{"title":"Replacing Iron and Preventing Anemia in Pregnant patients of Limited Economic means (RIPPLE): The Impact of Funding Iron Supplementation in Pregnancy","authors":"Suman Memon MD , Jeannie Callum BA, MD , Chantal Armali BSc, CCRP , Elaine Herer BSc, MD , Amie Malkin BSc, MSc, CCRP , Anne McLeod MD , Harley Meirovich BA , Michelle Sholzberg MDCM, MSc , Yulia Lin MD , Heather VanderMeulen MD, MSc, DRCPSC","doi":"10.1016/j.jogc.2025.103035","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>Can funding iron supplementation for low-income pregnant patients reduce socioeconomic disparities in anemia rates at delivery?</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < 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, <em>P</em> < 0.0001; ferritin 30.0 ± 24.0 μg/L, <em>P</em> < 0.0001) and non-low-income groups (hemoglobin 115.9 ± 8.1 g/L, <em>P</em> < 0.0001; ferritin 40.9 ± 44.1 μg/L, <em>P</em> < 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%).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103035"},"PeriodicalIF":2.2000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of obstetrics and gynaecology Canada","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1701216325002816","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
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.
期刊介绍:
Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.