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Poster Session 2

(539) How much is enough? Incomplete treatment course of intravenous iron to prevent postpartum blood transfusions.

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: To compare the benefit of partial and full doses of IV iron treatment in reducing postpartum blood transfusions.

Study Design: This was a retrospective cohort study of patients with Iron Deficiency Anemia (IDA) who presented for prenatal care at a tertiary urban academic center from June 2020 to June 2024. Women were included if they received IV iron antepartum and excluded if they had contraindications to blood transfusion. The primary outcome was postpartum blood transfusion. Secondary outcomes included hemoglobin (Hg) levels at admission and percent change in Hg (pre-treatment to admission). Fisher’s exact, chi square, parametric and non-parametric tests were used. Median (interquartile range) and mean +/- standard deviation shown.

Results: Among 224 patients with IDA, 116(52%) completed the calculated IV iron dose based on the iron deficit (Full dose, Group 1) and 108(48%) initiated, but did not complete the prescribed treatment (Partial dose, Group 2). The median dose of IV iron was 900 mg (400-1800) in Group 1 and 400 mg (200-1200) in Group 2 (p< 0.0001). Pre-treatment Hg was similar between Groups 1 and 2 (8.7 +/- 0.89 vs 8.6 g/dL +/- 0.92 respectively, p=0.71). However, Group 2 had more short interval pregnancies [8(7%) vs 24(22%) in Groups 1 and 2, p=0.001], later gestational age at treatment initiation [median 34(20-38) vs 36 weeks (24-40), p< 0.0001] and a higher median delivery blood loss [285(200-543) vs 361 mL(200-612), p=0.04]. There was no difference in postpartum transfusions between Groups 1 and 2 [8(7%) vs 11(10%), p=0.33]. However, Group 1 had a higher mean admission Hg than Group 2 (10.8 +/- 0.92 vs 9.7 g/dL +/- 0.98, p< 0.0001), a higher median percent increase in Hg [25% (12-36) vs 11% (4-21), p< 0.0001], and a higher mean postpartum day 1 Hg ( 9.8 +/- 1.18 vs 8.3 +/- 1.19 g/dL, p< 0.0001). 

Conclusion:

A full course of IV iron improved Hg response and admission Hg compared to partial course but did not significantly decrease postpartum blood transfusions. Partial treatment still benefits pregnant patients with anemia, even when optimal treatment cannot be completed.