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National management guidance is published by the British Society of Haematology (BSH), but the extent to which local National Health Service (NHS) guidelines align with it is unknown. We conducted a cross\u2010sectional document analysis of antenatal anaemia guidelines from 49 NHS sites across the United Kingdom, obtained through two national research programmes. Two reviewers independently extracted data on screening, diagnosis, treatment and monitoring, using the 2020 BSH guideline as the national reference standard. The included guidelines represented approximately 33% of annual UK births. Screening and diagnostic haemoglobin thresholds were broadly consistent with BSH guidance, whereas substantial variation was concentrated in treatment and monitoring: oral iron indications, dosing and duration; haemoglobin thresholds and clinical criteria for intravenous iron; and the timing, biomarkers and response definitions used after treatment. Ferritin thresholds, reassessment intervals and response criteria were frequently absent or divergent. Variation was greatest in domains where the underlying evidence base is least resolved. These findings characterise the nature and extent of guideline\u2010level variation across NHS maternity care and identify priority areas for future research and national guideline development.<\/jats:p>","DOI":"10.1111\/bjh.70780","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:14:16Z","timestamp":1787289256000},"page":"1301-1310","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variation in antenatal anaemia guidelines across the\n                    <scp>NHS<\/scp>\n                    in the\n                    <scp>United Kingdom<\/scp>\n                    : A cross\u2010sectional study"],"prefix":"10.1111","volume":"209","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8605-6263","authenticated-orcid":false,"given":"Sarah","family":"Haynes","sequence":"first","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Islam","family":"Balboula","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care Medicine Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Collins","sequence":"additional","affiliation":[{"name":"Institute of Infection and Immunity, School of Medicine Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Parry\u2010Smith","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology The Shrewsbury and Telford Hospital NHS Trust  Shrewsbury UK"},{"name":"Keele University School of Medicine  Keele UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5597-3975","authenticated-orcid":false,"given":"Haddy","family":"Fye","sequence":"additional","affiliation":[{"name":"Patient and Public Involvement and Engagement Representative, OBS\u2010UK Trial  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4669-4266","authenticated-orcid":false,"given":"Amy","family":"Elsmore","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology The Shrewsbury and Telford Hospital NHS Trust  Shrewsbury UK"},{"name":"Keele University School of Medicine  Keele UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Collis","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care Medicine Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4625-3260","authenticated-orcid":false,"given":"Lucy","family":"De Lloyd","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care Medicine Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0548-2953","authenticated-orcid":false,"given":"David","family":"Churchill","sequence":"additional","affiliation":[{"name":"Department of Obstetrics The Royal Wolverhampton NHS Trust, New Cross Hospital  Wolverhampton UK"},{"name":"Research Institute for Healthcare Science University of Wolverhampton  Wolverhampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0476-1360","authenticated-orcid":false,"given":"Sarah F.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care Medicine Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7414-4950","authenticated-orcid":false,"given":"Simon J.","family":"Stanworth","sequence":"additional","affiliation":[{"name":"Department of Haematology NHS Blood and Transplant  Oxford UK"},{"name":"Radcliffe Department of Medicine University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"Sustainable Development Goals UK Data.Prevalence of anaemia in women aged 15 to 49\u2009years by pregnancy status (percentage)\u2014UK Indicators for the Sustainable Development Goals[Internet] [cited 2024 Mar 18]. 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