Providing iron supplements during prenatal visits improves anemia rates

Key takeaways:

• Providing iron supplements led to higher average hematocrit levels during pregnancy, admission and discharge.
• Women who received iron supplements vs. a supplement recommendation were less likely to have anemia.

Providing iron supplements during prenatal visits improved hematocrit levels and anemia rates and reduced transfusions for acute blood loss anemia among women with Medicaid insurance, researchers reported.

“Although universal iron supplementation in pregnancy has been shown to reduce anemia, effective strategies to overcome barriers to medication and supplement access are less clear,” Lisa R. Thiele, MD, MPH, resident physician in the department of obstetrics and gynecology at the University of Texas Southwestern Medical Center, Dallas, and colleagues wrote. “We aimed to improve access to iron supplements, and thereby reduce anemia rates among our obstetric population, by reducing barriers to access including cost of supplements, access to transportation and other factors.”

Thiele and colleagues conducted a quality improvement study, published in JAMA Network Open, with 7,025 women (mean age, 27.6 years; 76% Hispanic) who delivered from May to December 2020 and who received prenatal iron supplements throughout their pregnancy. These women were compared with 6,886 women (mean age, 27.9 years; 76% Hispanic) who delivered from January to August 2019 without prenatal iron supplementation.

Women who delivered in 2019 were counseled to take iron supplements throughout their pregnancy, and women who delivered in 2020 were given prenatal iron supplements via clinic pharmacy during prenatal visits.

The primary outcome was maternal hematocrit levels at 28 to 32 weeks gestation, delivery admission and discharge; anemia rates; and postpartum transfusion for acute blood loss anemia.

Providing prenatal iron supplements was associated with higher average hematocrit levels at 28 to 32 weeks gestation, delivery admission and discharge. Researchers observed a significantly lower mean hematocrit level at delivery admission among women who were provided prenatal iron supplements (34%) compared with women who were not (35.3%).

More women who were not provided supplements had anemia on admission compared with women who were provided supplements (18% vs. 11%; RR = 0.61; 95% CI, 0.56-0.66). Women who were provided supplements had a maternal anemia prevalence of 36% before hospital discharge compared with 41% among women who were counseled to take iron supplements (RR = 0.89; 95% CI, 0.85-0.93).

In addition, researchers observed reduced postpartum transfusions for acute blood loss anemia among women who were provided prenatal iron supplements from 10 per 1,000 to 6.6 per 1,000 compared with women who were recommended such supplements (1% vs. 0.7%: RR = 0.62; 95% CI, 0.43-0.91).

“These data suggest that adherence may improve when supplements are directly provided to patients at their regular prenatal visits,” the researchers wrote. “Given this evidence, hospital systems should consider implementing programs to improve access to iron-containing prenatal vitamins, particularly when serving a medically at-risk population.”