(927) Prenatal Anemia: Examining Trends and Racial Disparities Before and After Standardized Clinical Interventions

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Supraja Rachuri, BA, MD

Resident Physician
Kaiser Permanente San Francisco
Kaiser Permanente San Francisco, California, United States

Coauthor(s)

EL

Edward Lievanos, MD

Kaiser Permanente San Francisco
Kaiser Permanente San Francisco, California, United States
AS

Aida Shirazi, MS, PhD

Kaiser Permanente San Francisco
Kaiser Permanente San Francisco, California, United States
DF

Deanna Fink, MPH

Kaiser Permanente
Oakland, California, United States
ZS

Zahra Samiezade-Yazd, MPH

Consulting Data Analyst
Kaiser Permanente Division of Research
Kaiser Permanente San Francisco, California, United States
LG

Lauren Gong Barres, MD, MS

Kaiser Permanente San Francisco
Kaiser Permanente San Francisco, California, United States

Objective: Anemia is a common complication of pregnancy that disproportionately affects Black women and is linked to adverse maternal outcomes including cesarean delivery, postpartum hemorrhage, intraamniotic infections and need for blood transfusions. The Controlling Anemia in Pregnancy (CAP) project introduced a clinical algorithm that standardized diagnosis and treatment of anemia across a large healthcare institution. We sought to assess the impact of this algorithm on the incidence of prenatal anemia and identify racial disparities.

Study Design: We conducted a retrospective cohort study of adult pregnant patients with term, singleton live-born deliveries. Data was collected from two cohorts: Cohort 1 (January-December 2016) pre-CAP and Cohort 2 (January-December 2019) post-CAP implementation. Primary outcomes included incidence of both prenatal anemia overall and on admission to labor and delivery. Secondary outcomes included prenatal ferritin and IV iron orders. Outcomes were stratified by ethnicity.

Results:
68,839 patients were included in the study. The incidence of anemia was 38.7%. After the CAP project, diagnosis of anemia increased across all ethnicities 1,344 (3.8%) in 2016 vs. 4,901 (14.4%) in 2019 (P< 0.0001). The percentage of patients with anemia on admission to labor and delivery decreased 4,723 (36%) in 2016 vs. 4,398 (32.6%) in 2019 (P< 0.0001). Ferritin orders increased 2,802 (21.3%) in 2016 vs. 7,377 (54.6%) in 2019 (P< 0.0001) and IV iron infusions increased 407 (3.1%) in 2016 vs. 1,392 (10.3%) in 2019 (P< 0.0001). Black women had a 1.8 times higher incidence (IRR [95%CI]:1.8 [1.7-1.9], p< 0.001) of anemia compared to white women. Identification of anemia increased in both black and white women after implementation of the CAP project 218 (8.9%) in 2016 vs 642 (25.2%) in 2019 in black women and 295 (2.2%) in 2016 vs 1290 (10.6%) in 2019.

Conclusion: The CAP protocol effectively improved the identification and treatment of prenatal anemia, with increased ferritin orders and IV iron treatments. Despite this, Black women remain disproportionately affected by anemia.