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Primary Submission Category: Reproductive health
Impact of prenatal care initiation on adverse perinatal outcomes in patients with anemia
Authors: Meghana Narahari, Bharti Garg, Amelia Gagliuso, Ashley Benson, Aaron Caughey,
Presenting Author: Meghana Narahari*
Objective: Iron deficiency anemia (IDA) in pregnancy is common and associated with worse maternal and neonatal outcomes. While early prenatal care is known to improve outcomes for many pregnancy-related conditions, its impact on IDA in pregnancy remains unclear. The objective of this study is to investigate the association between timing of prenatal care initiation, stratified by trimester, and adverse outcomes in pregnant individuals with anemia.
Study Design: This is a retrospective cohort study using California’s linked vital statistics and hospital discharge data (2008-2020). We included pregnant individuals with a singleton gestation, delivering between 23 and 42 weeks, with diagnosis of anemia. Individuals were classified by trimester of prenatal care initiation. Chi-square tests and multivariable Poisson regression models were used to assess the risk of outcomes among patients who started their care in the 2nd or 3rd trimester as compared to the first trimester (reference group).
Results: Among the 373,098 pregnant individuals with IDA, 83.7% started care in the first trimester, 12.4% in the second trimester and 3.9% in the third trimester. Third trimester prenatal care initiation was associated with increased risks of hypertensive disease of pregnancy (aRR =1.05, 95% CI 1.00 – 1.10), preterm birth <34 weeks (aRR=1.34, 95% CI 1.20 – 1.50), severe maternal morbidity (aRR=1.25, 95% CI 1.19 – 1.33), maternal blood transfusion (aRR=1.32, 95% CI 1.24 – 1.40) and maternal ICU admission (aRR=1.33, 95% CI 1.08 – 1.65). Neonates of individuals with late prenatal care initiation had a higher risk of NICU admission (aRR=1.34, 95% CI 1.29 – 1.41) and infant death (aRR=1.82, 95% CI 1.39 – 2.37).
Conclusion: Initiation of prenatal care in later trimesters is associated with increased risk of adverse maternal and neonatal outcomes among individuals with anemia.
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Table 1: Maternal and Neonatal outcomes by trimester of prenatal care initiation for anemia among pregnant individuals in California, 2008–2020
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