Anaemia in pregnancy: can we improve care?

Maternal anaemia is the most common condition in pregnancy. It has profound consequences for both the mother and child, despite being easily treatable with iron supplementation. Our study aimed to investigate its prevalence, risk factors, and the current compliance to screening and treatment.

Women who delivered a baby between 1 October 2019 and 31 December 2019 at KK Women's and Children's Hospital, Singapore, were included. Haemoglobin levels at booking, 24-28 weeks and delivery were analysed. The frequency of treatment with iron supplementation or blood transfusion was also evaluated. Patient demographics were analysed using descriptive statistical methods, while Pearson's chi-square test was used for analyses of proportions.

The prevalence of maternal anaemia at the time of delivery was 17.2%. Significant risk factors included receiving subsidised healthcare (associated with lower socioeconomic status), teenage pregnancy, multiparity, Indian ethnicity, thalassaemia and antepartum haemorrhage (P < 0.05). Compliance to screening was 62.8% at 24-28 weeks. Only 38.4% of women with anaemia at booking and 74.9% with anaemia at 24-28 weeks were prescribed oral iron. A total of 11.2% of women with maternal anaemia received intravenous iron. The mean haemoglobin level of women who received blood transfusion was 8.3 g/dL, which may not have been appropriate.

Institutions should create guidelines to standardise the screening and treatment of maternal anaemia and conduct regular audits to monitor their implementation. We recommend a multi-pronged strategy targeting prevention, routine screening, and appropriate treatment of maternal anaemia.