Providing iron supplements to patients at prenatal visits resulted in improved hematocrit levels, lower risk of anemia, and reduced transfusions unrelated to obstetric catastrophes, according to a study published in JAMA Network Open. 

Studies have shown that iron supplementation during pregnancy can substantially reduce the risk of maternal anemia; however, access is not universal. The authors of the study sought to investigate whether the direct dispensation of iron supplements during follow-ups to pregnant women will result in improvements in hematology-associated clinical outcomes. 

The study center was Parkland Health, a “safety-net” hospital in Dallas, Texas. A public health initiative started on September 25, 2019, from which all pregnant patients presenting for prenatal care at the healthcare center received iron-containing prenatal supplements up to the immediate postpartum period. During prenatal visits, clinicians advised patients on the importance of taking the iron supplements provided. 

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To assess the efficacy of this initiative, the research team conducted a quality improvement study of all patients who underwent delivery at Parkland Health during 2 time periods, from January 1, 2019 to August 1, 2019 (prior to the initiative), and from May 13, 2020 to December 13, 2020 (when iron supplements were dispensed). The inclusion criteria were that the infants delivered must be larger than 500 g. 

A total of 7075 patients were found to have delivered during the pre-initiative period, while 7160 patients underwent delivery when iron supplements were routinely provided. Of these 14,235 patients, 13,910 (98%) delivered an infant over 500 g. 

The research team reported that, compared with individuals in the first cohort, individuals in the second cohort had consistently higher mean hematocrit levels in the third trimester (35.2% vs 34.7%), upon admission for delivery (35.3% vs 34.0%), prior to discharge (31.1% vs 30.8%), and at subsequent clinical visit 20 days after discharge (39.1% vs 38.8%). 

In addition, the rate of maternal anemia was lower in the second cohort compared with the first cohort upon admission (7% lower) and prior to discharge (5% lower). Lastly, patients who received iron supplements had lower transfusion rates for acute blood loss anemia (not due to obstetric catastrophe/hypovolemia) compared with those who did not (1.0% vs 0.7%). 

“Given this evidence, hospital systems should consider implementing programs to improve access to iron-containing prenatal vitamins, particularly when serving a medically at-risk population,” the authors of the study concluded. 


Thiele LR, Duryea EL, Ragsdale AS, et al. Direct dispensation of prenatal supplements with iron and anemia among pregnant peopleJAMA Netw Open. 2023;6(9):e2332100. doi:10.1001/jamanetworkopen.2023.32100