Iron Deficiency Anemia: Developing and Implementing an Intervention to Treat this Preventable Cause of Maternal Morbidity

Postpartum hemorrhage (PPH) complicates 4-6% of all pregnancies and is a leading cause of maternal morbidity and mortality. Hemorrhage-related morbidity includes the risk of receiving a blood transfusion, as well as end-organ damage to the patient (e.g., renal injury), and loss of future fertility if a hysterectomy is performed. Poor outcomes in PPH are highly preventable and amenable to safety interventions. Women who are anemic have worse PPH-related outcomes due to their diminished reserve, but antepartum anemia is a modifiable risk factor for preventing adverse outcomes such as peripartum blood transfusions and other hemorrhage-related morbidity including hemorrhagic shock, cardiovascular failure, and higher rates of infection. Additionally, women with severe anemia, hemoglobin concentrations of < 7 g/dL, have a 2.4 greater odds of death than less anemic women. The burden of maternal anemia falls upon minority women, with black women being more likely to have peripartum anemia than non-Hispanic white women. Racial/ethnic disparities in both the frequency and severity of PPH have been documented. The higher prevalence of maternal anemia among minority women could therefore contribute to disparities in morbidity and mortality, with black women experiencing a two-fold higher frequency of severe maternal morbidity than white women and four-fold higher frequency of maternal mortality. Yet, despite effective, economical, and safe treatment options, anemia is not optimally managed, as there is a dearth of appropriate management guidelines. Failure to effectively treat anemia could be due to patient-, provider-, or systems-level factors. In this study, we will use qualitative methods to evaluate patient awareness of peripartum anemia and management options, as well as barriers to treatment. We will also evaluate providers’ approaches to anemia management and awareness of treatment modalities such as intravenous iron therapy. We will then convene an expert panel to cre