Our Spanish population of older mothers showed a higher risk for being delivered by cesarean section and for developing either preeclampsia or gestational diabetes. The overall neonatal outcome was unaffected. These data may be helpfull to counsel patients about their pregnancy expectations and possible outcomes.

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INTRODUCTION: Iron deficiency anemia is associated with risk of transfusion, preterm delivery, and cesarean birth. We aimed to optimize management of iron deficiency anemia with a novel protocol. METHODS: A multidisciplinary team developed an evidence-based treatment protocol for anemia in pregnancy. Resident and maternal fetal medicine (MFM) practices in a tertiary care center implemented this in October 2016. Two weeks of iron supplementation without 1g/dL hemoglobin increase prompted hematology consultation. Protocol adherence in five fields and rates of anemia in the third trimester and at delivery were compared between sites using Fisher exact and χ2 tests. RESULTS: Rates of third trimester anemia were significantly higher in the resident practice (29%) than MFM (15%), P=.03. Term anemia rates were similar (31% and 27%). Rates of iron supplementation in resident patients varied from 50% to 100%, and in MFM from 75% to 100%. Referral to hematology for consideration of iron infusion rates were similar between groups (20% versus 30%), P=.68, as were rates of iron infusion (11% versus 25%). Protocol adherence was inconsistent. CONCLUSION: Adherence to a novel pregnancy-related anemia protocol was inconsistent and did not result in a decline in iron deficiency anemia at term. Further investigation is necessary to determine whether protocol adherence could improve rates of anemia.