Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy
Oral Concurrent Sessions
Carolyn M. Webster, MD (she/her/hers)
Assistant Professor, Maternal-Fetal Medicine
University of Alabama at Birmingham
Birmingham, Alabama, United States
Charlotte B. McCarley, MD
Assistant Professor, Maternal-Fetal Medicine
University of Tennessee Medical Center
Knoxville, Tennessee, United States
Gabriella D. Cozzi-Glaser, MD
Assistant Professor, Maternal-Fetal Medicine
Feinberg School of Medicine
Chicago, Illinois, United States
Jori May, MD
Assistant Professor, Hematology/Oncology
University of Alabama at Birmingham
University of Alabama at Birmingham, Alabama, United States
Amy Boone, MD
Assistant Professor, Obstetrics & Gynecology
Indiana University
Indianapolis, Indiana, United States
Ashley N. Battarbee, MD, MSCR
Associate Professor, Maternal-Fetal Medicine
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Iron deficiency (ID) is associated with anemia and adverse obstetrical outcomes. Iron supplementation is standard, but there is no consensus on optimal methods of repletion, and prior studies have failed to show improvement in obstetrical outcomes.
Due to high rates of maternal anemia and peri-delivery transfusion at our tertiary care center, we developed a quality improvement (QI) algorithm for early identification and treatment of ID. We sought to evaluate the impact on anemia, transfusion, and other adverse outcomes.
Study Design:
Observational cohort study of patients who delivered at ≥23 weeks GA before (1/2021-9/2023) and after (1/2024-3/2025) QI algorithm implementation, excluding a 3-month washout and sickle cell disease. The algorithm included universal ferritin screening (intake and 24-28wks) and treatment of ID with oral or IV iron based on anemia severity and GA. The primary outcome was anemia at delivery admission (Hgb < 10.5mg/dL in 2nd trimester; Hgb < 11mg/dL in 3rd trimester). Secondary outcomes were peri-delivery transfusion, moderate and severe anemia, mean Hgb, and select infant outcomes. QI process measures included ferritin testing and IV iron therapy. Multivariable logistic regression estimated the association between post-implementation and outcomes.
Results:
Of 13,968 included patients: 9,237 (66%) delivered pre-implementation and 4,731 (33%) post- implementation. Compliance was high: 83% of those initiating care < 28wks had ≥2 ferritin values. IV iron use increased >7-fold (3% v 23%). Deliveries post-implementation had lower odds of both pre-delivery anemia (36% v 23%, aOR 0.48, CI 0.43-0.53) and transfusion (5.9% v 5.0%, aOR 0.71, CI 0.59-0.87). Neonatal outcomes were similar, although a small increase in mean birthweight was seen post-implementation (p=0.02; Table 2).
Conclusion:
Early identification and treatment of maternal ID using a standardized algorithm with universal ferritin testing and iron repletion reduced pre-delivery anemia by 50% and transfusion by 30% at our center. Further study is needed to evaluate generalizability and cost-effectiveness of this approach.