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Obstetric Quality and Safety

Poster Session 2

(439) Early treatment with IV iron is associated with improved maternal hemorrhage-related outcomes

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Anemia in pregnancy is associated with hemorrhage-related morbidity and mortality. Iron deficiency anemia (IDA) is a modifiable risk factor when identified and treated antenatally. The purpose of this study is to evaluate how timing of IV iron therapy in relation to delivery impacts hemorrhage-related maternal morbidity and fetal outcomes.

Study Design: This retrospective cohort study from a single center included patients who received antenatal IV iron therapy for a diagnosis of anemia in pregnancy from January 2017 through January 2023. Anemia was defined as admission hemoglobin < 11 g/dL. Timing of IV iron administration in relation to delivery date was analyzed. An unadjusted analysis was performed using Fisher’s exact test and Student’s paired t-test. Multivariate logistic regression was used to calculate odds ratios (95% confidence intervals) to compare pregnancy outcomes for IV iron therapy more than and less than 10 days prior to delivery.

Results: Of 83 included pregnancies with IDA, 45 received IV iron therapy more than 10 days prior to delivery, while 38 received IV iron therapy fewer than 10 days before delivery. Pregnant patients who received their final transfusion of IV iron >10 days before delivery had significantly higher hemoglobin at delivery admission (p< 0.001). Those who received IV iron < 10 days before delivery were 6.8 times more likely to receive a blood transfusion (p=0.01, aOR=6.8, 95%CI 1.6-22) and 5.3 times more likely to have preterm birth (p=0.001, aOR =5.3). Patients who received IV iron > 10 days were significantly less likely to have ICU admission (p=0.04) or a birth resulting in NICU admission (p=0.02). There was no significant difference in the mode of delivery, postpartum hemorrhage, or pre-existing pregnancy comorbidities between groups.

Conclusion: Patients who received IV iron more than 10 days prior to delivery had improved maternal and fetal outcomes, including fewer maternal blood transfusions, maternal ICU admissions, preterm births, and NICU admissions. Earlier treatment of IDA with IV iron in pregnancy may mitigate hemorrhage-related morbidity.