Intravenous Iron Supplementation Timing in Pregnancy: A Quality Improvement Project on Maternal Transfusion Reduction [ID 2683470

Abstract

INTRODUCTION: Intravenous iron supplementation (IVFe) for pregnant patients with iron deficiency anemia improves hemoglobin (Hb) levels in the peripartum period. Optimal timing of this therapy, however, is unknown. We analyzed the effects of IVFe as part of an institution-based protocol on maternal Hb levels, stratifying by gestational age (GA). METHODS: We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by gestational age (<34 or ≥34 weeks) at time of IVFe. We excluded patients with known antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software. RESULTS: Of 295 patients who met inclusion criteria, maternal age, body mass index, nulliparity, and ferritin levels were similar in both groups. Mean GA for the cohorts at time of IV iron transfusion were 29.6 ± 4.9 weeks (early third trimester) and 36.6 ± 2.4 weeks (late third trimester), respectively (P<.0001). Higher delta Hb (2.5 g/dL at <34 weeks versus 1.3 g/dL at ≥34 weeks) and improved mean pre-delivery Hb were seen when IV iron was given in the early third trimester (P<.0001). CONCLUSION: Early third-trimester IVFe improves maternal pre-delivery Hb levels and may reduce significant maternal morbidity hemorrhage complications.