IRON supplementation during pregnancy has been shown to successfully reduce maternal anaemia. However, access is not universal. Anaemia during pregnancy has been associated with higher rates of blood transfusion, postpartum anaemia, and adverse neonatal outcomes such as fetal growth restriction and perinatal mortality. Furthermore, symptomatic anaemia during delivery may require blood transfusion, the leading cause of severe maternal morbidity in the USA. The authors investigated the direct dispensation of iron supplements during follow-ups. Specifically, improvements to haematology-associated clinical outcomes were recorded.
Patients attending Parkland Health, Dallas, Texas, USA, were included in the study. All pregnant patients presenting for prenatal care received iron-containing prenatal supplements and clinicians advised patients on the importance of taking the supplements. To assess the efficacy of this initiative, quality improvement studies were conducted between 1st January 2019–1st August 2020 and again between 13th May 2020–13th December 2020. The inclusion criteria were that the infants delivered must weigh over 500 g.
A total of 7,075 patients delivered during the first study period termed the ‘pre-initiation’ period, while 7,106 patients delivered during the period where iron supplements were routinely provided. Of the combined number of deliveries (n=14,235), 13,910 delivered an infant over 500 g. Compared to individuals in the first cohort, the second cohort reported consistently higher mean haematocrit levels in the third trimester (35.2% and 34.7%), upon admission for delivery (35.3% versus 34.0%), prior to discharge (35.3% versus 34.0%), and at a visit 20 days after discharge (39.1% versus 38.8%). Furthermore, the rate of maternal anaemia was 7% lower in the second cohort at admission and 5% lower prior to discharge. Finally, patients receiving iron supplements had lower transfusion rates as a result of acute blood loss anaemia.
The authors concluded: “Hospital systems should consider implementing programmes to improve access to iron-containing prenatal vitamins, particularly when serving a medically at-risk population,” due to the reported improved haematocrit levels, rates of anaemia, and reduced transfusions in the patients receiving supplements.
