FIGO good practice recommendations on anemia in pregnancy, to reduce the incidence and impact of postpartum hemorrhage (PPH)

Anemia affects 32 million pregnant women globally, contributing annually to more than 115 000 maternal deaths and 591 000 perinatal deaths worldwide. Low- and middle-income countries (LMICs) bear the highest burden of anemia in pregnancy, with nearly 50% of affected pregnant women. It is now 2025, which is WHO's target year for a 50% reduction in maternal anemia, and the global prevalence of anemia in pregnancy remains more than twice the target of 15%. This calls for a renewed global focus on optimal approaches for reducing the burden and complications of anemia in pregnancy. In this FIGO Childbirth and Postpartum Hemorrhage (PPH) Committee paper, current best evidence on anemia in pregnancy has been reviewed and synthesized, to make recommendations on screening, diagnosis, prevention, and treatment of anemia in pregnancy. We recommend that all pregnant women should be screened for anemia in pregnancy at booking and again at 28 weeks of pregnancy, with a full blood count (FBC), or packed cell volume/hemoglobin concentration in settings where FBC is not available. A hemoglobin concentration cutoff of less than 11 g/dL in all trimesters of pregnancy and during the postpartum period, as well as in all settings and populations, is recommended for the diagnosis of anemia in pregnancy. Routine iron and folic acid supplementation, either alone, or as components of multiple micronutrient supplements, is also recommended during pregnancy. We also made recommendations for malaria and anti-helminthic chemoprophylaxis, hemoglobinopathy screening, iron, folate, and multiple micronutrient supplementation, and blood transfusion in pregnant women with hemoglobinopathies. Finally, the relationship between anemia and postpartum hemorrhage is highlighted.