(153) Prevalence of antenatal iron deficiency and anemia in single healthcare network: rationale for QI initiative

Iron deficiency (ID) is the most common cause of anemia in pregnancy. However, screening with hemoglobin alone may miss up to 55% of iron-deficient gravidas, and ID may precede the onset of anemia. This study aims to determine the rate of diagnosed antenatal ID and anemia as a basis for a quality improvement initiative to enhance the detection and treatment of ID and ID anemia.

Study Design:

We conducted a retrospective analysis of pregnant patients admitted to labor and delivery in August 2019. Hemoglobin < 11 g/dL was considered anemia. Ferritin < 30 ng/mL was considered iron deficiency. Descriptive statistics are presented as percentages for categorical data and medians with interquartile range for quantitative data. Univariate and multivariate logistic regression models were used to analyze predictors of anemia at labor.

Results:

We identified 928 pregnant patients in August 2019. Median age was 28. The majority were white (81.1%) and had private insurance (58.3%). Only 3.3% of patients had twin gestations. Hemoglobin was checked in 68.6%, 69.7%, and 98.1% of patients in 1^st trimester, 2^nd trimester, and at labor, respectively. Of those patients, anemia was identified in 4.6%, 29.5%, and 31.4% of patients in 1^st trimester, 2^nd trimester, and at labor, respectively. During pregnancy, 7.1% of patients had ferritin assessed, and of those patients, 65.2% had low ferritin. African American race, higher parity, and twin pregnancy were associated with anemia at labor. Privately insured patients had a lower incidence of anemia.

Conclusion:

The prevalence of anemia in our population was almost triple the estimated prevalence in the US by the WHO in 2019. Few patients were assessed for ID although most who were met criteria for ID. These findings suggest that anemia and ID are underappreciated pregnancy complications and that ID may often remain undetected.  We also identified clinical and socioeconomic factors that can affect antenatal anemia. Those should be considered in clinical practice and future research. As such, we implemented a network-wide policy for ID screening and iron supplementation workflow.