There was a wide range in the midwives' practice. Maternal iron status was difficult to categorize, because of inconsistent testing. This study indicates the need for an evidence-based clinical guideline for New Zealand midwives and maternity care providers.

Background The incidence of postpartum anaemia (PPA) in New Zealand, and the extent of intravenous iron (IV‐iron) use in its treatment, are unknown. Aims To report the incidence of PPA in three district health board (DHB) regions and describe current management of moderate to severe PPA, including by ethnicity. Materials and Methods Retrospective observational study of PPA (haemoglobin (Hb) <100 g/L) in three DHBs from July–December 2019. Cases with moderate to severe PPA (Hb <90 g/L) were reviewed and management compared to local and national guidance. Logistic regression examined demographic associations of PPA. Results There were 8849 women who gave birth during the study period: 4076 (46%) had postpartum Hb testing and 1544 (38%) had PPA. Of those tested, and after adjusting for deprivation and region, European women had lower adjusted odds ratios compared to Māori for being identified as having PPA (0.46, 95% CI 0.37–0.57, P < 0.01). Of 681 women with Hb <90 g/L, 278 (41%) received IV‐iron only, 66 (10%) red blood cell transfusion (RBC‐T) only and 155 (23%) both. Of those receiving RBC‐T, 40/221 (18%) were actively bleeding. Māori (92/138, 67%) and Pacific (127/188, 68%) women with Hb <90 g/L had the highest incidence of IV‐iron use. No guidelines provided recommendations for haemodynamically stable women without active bleeding. Conclusion The incidence and management of PPA differs by ethnicity but fewer than half of the women had Hb testing, making precise determination of incidence impossible. The majority of women with Hb <90 g/L received IV‐iron, with or without RBC‐T.

No abstract

<p>Background: Globally there is no consensus on haemoglobin (Hb) parameters that define maternal anaemia. Therefore it is difficult to distinguish physiological anaemia of pregnancy from anaemia associated with pathology. Low maternal iron status is associated with adverse outcomes, although the evidence is difficult to interpret. Non-anaemic iron deficiency requires prevention and treatment, before end stage iron deficiency anaemia. Increases in serum ferritin (SF) secondary to inflammation, gives misleading results of iron stores if not tested with C-reactive protein (CRP). Given the complexities, how do Lead Maternity Carer (LMC) midwives in New Zealand manage anaemia and iron deficiency, without a clinical guideline?  Methods: In this descriptive study, quantitative data was retrospectively collected from September-December 2013, from LMC midwives (n=21) and women (n=189), in one New Zealand area. Main outcomes assessed were women’s iron status. Anaemia was defined as Hb <110g/L in the first trimester, <105g/L in subsequent trimesters, and <100g/L postnatally. Iron deficiency was defined as SF <20 μg/L, if CRP<5mg/L. A secondary analysis of iron status and body mass index (BMI) was undertaken.  Results: Of the 186 women who had Hb testing at booking, 46% did not have ferritin tested concurrently. Of the 385 ferritin tests undertaken, 86% were not tested with CRP. Despite midwives prescribing iron for 48.7%, and recommending iron for 16.9% of second trimester women, 47.1% had low iron status before birth. Only 22.8% had Hb testing postpartum, including 65.1% (of 38) with blood loss >500mls. Results of a secondary analysis showed a significant difference (p=.05) between third trimester ferritin levels in women with BMI ≥ 25 (Md SF 14 μg/L) and BMI < 25 (Md SF 18 μg/L).  Conclusions: Inconsistent testing of ferritin made it difficult to assess maternal iron status, especially without concurrent testing of CRP. Midwives may not understand and recognise the progression from iron sufficiency to end-stage iron deficiency anaemia. Even without further research this small study may indicate the need for improved education for midwives, and a clinical guideline. More complex studies on the prevalence in New Zealand, BMI and iron status, and maternal outcomes especially in the postpartum period, are warranted.</p>

<p>Background: Globally there is no consensus on haemoglobin (Hb) parameters that define maternal anaemia. Therefore it is difficult to distinguish physiological anaemia of pregnancy from anaemia associated with pathology. Low maternal iron status is associated with adverse outcomes, although the evidence is difficult to interpret. Non-anaemic iron deficiency requires prevention and treatment, before end stage iron deficiency anaemia. Increases in serum ferritin (SF) secondary to inflammation, gives misleading results of iron stores if not tested with C-reactive protein (CRP). Given the complexities, how do Lead Maternity Carer (LMC) midwives in New Zealand manage anaemia and iron deficiency, without a clinical guideline?  Methods: In this descriptive study, quantitative data was retrospectively collected from September-December 2013, from LMC midwives (n=21) and women (n=189), in one New Zealand area. Main outcomes assessed were women’s iron status. Anaemia was defined as Hb <110g/L in the first trimester, <105g/L in subsequent trimesters, and <100g/L postnatally. Iron deficiency was defined as SF <20 μg/L, if CRP<5mg/L. A secondary analysis of iron status and body mass index (BMI) was undertaken.  Results: Of the 186 women who had Hb testing at booking, 46% did not have ferritin tested concurrently. Of the 385 ferritin tests undertaken, 86% were not tested with CRP. Despite midwives prescribing iron for 48.7%, and recommending iron for 16.9% of second trimester women, 47.1% had low iron status before birth. Only 22.8% had Hb testing postpartum, including 65.1% (of 38) with blood loss >500mls. Results of a secondary analysis showed a significant difference (p=.05) between third trimester ferritin levels in women with BMI ≥ 25 (Md SF 14 μg/L) and BMI < 25 (Md SF 18 μg/L).  Conclusions: Inconsistent testing of ferritin made it difficult to assess maternal iron status, especially without concurrent testing of CRP. Midwives may not understand and recognise the progression from iron sufficiency to end-stage iron deficiency anaemia. Even without further research this small study may indicate the need for improved education for midwives, and a clinical guideline. More complex studies on the prevalence in New Zealand, BMI and iron status, and maternal outcomes especially in the postpartum period, are warranted.</p>