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Practitioner Survey Regarding Knowledge of Iron Deficiency Anemia in Pregnancy
Abstract Number: SA-03
Abstract Type: Original Research
Introduction: Iron deficiency anemia (IDA), defined by the World Health Organization (WHO) as hemoglobin (Hgb) <11 g/dL, is common in pregnancy and is associated with multiple adverse consequences for the mother and her infant. IDA is prevalent, affecting 17.4% of pregnant patients in industrialized countries, and 51% of pregnant patients worldwide.1 Negative outcomes include low fetal birth weight, reduced maternal cognitive performance, and an increased incidence of postpartum clinical depression.2
Due to the prevalence of IDA and the ability to intervene and correct IDA prior to delivery with iron therapies, as part of a needs assessment we surveyed residents, fellows and faculty to evaluate their understanding of iron deficiency anemia in pregnant women.
Methods: Following IRB approval, we sent a survey to Obstetric and Gynecology (OB/GYN) and Anesthesia residents, fellows and faculty. The survey was administered using REDCap through the University of Chicago. Questions were prepared by OB/GYN and OB Anesthesia attendings with expertise in IDA and an OB anesthesia fellow. Questions were presented to survey respondents two separate times; after respondents entered an answer the correct answer was displayed so that this survey could also act as a learning opportunity.
Results: Forty-nine participants completed the 35 question survey for a response rate of 40.5%. Of those who completed all questions, the average score was 22 (62% correct). The WHO definition of anemia in pregnancy was correctly identified by 45% of respondents; 59% correctly identified the amount of oral iron needed to treat IDA. Only 22% of respondents knew the correct amount of iron absorbed daily through the GI tract, with most respondents overestimating the amount. Providers scored well in questions asking them to consider when to use IV iron; 82% and 94% correctly selected IV iron use in women with poor adherence to oral iron or in women with GI issues. Almost half, 47%, of respondents knew that a 1g increase of hemoglobin in 1 month demonstrated effectiveness of oral treatment.
Discussion: While many survey respondents were able to identify situations where IV iron therapy may be indicated, there is demonstrable need for additional education about iron deficiency anemia in parturient women. A minority of respondents were able to correctly identify the WHO definition of anemia in pregnancy, the amount of iron absorbed, or the Hgb rise that marks effective iron treatment. With more education, practitioners may recognize IDA early and intervene with intravenous iron therapy to raise Hgb levels and reduce transfusion rates when patients are intolerant to oral iron therapy.
Khalafallah AA, et. al. Journal of Pregnancy 2012; 2012: 1-10
Milman N. Am. Hematol 2011; 90:1247-53