Category: Medical/Surgical/Diseases/Complications
Poster Session II
Anemia is associated with adverse maternal and neonatal outcomes. In 2021, the American College of Obstetricians and Gynecologists (ACOG) eliminated race-based definitions of anemia from screening recommendations. We aimed to assess how a non-race-based anemia protocol reduces disparities between patients receiving care at two different prenatal sites.
Study Design:
An institutional protocol was developed in concordance with new ACOG recommendations to guide diagnosis and treatment of iron deficiency anemia in pregnancy. Medical records from two disparate clinical sites (Site A and Site B) were reviewed for sociodemographic, prenatal, and delivery data during a 3-month period before and after protocol implementation. Those with incomplete prenatal records or delivery < 37 weeks were excluded. The primary outcome was delivery admission hemoglobin. Secondary outcome was rates of iron replacement therapy. Continuous variables were analyzed with Student’s T-test and categorical variables with Chi-square and Fisher’s Exact test. A p < 0.05 was considered significant.
Results:
Data was available for 201 pre- and 210 post-implementation patients. Site A had a higher prevalence of non-White (74.1 vs 32.5%) and Medicaid insured patients (76.1 vs 7.8%) compared to Site B (Table 1). Patients receiving care at Site A had lower mean delivery admission hemoglobin (11.2 vs 11.9 g/dL, p < 0.001) with 40.4% of patients with hemoglobin < 11 g/dL compared to 21.7% from Site B. These metrics were unchanged in the first 3 months post-implementation (44.6 vs 23.9%). After implementation, rates of oral iron (29.9 to 45.6%, p=0.03) and IV iron infusion (1.9% to 12.9%, p=0.003) increased for Site A patients.
Conclusion:
Prior to protocol implementation, socioeconomically disadvantaged patients had more severe anemia at delivery but were less likely to receive antenatal oral or IV iron therapy. Implementation of a non-race-based protocol for prenatal anemia resulted in more equitable iron prescribing practices. Longer follow up is indicated to assess how appropriate iron therapy improves delivery admission anemia.
Anthony Kendle, MD (he/him/his)
Fellow Maternal Fetal Medicine
Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine
Tampa, Florida, United States
Judette M. Louis, MD, MPH
Department Chair
Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine
Tampa, Florida, United States
Michelle Whittum, MD
Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine
Tampa, Florida, United States