Direct dispensation of free prenatal supplements improves outcomes in underserved communities

1. In an underserved community, providing free iron-containing prenatal vitamins improved hematocrit, reduced the prevalence of anemia, and reduced the need for postpartum blood transfusions. 

Evidence rating level: 2 (Good)

Maternal anemia during pregnancy is associated with a greater need for postpartum blood transfusions, intrauterine growth restriction, and perinatal mortality. Researchers aimed to determine whether providing free iron supplements to an underserved patient population during prenatal visits would improve hematologic indices and reduce the need for postpartum blood transfusions. This study was conducted at Parkland Health, a hospital in Texas with a 95% Medicaid-funded or self-pay patient population. Patients who delivered between January and August 2019 were recommended iron supplements, while those who delivered between May and December 2020 were provided with free iron-containing prenatal vitamins throughout pregnancy. 13,910 patients were included in this study, with 7075 patients in the recommended supplements cohort and 7160 in the provided supplements cohort. Both cohorts had similar characteristics for age, race, ethnicity (76% Hispanic population), insurance payer status, and parity. On admission for delivery, the provided supplements cohort had a greater hematocrit compared to the recommended supplements cohort, with a mean difference of 1.27%; 95% CI, 1.13%-1.42%, as well as a lower prevalence of anemia, 11% compared to 18% (risk ratio [RR], 0.61; 95% CI, 0.56-0.66). The need for postpartum blood transfusion was also reduced by one-third for the provided supplements group compared to the recommended supplements group, from 10 per 1000 to 6.6 per 1000 (RR, 0.62; 95% CI, 0.43-0.91). A limitation of this study is that patients were not randomized into these two cohorts and were instead grouped based on the timing of their pregnancies. As such, data may be affected by factors such as the COVID-19 pandemic, which predominantly affected those in the provided supplements group. As well, researchers did not collect data from either group on adherence to iron supplementation. Overall, this study demonstrates that providing iron-containing prenatal vitamins to patients during prenatal visits, particularly for patients in an underserved community, may be an effective quality-improvement initiative for improving hematocrit, reducing the prevalence of anemia, and reducing the need for postpartum blood transfusions. 

Click to read the study in JAMA Network Open

Image: PD

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