. Yet our research shows that although anemia in pregnancy has increased in the past decades, only 50% of clinical providers routinely screen for the condition at the start of prenatal care. Too many women are unaware that they are anemic, which means they and their newborns bear the consequences.

So I ask: How can the tide be turned?

The solution starts with revamping the current — and flawed — norms in how we screen and treat anemia in pregnancy. To help bring this change about, I am studying the incidence of anemia and learning from those most affected in the U.S. — Black pregnant women. I’m a co-investigator for a National Institutes of Health-funded collaboration between Stanford Medicine’s Obstetrics and Gynecology Department and the BLACK Wellness and Prosperity Center in California’s Central Valley, conducting focus groups to understand the experiences Black pregnant patients had with care. Separately, I lead a team involved in providing nutrition education with the Santa Clara County Black Infant Health Program and Roots Community Health’s San Jose clinic.

Participants in our studies, members of historically marginalized groups, universally expressed how symptoms were dismissed, information and education on anemia were minimal, nutritional advice was nonexistent, and treatment options were limited. Imagine fearing the high rates of stillbirths, hemorrhaging and other pregnancy complications you face as a Black pregnant woman and believing there is no way around it. In truth, discrimination, inequality and racism, not biology, are at the root.

Beyond understanding the barriers, we are creating solutions, finding ways to boost iron levels for those in need. With a grant from Stanford Medicine’s Maternal and Child Health Research Institute, we are working with nutritionist Jocelyn Dubin at the Santa Clara County Public Health Department to increase access to information on nutrition, iron deficiency and anemia prevention in pregnancy through community health workers and doulas.

And I’m excited to be part of a Stanford Medicine-led effort funded by the NIH to reevaluate and revise how clinicians approach iron deficiency in pregnancy and resulting anemia from the first prenatal visit to the postpartum period. Ultimately, our goal is to improve birthing outcomes for all pregnant people.

So, yes, anemia is common and it is treatable. And we’re finally paying attention. The hope is that other physicians will too.

— Irogue Igbinosa, MD, is a maternal-fetal medicine physician and an instructor of obstetrics and gynecology at Stanford Medicine. Information about participating in her current study of nutrition among people who are Black and currently or recently pregnant is available here.