Examining prescribing practices with respect to oral iron supplementation for post-partum anemia: a retrospective review

Abstract

Purpose

Treatment for post-partum anemia frequently entails oral iron supplementation, but questions remain regarding optimal dosing, frequency, and efficacy. The objective of this study was to describe oral iron prescribing practices in post-partum women delivered via Cesarean section, and identify factors associated with iron supplementation.

Methods

A retrospective review of Cesarean section deliveries at a single tertiary center between May 2019 and April 2020 was undertaken. Patient demographics, hematological indices, indication for Cesarean section and discharge prescriptions were collected. Univariate and multivariable analyses were performed to identify factors associated with oral iron prescription at discharge.

Results

During the study period, 1470 women were eligible for inclusion. The mean age at delivery was 34.4 ± 4.9 years and mean gestational age was 37.2 ± 3.6 weeks. Most pregnancies (92%) were singleton. Ninety-six total patients (6.5%) received intravenous iron post-partum. Fourteen percent of women (210/1470) received prescriptions for oral iron at discharge, most commonly ferrous fumarate (61.9%, 130/210). The most common dose provided was 300 mg (145/210). Ante-partum ferritin was available for most patients (64.3%, 945/1470), but only for 17 post-partum patients (1.2%). Factors significantly associated with oral iron prescription were earlier gestational age at birth (aOR 0.93, 95% CI 0.89–0.97), history of complications during pregnancy or labor (aOR 1.92, 95% CI 1.26–2.98), higher blood loss (aOR 2.66, 95% CI 1.36–5.44), post-partum anemia (aOR 6.28, 95%-CI 4.41–8.96), blood transfusion (aOR 5.43, 95%-CI 1.81–18.19) and antenatal iron supplementation (aOR 5.70, 95%-CI 4.02–8.17).

Conclusions

In summary, a relatively small proportion of women following Cesarean section were prescribed oral iron at discharge. We identified several factors associated with post-partum iron supplementation. This information will inform future prospective studies investigating the efficacy of iron supplementation in the treatment of post-partum anemia.

Keywords:

• postpartum period
• iron-deficiency
• anemia
• iron supplementation

Acknowledgements

Our team would like to acknowledge Ms. Liying Zhang for her contributions to our statistical analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data used in this retrospective review was accessed from an existing patient database which was not generated for the purposes of this study. Thus, the datasets analyzed during the current study are not publicly available without approval from the local research ethics board.

Additional information

Funding

This research received funding support from Canadian Blood Services, Program Support Award (The University of Toronto QUEST Transfusion Program), funded by the federal government (Health Canada) and the provincial and territorial ministries of health. The views herein do not necessarily reflect the views of Canadian Blood Services, the federal, provincial, or territorial governments of Canada.