Iron deficiency and anemia in pregnancy: a health equity issue

Objectives We compared iron supplementation and hematologic parameters in pregnancy between women living in low-income neighbourhoods (median household income ≤$50,000/year) and non-low-income neighbourhoods (median household income >$50,000/year). Methods We performed a baseline audit of the 1st 100 eligible patients to deliver at a tertiary care centre in January 2020. Using their postal codes, patients were stratified to low income neighbourhoods and non-low-income neighbourhoods. Patients were excluded if they had an alternate cause of anemia (e.g. hemoglobinopathy) or were followed elsewhere for their pregnancy prior to delivery. We compared baseline characteristics, hematologic parameters and iron supplementation between the two groups. Results 109 patients were screened: 37 patients from low income neighbourhoods and 63 patients from non-low-income neighbourhoods were included; 9 patients were excluded (2 with chronic kidney disease, 7 followed elsewhere during pregnancy). Women living in low income neighbourhoods had lower ferritin values before 20 weeks GA (mean 49.4 ug/L vs. 75.4 ug/L, p=0.01), lower hemoglobin levels and mean corpuscular volumes at admission to labour and delivery (LD 87.6 fL vs. 90.4 fL, p=0.03) and more frequent anemia ( Conclusions Women living in low income neighbourhoods have lower ferritin values at the start of pregnancy and more frequent anemia at delivery. This highlights a critical opportunity for early intervention to address iron deficiency anemia amongst individuals of lower socioeconomic status who are at higher risk in pregnancy .