Early treatment with IV iron is associated with improved maternal hemorrhage-related outcomes

Anemia in pregnancy is associated with maternal hemorrhage-related morbidity and mortality, neonatal neurodevelopmental effects, and postnatal neonatal anemia. This study evaluates how the timing of IV iron therapy prior to delivery impacts maternal and fetal outcomes and to better understand how neighborhood context impacts the timing of IV iron administration.

This retrospective cohort study included pregnant patients who received antenatal IV iron therapy for anemia from January 2017 through November 2023. Timing of IV iron administration in relation to the delivery date was analyzed. The primary outcome was hemorrhage-associated morbidity. The Area Deprivation Index (ADI) was used as a surrogate of socioeconomic disadvantage to understand how neighborhood context impacts IV iron administration in relation to the delivery date.

Of 183 included pregnancies with iron deficiency anemia (IDA), 128 (69.9%) received IV iron therapy more than 10 days prior to delivery, while 55 (30.1%) received IV iron therapy fewer than 10 days before delivery. Pregnant patients who received their final transfusion of IV iron >10 days before delivery had significantly higher hemoglobin at delivery admission (11.1 vs. 9.7, p < .001) and were less likely to receive a blood transfusion (p = .03), have a preterm delivery (p = .003), or receive uterotonics during delivery (all p ≤ .05). Additionally, in patients who received IV iron, neighborhood disadvantage did not contribute to late diagnosis or treatment of IDA.

Patients who received IV iron more than 10 days before delivery had improved maternal and fetal outcomes, including fewer maternal blood transfusions and preterm births.