Implementation of a protocol for management of antepartum iron deficiency anemia: a prospective cohort study

• Published in: American journal of obstetrics & gynecology MFM Vol. 4; no. 2; p. 100533
• Main Authors: Hamm, Rebecca F., Wang, Eileen Y., Levine, Lisa D., Speranza, Rosa J., Srinivas, Sindhu K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022
• Subjects: anemia; Anemia - diagnosis; Anemia - drug therapy; Anemia - epidemiology; Anemia, Iron-Deficiency - diagnosis; Anemia, Iron-Deficiency - drug therapy; Anemia, Iron-Deficiency - epidemiology; blood transfusion; Female; Ferric Compounds - therapeutic use; Ferric Oxide, Saccharated - therapeutic use; Hematinics - therapeutic use; hemoglobin; Hemoglobins - analysis; Hemoglobins - metabolism; Hemoglobins - therapeutic use; Humans; intravenous iron; Iron Deficiencies; Male; postimplementation; preimplementation; Prospective Studies; protocol; Puerperal Disorders - drug therapy; Treatment Outcome; intravenous iron; postimplementation; blood transfusion; protocol; preimplementation; anemia; hemoglobin
• DOI: 10.1016/j.ajogmf.2021.100533
• ISSN: 2589-9333

In randomized trials, antepartum intravenous iron sucrose is effective at improving predelivery hemoglobin in iron deficiency anemia. Yet, there is a gap between this knowledge and its implementation into care. We aimed to determine if the implementation of a standardized protocol for the management of antepartum anemia outside of a clinical trial improves intravenous iron sucrose utilization and clinical outcomes. We performed a prospective cohort study evaluating the incorporation of an anemia protocol into routine clinical care for women with antepartum hemoglobin <11.0 g/dL. Our protocol, developed with multidisciplinary stakeholders, included (1) serial third trimester hemoglobin assessment, (2) oral iron supplementation for antepartum hemoglobin 9.5–11 g/dL, and (3) antepartum intravenous iron sucrose use (300 mg weekly for 3 weeks) for hemoglobin <9.5 g/dL. We compared 6-months preimplementation (January 2018 to June 2018) to 6-months postimplementation (January 2019 to June 2019). The outcomes evaluated were antepartum intravenous iron sucrose utilization, the number of intravenous iron sucrose dosages, predelivery hemoglobin, and blood transfusion. A total of 1423 women were included (pre=778; post=645) without significant baseline differences. The antepartum hemoglobin nadir was no different between the groups (pre: 10.2; interquartile range [9.6–10.6] vs post: 10.2; interquartile range [9.6–10.6]; P=.77). The implementation of a standardized protocol for the management of antepartum anemia was associated with 80% increased odds of receiving intravenous iron sucrose than the preimplementation group (pre: 4.8% vs post: 8.2%, P=.008; odds ratio, 1.79; 95% confidence interval, [1.16–2.77]). The implementation of a standardized protocol for the management of antepartum iron deficiency anemia was also associated with higher hemoglobin at admission for delivery (pre: 10.9; interquartile range [10.1–11.6] vs post: 11.0; interquartile range [10.3–11.7], P=.048). There were no significant differences between the groups in blood product transfusion (pre: 7.1% vs post: 5.1%, P=.13). Implementation of a standardized antepartum anemia protocol is associated with increased intravenous iron sucrose utilization and improvement in predelivery hemoglobin.