Iron Supplements During Prenatal Checkups Improved Outcomes

Giving free prenatal iron supplements to medically underserved pregnant women rather than just advising them reduced anemia and postpartum blood transfusions, according to a study published in JAMA Network Open by researchers at UT Southwestern Medical Center and Parkland Health.

“Anemia during pregnancy and the postpartum period can lead to severe health complications. We now have data supporting ways to prevent postpartum anemia on a population level by ensuring normal blood volume during delivery, reducing the need for transfusions, and positively impacting the health of mothers and their newborns,” said Catherine Spong, M.D., Chair and Professor of Obstetrics and Gynecology. Dr. Spong co-led the study with Lisa Thiele, M.D., M.P.H., an Obstetrics and Gynecology resident at UT Southwestern.

According to research, pregnant women have a 15%-20% increase in blood volume and require more iron to produce enough hemoglobin, a protein in red blood cells that transports oxygen throughout the body. Anemia is caused by a lack of healthy red blood cells. According to the Centers for Disease Control and Prevention, anemia during pregnancy is associated with negative health outcomes for women and newborns, such as blood transfusions, postpartum anemia and depression, early birth, low birth weight, and perinatal mortality.

Iron supplements are commonly recommended by obstetricians to prevent anemia during pregnancy. However, iron was reclassified as a nutritional supplement in 2015 and is no longer covered by insurance as a prescription, denying many low-income pregnant patients access to these supplements. While doctors continue to recommend them, Drs. Spong and Thiele and their colleagues investigated whether offering complimentary supplements during prenatal visits would enhance outcomes.

The researchers examined deliveries at Parkland Memorial Hospital, which serves as UT Southwestern’s principal teaching hospital and has one of the busiest maternity departments in the country, serving patients with limited socioeconomic resources. One group included 7,075 patients who gave birth between January and August 2019 and were advised to take prenatal iron supplements. The second study involved 7,160 patients who gave birth between May and December 2020 and got free iron supplements throughout their pregnancy.

Hematocrit levels were measured in both groups at 24 to 32 weeks, after birth, before discharge, and during postpartum follow-up. Hematocrit, which represents the percentage of blood volume made up of red cells, is a common test for prenatal and postpartum anemia.

They discovered that patients who took iron supplements consistently had higher hematocrit levels at each assessment period than those who just received a recommendation to take them. Notably, patients who received supplements had 7% less maternal anemia during admission. Furthermore, transfusions for acute blood loss anemia unrelated to obstetric catastrophe occurred in 46 deliveries among those getting supplements versus 71 among those who were advised to take iron.

The findings, according to Dr. Thiele, laureate of the Southwestern Gynecologic Assembly Award, give a mechanism for eliminating patients’ barriers to access, resulting in concrete clinical effects.

“We can make a large impact on our patients’ health and outcomes by implementing simple interventions,” Dr. Spong said. “This study demonstrates the efficacy of a public health initiative to reduce maternal anemia and the most common cause of severe maternal morbidity and gives other institutions data to implement similar programs in their own populations.”

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