Wei S, Liu W, Qi Y, et al. - Although various studies have been performed to determine the etiology of spontaneous abortion, limited understanding remained concerning the disordered iron transportation between mother and fetus through the placenta. In recent work, erythroferrone (ERFE) was identified to be a novel negative regulator of hepcidin that can increase nutritional iron absorption and macrophagic iron egress for improved erythropoiesis. In the present study, women who had spontaneous abortions were identified exhibiting disordered iron homeostasis during early pregnancy, as characterized by raised serum iron and hepcidin levels, and conversely, decreased serum ERFE levels, compared with healthy control individuals and women with normal pregnancy. Comprehensive statistical analyses indicated that different variables correlate with pregnancy status, signifying the pronounced diagnostic value of an increased ratio of serum hepcidin and ERFE (HE ratio) in identifying adverse pregnancy status. In contrast to prior non‐selective discrete surrogates, such as iron, hepcidin and ferritin, the HE ratio may otherwise represent a novel and more representative hallmark for early spontaneous abortion.