(853) Trends in Antepartum Anemia Prevalence Among Commercially Insured Individuals in the United States, 2018-2023

Anemia during pregnancy increases the risk of adverse perinatal outcomes, yet recent data on the prevalence of anemia in pregnancy in the U.S. are lacking. We assessed the prevalence of anemia during pregnancy by analyzing hemoglobin and hematocrit laboratory values in a national cohort of commercially insured individuals from 2018 to 2023.

Study Design:

We conducted a retrospective cohort study using the Merative^TM Marketscan^® Commercial Database of commercial insurance claims and laboratory data in the U.S. between 2018-2023. We included pregnant individuals without hereditary anemia, and with a live- or stillbirth at ≥28 weeks’ gestation. We defined anemia as hemoglobin < 11.0 g/dL or hematocrit < 33% in the first and third trimesters and hemoglobin < 10.5 g/dL or hematocrit < 32% in the second trimester, following ACOG and WHO guidelines. We calculated anemia prevalence overall and by age, obesity status, and region. We then assessed prevalence of anemia over time.

Results:

Among 134,163 individuals, 34,314 (25.6%) of individuals had anemia during pregnancy based on hemoglobin and hematocrit measurements (Figure 1). The prevalence was higher in individuals with younger age, obesity, and those who lived in the South and Northeast. The prevalence of anemia remained consistent from 25.9% in 2018 to 25.7% in 2023 (Figure 2).

Conclusion:

One-quarter of individuals had anemia during pregnancy in this national study of commercially insured individuals and this prevalence remained steady over time with variation by patient characteristics. The prevalence of anemia was higher than previous estimates and is likely to be even higher in an economically disadvantaged population.