Implementation of Routine Screening Practices for Pregnancy-Related Anaemia: A Scoping Review

Background: Screening for anaemia in pregnancy and the postpartum period is an important component of maternal care to prevent associated morbidity and mortality. However, the implementation of routine screening practices for pregnancy-related anaemia remains variable, inconsistent, and suboptimal. This review aimed to synthesise the literature on practices, facilitators, barriers, implementation strategies, and outcomes of routine screening for pregnancy-related anaemia. 

Methods: This scoping review followed the JBI methodology and PRISMA-ScR checklist with a comprehensive systematic search of seven academic databases (PubMed, EMBASE, Scopus, CINAHL, Web of Science, Global Index Medicus, and African Journals Online) and selected grey literature sources. Retrieved citations were screened, and relevant references were assessed for eligibility. Articles included were analysed qualitatively and presented descriptively by concept, comparing settings with high and low prevalence of anaemia in pregnancy. 

Results: We identified 9497 references and included 116 articles in this review. Clinical practice guidelines recommend universal screening for anaemia during pregnancy and selective screening in the postpartum period using automated or point-of-care haemoglobin testing and iron studies, with variations in screening frequency and timing. Screening coverage for anaemia in pregnancy was lower in high-prevalence compared to low-prevalence settings. Effective supportive supervision was the main facilitator of anaemia screening in pregnancy, while lack of screening materials served as the main barrier, particularly in high-prevalence settings. Training health workers on point-of-care testing in high-prevalence settings was the most common strategy used to improve the implementation of routine screening for anaemia in pregnancy, and its feasibility was the most studied implementation outcome. 

Conclusion: Implementing routine screening practices for pregnancy-related anaemia in all settings will benefit from harmonised clinical practice guidelines. Efforts are required to address implementation challenges and move from the early phase of implementation towards sustainability. Future research should aim to fill the knowledge gaps in implementing anaemia screening, particularly in the postpartum period.