Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2025
Replacing Iron and Preventing Anemia in Pregnant patients of Limited Economic means (RIPPLE): The Impact of Funding Iron Supplementation in Pregnancy.
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Memon Suman, Callum Jeannie, Armali Chantal, Herer Elaine, Malkin Amie, McLeod Anne, Meirovich Harley, Sholzberg Michelle, Lin Yulia, VanderMeulen Heather
Аннотация
OBJECTIVES: Can funding iron supplementation for low-income pregnant patients reduce socioeconomic disparities in anemia rates at delivery?
METHODS: This single-centre cohort study reviewed hematologic parameters and iron supplementation patterns in 3 groups: patients from low-income neighbourhoods, non-low-income neighbourhoods, and low-income patients enrolled in the RIPPLE (Replacing Iron and Preventing anemia in Pregnant patients of Limited Economic means) program. RIPPLE provided access to intravenous iron to patients with an annual household income ≤$50 000 CAD and moderate-to-severe iron deficiency anemia, symptomatic iron deficiency with intolerance/inadequate response to oral iron, or iron deficiency anemia with less than 4 weeks to delivery. Patients were referred by their obstetrical provider, hematologist, or pharmacist. The primary outcome was anemia (hemoglobin <110 g/L) at delivery.
RESULTS: Among 1206 patients (577 low-income, 603 non-low-income, 26 RIPPLE), anemia at delivery was more frequent in RIPPLE (54%) versus low-income (10%) and non-low-income (7%) groups (P < 0.0001). RIPPLE participants exhibited lower nadir hemoglobin (98.8 ± 9.9 g/L) and ferritin (9.6 ± 6.4 μg/L) compared to low-income (hemoglobin 114.2 ± 10.1 g/L, P < 0.0001; ferritin 30.0 ± 24.0 μg/L, P < 0.0001) and non-low-income groups (hemoglobin 115.9 ± 8.1 g/L, P < 0.0001; ferritin 40.9 ± 44.1 μg/L, P < 0.0001), and received infusions later in pregnancy (≤3 weeks pre-delivery: 42% vs. 27% vs. 9%). The RIPPLE cohort included more racial and ethnic minoritized individuals (73% vs. 58% vs. 33%).
CONCLUSIONS: While funding for iron supplementation addressed cost barriers, disparities in care persisted. Our findings underscore the need for universal access to early screening and timely escalation from oral to intravenous iron to reduce social, racial, and ethnic disparities in care.
METHODS: This single-centre cohort study reviewed hematologic parameters and iron supplementation patterns in 3 groups: patients from low-income neighbourhoods, non-low-income neighbourhoods, and low-income patients enrolled in the RIPPLE (Replacing Iron and Preventing anemia in Pregnant patients of Limited Economic means) program. RIPPLE provided access to intravenous iron to patients with an annual household income ≤$50 000 CAD and moderate-to-severe iron deficiency anemia, symptomatic iron deficiency with intolerance/inadequate response to oral iron, or iron deficiency anemia with less than 4 weeks to delivery. Patients were referred by their obstetrical provider, hematologist, or pharmacist. The primary outcome was anemia (hemoglobin <110 g/L) at delivery.
RESULTS: Among 1206 patients (577 low-income, 603 non-low-income, 26 RIPPLE), anemia at delivery was more frequent in RIPPLE (54%) versus low-income (10%) and non-low-income (7%) groups (P < 0.0001). RIPPLE participants exhibited lower nadir hemoglobin (98.8 ± 9.9 g/L) and ferritin (9.6 ± 6.4 μg/L) compared to low-income (hemoglobin 114.2 ± 10.1 g/L, P < 0.0001; ferritin 30.0 ± 24.0 μg/L, P < 0.0001) and non-low-income groups (hemoglobin 115.9 ± 8.1 g/L, P < 0.0001; ferritin 40.9 ± 44.1 μg/L, P < 0.0001), and received infusions later in pregnancy (≤3 weeks pre-delivery: 42% vs. 27% vs. 9%). The RIPPLE cohort included more racial and ethnic minoritized individuals (73% vs. 58% vs. 33%).
CONCLUSIONS: While funding for iron supplementation addressed cost barriers, disparities in care persisted. Our findings underscore the need for universal access to early screening and timely escalation from oral to intravenous iron to reduce social, racial, and ethnic disparities in care.