PB1391 - Iron deficiency in pregnancy is highly prevalent despite suboptimal screening: A population-based cohort study

Background: Iron deficiency anemia (IDA) is highly prevalent among pregnant women worldwide. Despite its association with adverse pregnancy outcomes, suboptimal testing results in under recognition.

Aims: To describe 1) the frequency of iron deficiency (ID) screening and 2) the prevalence and risk factors of ID and IDA among all pregnancies associated with hospitalized live births in Alberta, Canada.

Methods: This is a retrospective population-based cohort study using the Alberta Pregnancy Birth Cohort which was created by linked administrative databases and previously described. Research ethics approval was obtained. Hemoglobin and ferritin tests ordered between January 1, 2014 and December 31, 2017 were retrieved from laboratory database. Anemia was defined as hemoglobin < 110 g/l in first and third trimester and < 105 g/l in second trimester. ID was defined as ferritin < 30 mcg/l in any trimester. IDA was defined as at least one record of concurrent anemia and low ferritin within the same trimester. Logistic regression was used to identify risk factors of IDA.

Results: Among the 207,355 pregnancies with available hemoglobin results, 36,500 (18%) had anemia at least once during pregnancy (Figure 1). Only 1 in 3 pregnancies with anemia had a concurrent ferritin test and over 80% of them demonstrated ID. Ferritin screening occurred at least once in only 60% of our cohort and a high prevalence of ID (61%) was identified among those tested. Ferritin testing was more frequent in first trimester (42%) than subsequent trimesters (21-24%), and infrequently tested postpartum (8%). 85% of the women were in the younger age group (Table 1). Advanced maternal age, multiparity and African and Asian ethnicity were identified as significant predictors of IDA.

Conclusion(s): Concordant with prior studies, testing of IDA is suboptimal among pregnant women, with racialized groups at highest risk for IDA. Further investigation is ongoing to identify gaps in care.