{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T14:35:24Z","timestamp":1745850924024,"version":"3.40.2"},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"Thomas B. McCabe and Jeannette E. Laws McCabe Fund"},{"name":"Eunice Kennedy Shriver National Institute for Child Health and Development","award":["K23 HD102523"],"award-info":[{"award-number":["K23 HD102523"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Implementation of standardized protocols for antepartum anemia increases intravenous iron (IVFe) use and improves predelivery hemoglobin (Hb). However, this condition is often overlooked and inadequately treated in postpartum care settings. We aimed to determine if implementation of a standardized protocol for postpartum anemia increases postpartum IVFe use and affects clinical outcomes.<\/jats:p><jats:p>We performed a prospective cohort study evaluating implementation of a standardized inpatient protocol for postpartum anemia. This protocol, implemented in December 2021, recommends (1) IVFe for postpartum Hb 7.0 to 8.9\u2009g\/dL and (2) oral iron for postpartum Hb 9.0 to 9.9\u2009g\/dL. We compared all postpartum inpatients at a single site from April 2021 (preimplementation period [PRE]) to April 2022 (postimplementation period [POST]). The primary outcome was any IVFe use. Secondary outcomes included number of IVFe doses, oral iron supplementation at discharge, postpartum complications, and length of stay.<\/jats:p><jats:p>A total of 805 patients were included (PRE\u2009=\u2009401; POST\u2009=\u2009404). Patients in the PRE and POST groups differed in ethnicity (PRE: 8.2% Hispanic vs. POST: 14.9% Hispanic, p\u2009=\u20090.003). IVFe use significantly increased from PRE to POST (PRE: 6.0% vs. POST: 11.1%, p\u2009=\u20090.009) even when controlling for differences between groups (adjusted odds ratio: 2.48, 95% confidence interval: [1.08\u20135.67]). Patients receiving IVFe in the POST group were more likely to receive the recommended three doses of IVFe compared with patients receiving IVFe in the PRE group (POST: 29% vs. PRE: 4%, p\u2009=\u20090.04). Patients in the POST group had shorter lengths of stay than in the PRE group (POST: 1.69 days vs. PRE: 1.81 days, p\u2009&lt;\u20090.001). There were no significant differences in blood transfusion, oral iron supplementation, or postpartum complications.<\/jats:p><jats:p>Implementation of a standardized protocol for postpartum anemia increased IVFe use without increasing length of stay.<\/jats:p>","DOI":"10.1055\/a-2414-1262","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T23:03:09Z","timestamp":1726786989000},"page":"660-665","source":"Crossref","is-referenced-by-count":1,"title":["Implementation of a Standardized Protocol for Postpartum Anemia: A Prospective Cohort Study"],"prefix":"10.1055","volume":"42","author":[{"given":"Casey A.","family":"Lower","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, University of Pennsylvania Maternal Fetal Medicine Research Program, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily G.","family":"Gleason","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, University of Pennsylvania Maternal Fetal Medicine Research Program, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asaki","family":"Toda","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sindhu K.","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, University of Pennsylvania Maternal Fetal Medicine Research Program, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa D.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, University of Pennsylvania Maternal Fetal Medicine Research Program, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maggie E.","family":"Power","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, University of Pennsylvania Maternal Fetal Medicine Research Program, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca F.","family":"Hamm","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, University of Pennsylvania Maternal Fetal Medicine Research Program, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/birt.12519","article-title":"The definition, screening, and treatment of postpartum anemia: a systematic review of guidelines","volume":"48","author":"R Ruiz de Vi\u00f1aspre-Hern\u00e1ndez","year":"2021","journal-title":"Birth"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"102985","DOI":"10.1016\/j.ijoa.2021.102985","article-title":"Antepartum and postpartum anemia: a narrative review","volume":"47","author":"A J Butwick","year":"2021","journal-title":"Int J Obstet Anesth"},{"issue":"04","key":"ref3","first-page":"B5471","article-title":"Intravenous iron treatment in the puerperium","volume":"65","author":"C Holm","year":"2018","journal-title":"Dan Med J"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/0167482X.2018.1427725","article-title":"Anaemia and depletion of iron stores as risk factors for postpartum depression: a literature review","volume":"40","author":"A Wassef","year":"2019","journal-title":"J Psychosom Obstet Gynaecol"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/0301-2115(95)02538-3","article-title":"Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy","volume":"69","author":"A K al-Momen","year":"1996","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref6","first-page":"48","article-title":"Oral iron versus parenteral iron sucrose in a rural tertiary care hospital of Southern India","author":"R S Pukale","year":"2021","journal-title":"Int J Sci Res"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1097\/AOG.0000000000005143","article-title":"Intravenous iron compared with oral iron supplementation for the treatment of postpartum anemia: a randomized controlled trial","volume":"141","author":"A F Saad","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"100533","DOI":"10.1016\/j.ajogmf.2021.100533","article-title":"Implementation of a protocol for management of antepartum iron deficiency anemia: a prospective cohort study","volume":"4","author":"R F Hamm","year":"2022","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1002\/ajh.24361","article-title":"Safety and efficacy of rapid (1,000\u2009mg in 1\u2009hr) intravenous iron dextran for treatment of maternal iron deficient anemia of pregnancy","volume":"91","author":"L Wong","year":"2016","journal-title":"Am J Hematol"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/j.1365-2796.2010.02251.x","article-title":"A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy","volume":"268","author":"A Khalafallah","year":"2010","journal-title":"J Intern Med"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1067\/mob.2002.121894","article-title":"Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route","volume":"186","author":"F Bayoumeu","year":"2002","journal-title":"Am J Obstet Gynecol"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"e1002867","DOI":"10.1371\/journal.pmed.1002867","article-title":"Development and implementation of a quality improvement toolkit, iron deficiency in pregnancy with maternal iron optimization (IRON MOM): a before-and-after study","volume":"16","author":"J Abdulrehman","year":"2019","journal-title":"PLoS Med"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ajog.2018.12.016","article-title":"Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis","volume":"221","author":"P Sultan","year":"2019","journal-title":"Am J Obstet Gynecol"}],"container-title":["American Journal of 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