Lower Casey A, Gleason Emily G, Toda Asaki, Srinivas Sindhu K, Levine Lisa D, Power Maggie E, Hamm Rebecca F
Department of OB/GYN, University of Pennsylvania Maternal Fetal Medicine Research Program, Philadelphia, Pennsylvania.
Department of OB/GYN, University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, Pennsylvania.
Am J Perinatol. 2025 Apr;42(5):660-665. doi: 10.1055/a-2414-1262. Epub 2024 Sep 19.
Implementation of standardized protocols for antepartum anemia increases intravenous iron (IVFe) use and improves predelivery hemoglobin (Hb). However, this condition is often overlooked and inadequately treated in postpartum care settings. We aimed to determine if implementation of a standardized protocol for postpartum anemia increases postpartum IVFe use and affects clinical outcomes.We performed a prospective cohort study evaluating implementation of a standardized inpatient protocol for postpartum anemia. This protocol, implemented in December 2021, recommends (1) IVFe for postpartum Hb 7.0 to 8.9 g/dL and (2) oral iron for postpartum Hb 9.0 to 9.9 g/dL. We compared all postpartum inpatients at a single site from April 2021 (preimplementation period [PRE]) to April 2022 (postimplementation period [POST]). The primary outcome was any IVFe use. Secondary outcomes included number of IVFe doses, oral iron supplementation at discharge, postpartum complications, and length of stay.A total of 805 patients were included (PRE = 401; POST = 404). Patients in the PRE and POST groups differed in ethnicity (PRE: 8.2% Hispanic vs. POST: 14.9% Hispanic, = 0.003). IVFe use significantly increased from PRE to POST (PRE: 6.0% vs. POST: 11.1%, = 0.009) even when controlling for differences between groups (adjusted odds ratio: 2.48, 95% confidence interval: [1.08-5.67]). Patients receiving IVFe in the POST group were more likely to receive the recommended three doses of IVFe compared with patients receiving IVFe in the PRE group (POST: 29% vs. PRE: 4%, = 0.04). Patients in the POST group had shorter lengths of stay than in the PRE group (POST: 1.69 days vs. PRE: 1.81 days, < 0.001). There were no significant differences in blood transfusion, oral iron supplementation, or postpartum complications.Implementation of a standardized protocol for postpartum anemia increased IVFe use without increasing length of stay. · Postpartum anemia is associated with postpartum depression, fatigue, impaired cognition, and altered maternal-infant bonding.. · IVFe is more effective and better tolerated than oral iron.. · Implementation of standardized protocols for antepartum anemia has been shown to increase IVFe use.. · Implementation of a standardized protocol for postpartum anemia increased IVFe use without increasing length of stay..
实施标准化的产前贫血治疗方案可增加静脉铁剂（IVFe）的使用，并改善分娩前血红蛋白（Hb）水平。然而，在产后护理环境中，这种情况常常被忽视且治疗不充分。我们旨在确定实施标准化的产后贫血治疗方案是否会增加产后IVFe的使用并影响临床结局。我们进行了一项前瞻性队列研究，评估标准化的产后贫血住院治疗方案的实施情况。该方案于2021年12月实施，建议：（1）产后Hb为7.0至8.9g/dL时使用IVFe；（2）产后Hb为9.0至9.9g/dL时使用口服铁剂。我们比较了2021年4月（实施前时期[PRE]）至2022年4月（实施后时期[POST]）同一地点的所有产后住院患者。主要结局是是否使用任何IVFe。次要结局包括IVFe剂量数、出院时口服铁剂补充情况、产后并发症和住院时间。总共纳入了805例患者（PRE = 401；POST = 404）。PRE组和POST组患者在种族方面存在差异（PRE组：8.2%为西班牙裔，POST组：14.9%为西班牙裔，P = 0.003）。即使在控制组间差异后，从PRE到POST，IVFe的使用仍显著增加（PRE组：6.0%，POST组：11.1%，P = 0.009）（调整后的优势比：2.48，95%置信区间：[1.08 - 5.67]）。与PRE组接受IVFe的患者相比，POST组接受IVFe的患者更有可能接受推荐的三剂IVFe（POST组：29%，PRE组：4%，P = 0.04）。POST组患者的住院时间比PRE组短（POST组：1.69天，PRE组：1.81天，P < 0.001）。在输血、口服铁剂补充或产后并发症方面没有显著差异。实施标准化的产后贫血治疗方案增加了IVFe的使用，且未增加住院时间。·产后贫血与产后抑郁、疲劳、认知障碍以及母婴关系改变有关。·IVFe比口服铁剂更有效且耐受性更好。·已证明实施标准化的产前贫血治疗方案可增加IVFe的使用。·实施标准化的产后贫血治疗方案增加了IVFe的使用，且未增加住院时间。
