Implementation of a protocol for management of antepartum iron deficiency anemia: a prospective cohort study.

Abstract Background In randomized trials, antepartum intravenous iron sucrose (IVFe) is effective at improving pre-delivery Hemoglobin (Hb) in iron deficiency anemia (IDA). Yet, there is a gap between this knowledge and implementation into care. Objective We aimed to determine if implementation of a standardized protocol for management of antepartum anemia outside of a clinical trial improves IVFe utilization and clinical outcomes. Methods We performed a prospective cohort study evaluating incorporation of an anemia protocol into routine clinical care for women with an antepartum Hb Results 1423 women were included (Pre=778; Post=645) without significant baseline differences. Antepartum Hb nadir was no different between groups (Pre: 10.2 IQR [9.6-10.6] vs. Post: 10.2 IQR [9.6-10.6], p=0.77). Implementation of a standardized protocol for management of antepartum anemia was associated with 80% increased odds of receiving IVFe when compared to the pre-implementation group (Pre: 4.8% vs. Post: 8.2%, p=0.008; OR 1.79 95%CI [1.16-2.77]). Implementation of a standardized protocol for management of antepartum IDA was also associated with higher Hb at admission for delivery (Pre: 10.9 IQR [10.1-11.6] vs. Post: 11.0 IQR [10.3-11.7], p=0.048). There were no significant differences between groups in blood product transfusion (Pre: 7.1% vs. Post: 5.1%, p=0.13). Conclusion Implementation of a standardized antepartum anemia protocol is associated with increased IVFe utilization and an improvement in pre-delivery hemoglobin.