Iron supplementation at prenatal care visits reduces iron anemia risk

Iron supplementation at prenatal care visits reduces iron anemia risk | Image Credit: © Dragana Gordic - © Dragana Gordic - stock.adobe.com.

According to a recent study published in JAMA Network Open, administration of iron supplements at prenatal visits improves hematocrit levels and anemia rates in patients of a mostly Medicaid population, as well as decreases the number of transfusions unrelated to obstetric catastrophes.

Maternal plasma volume expands by 40% to 50% during pregnancy, leading to increased iron demands. Anemia in pregnancy increases the risks of blood transfusion, postpartum anemia, and neonatal adverse outcomes such as fetal growth restriction. Blood transfusion during pregnancy carries the risk of severe maternal morbidity, making preemptive iron restoration vital.

Iron supplementation during pregnancy has been associated with reduced maternal anemia by up to 70%, with the CDC and American College of Obstetrics and Gynecologists recommending a starting iron supplementation of at least 27 mg of elemental iron. However, patients with a low socioeconomic status may not be able to receive this treatment.

Disparities in iron deficiency may be addressed through dispensing iron supplements during clinic visits. Investigators conducted a study to evaluate the associations between dispensing iron supplements during clinic visits and rates of anemia.

Participants included patients at Parkland Health, a safety-net hospital in Dallas, Texas. The hospital initiated a program to improve access to iron supplements during prenatal care on September 25, 2019. This program allowed patients to have iron supplements directly distributed to them during prenatal care visits.

To assess the results of the program, investigators conducted a quality improvement study. Patients were grouped based on whether they received care prior to the supplement administration. The pre-supplementation group received care from January 1 to August 1, 2019, while the post-supplementation group received care from May 13 to December 13, 2020.

Patients in the pre-supplement cohort received a prenatal supplement without iron, while those in the post-supplementation cohort had iron supplements directly dispensed to them during their first prenatal care visit. Refills were also given to patients in the post-supplementation group as needed.

An obstetric quality database was evaluated for data on maternal demographics, visits, and perinatal outcomes. This included race, body mass index, parity, age, gestational age at enrollment, postpartum hemorrhage enrollment, and transfusion requirement.

The average hematocrit values at 24 to 32 weeks’ of gestation, admission for delivery, before discharge, and at postpartum follow-up were measured as the primary outcome of the study. Secondary outcomes included the rate of anemia in a population and incidence of transfusion for symptomatic blood loss anemia.

There were 13,910 participants included in the final analysis, with similar age, race and ethnicity, insurance payer status, and parity data between both groups. Patients were at a median 12 weeks' of gestation upon enrollment to prenatal care in the pre-supplementation group and a median 11 weeks’ in the post-supplementation group.

Postpartum hemorrhage and placental invasion rates did not differ between the 2 groups. Antepartum transfusion was observed in 19 patients in the pre-supplementation group and 10 in the post-supplementation group.

Higher hematocrit levels in the third trimester, at admission for delivery, before discharge, and at postpartum follow-up were found in the post-supplementation group. The mean hematocrit levels at admission for delivery were 34% and 35.3% in the pre-supplementation and post-supplementation group respectively.

Patients in the post-supplementation group also had significantly decreased rates of iron anemia, with the pre-supplementation group having a risk ratio of 0.68 for anemia in comparison. On admission, the post-supplementation group had a 7% reduced rate of iron anemia compared to the pre-supplementation group.

These results indicated reduced rates of iron anemia among patients directly receiving iron supplementation at prenatal care visits, reducing the need for transfusion for acute blood loss anemia. Investigators recommended hospital systems consider implementing iron supplementation programs.

Reference

Thiele LR, Duryea EL, Ragsdale AS, et al. Direct dispensation of prenatal supplements with iron and anemia among pregnant people. JAMA Netw Open. 2023;6(9):e2332100. doi:10.1001/jamanetworkopen.2023.32100