(244) An anemia protocol and obstetric clinic-based iron infusion center decreases disparities in IV iron access

Racial disparities in antepartum anemia exist with Black pregnant people experiencing 2x greater prevalence of anemia than non-Hispanic Whites. The use of protocols for the diagnosis and management of anemia increases the use of intravenous (IV) iron and delivery hematocrit, but it is unknown if all racial and ethnic groups benefit. IV iron can be difficult to access because it is often administered in IV infusion centers or inpatient. To improve access, our institution established a standardized anemia protocol and infusion center housed in the obstetrics clinic.

Study Design:

This retrospective cohort study examined patients admitted for delivery at a large academic hospital in the 10 months pre- and post-intervention (3/2021-12/2021 and 8/2022-6/2023). Patients with Hct < 33% at any point in pregnancy were included. Those with hemoglobinopathy, renal disease, and bleeding in pregnancy were excluded. Self-reported race/ethnicity data was abstracted from the EMR. The primary outcome was anemia on admission and secondary outcomes were rates of IV iron and blood transfusion during the delivery encounter.

Results:

There were 2,704 and 2,624 patients in the pre- and post-intervention groups respectively, including 1,772 White (78%) and 206 Black (8%). Black patients had higher baseline rates of anemia than White patients (39% vs 27%). All racial and ethnic groups saw increases in IV iron administration after the intervention (p< 0.05), with Black patients experiencing an 11-point increase compared to a 10-point increase among White patients. The rates of anemia on admission for delivery and transfusion were not statistically different for any racial or ethnic groups pre- or post-intervention but were significant for the cohort as a whole.

Conclusion:

Implementation of a standardized anemia protocol and an obstetrics clinic-based infusion center improved access to IV iron administration for all racial and ethnic groups, including for black patients. Given the urgent need to address disparities in maternity care, practices should consider implementation of similar interventions.