Iron deficiency anemia (IDA) in pregnancy is associated with poor maternal and childhood outcomes, yet ferritin testing, the standard test for iron deficiency (ID), is not considered part of routine prenatal bloodwork in Canada. We conducted a retrospective cohort study of 44,552 pregnant patients with prenatal testing at community laboratories in Ontario, Canada to determine the prevalence of ferritin testing over five years. Secondary objectives were to determine the prevalence and severity of ID, and to identify clinical and demographic variables that influence the likelihood of ID screening. 59.4% of patients had a ferritin checked during pregnancy; 71.4% were ordered in the first trimester, when the risk of ID is lowest. Excluding patients with abnormally elevated ferritins, 25.2% were iron insufficient (30-44 µg/L) and 52.8% were iron deficient (≤29 µg/L) at least once in pregnancy. 8.3% were anemic (hemoglobin <105 g/L). The proportion of anemic patients with a subsequent ferritin test in pregnancy ranged from 22% to 67% in the lowest and highest anemia severity categories, respectively. Lower annual household income was negatively associated with the odds of a ferritin test; compared to those in the fifth (i.e. highest) income quintile, the odds of ferritin testing for patients in the first, second, and fourth quintiles were 0.83 (95%CI 0.74-0.91), 0.82 (95%CI 0.74-0.91), and 0.86 (95%CI 0.77-0.97), respectively. These data highlight gaps in prenatal care and issues of health equity that warrant harmonization of obstetrical guidelines to recommend routine ferritin testing in pregnancy.
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