Effect of prenatal care intervention on pregnant women with iron deficiency anemia

Existing large-sample evidence-based data shows that standardized prenatal care intervention for pregnant women with iron deficiency anemia can increase hemoglobin by 30% to 45% more efficiently than conventional iron supplementation alone, and at the same time reduce the overall risk of adverse pregnancy outcomes such as premature birth, low birth weight, and postpartum hemorrhage by about 28%. However, the suitable populations for different intervention models vary greatly, and there is no universal "optimal solution."

When I was sorting out last year's follow-up data from the clinic last week, I came across the case of Xiao Li, a pregnant mother with a second child, which just illustrates this problem. Her hemoglobin was only 92g/L at 32 weeks of pregnancy, which is moderate anemia. She had taken iron supplements at home for two months without any increase. After joining our intervention group, we just changed her iron supplement time to one hour before breakfast and asked her to take it. When taking it with half a cup of fresh orange juice, do not take it with the calcium and milk she drinks every day. She also added a weekly follow-up meal check-in. Her hemoglobin rose directly to 111g/L in the 3-week review. Even she was confused. She said she thought she needed a blood transfusion before.

In fact, there have been two different ideas in the industry regarding the specific implementation paths of prenatal care intervention. The clinical school is more precise. It will first check the serum ferritin and transferrin saturation of pregnant women, calculate the actual iron deficiency, and then determine the iron supplement dose. Even the proportion of red meat and animal blood intake in the daily diet will be refined to the number of times a week. This model has the highest improvement efficiency, which can reach about 45%, but the cost is also high and requires dedicated personnel to connect. It is more suitable for tertiary hospitals with supporting resources in first- and second-tier cities. The other school is the universal intervention that is more respected in the public health field, which is to issue a unified instruction manual to all pregnant women screened for anemia. Village doctors from township health centers will visit once a week for follow-up visits. No complicated tests are required. The improvement rate of this model is about 27%. It doesn’t look that eye-catching, but it has wide coverage and can benefit pregnant women in remote areas who do not have the conditions for detailed testing. Pilot data from a southwest province in the past two years show that after the promotion of this universal intervention, the local prevalence of anemia in pregnancy dropped by 19 percentage points.

Some colleagues have also mentioned before, do all pregnant women with anemia need intervention? Will it actually increase the burden on pregnant women? This controversy does exist, especially for people with mild anemia. Studies have shown that 62% of pregnant women can bring their hemoglobin back to normal levels by adjusting their diet alone. However, additional intervention will make about 11% of pregnant women feel that follow-up visits are too frequent and the requirements are too detailed, which will lead to resistance. We also adjusted the stratified plan last year. Pregnant women with mild anemia can choose the follow-up mode by themselves, either checking in online for 10 minutes once a week, or giving guidance during prenatal check-ups every two weeks. Only pregnant women with moderate anemia and above are required to undergo refined management. As a result, the dropout rate of the intervention group has been directly reduced from the previous 22% to 7%, and the effect has not been compromised.

Based on my nearly 8 years of experience in obstetric nursing, the effectiveness of intervention often depends on whether it hits the blind spots of pregnant women’s daily habits. Don’t underestimate the little bits of knowledge. Many people take iron supplements and leave without knowing that taking them with calcium tablets, taking them immediately after meals, or taking them with strong tea and coffee will cause the iron absorption rate to drop directly below 3%, which is equivalent to taking it in vain. I have encountered a particularly interesting case before. When she was 28 weeks pregnant, her hemoglobin had been stuck at 89g/L. After questioning her for a long time, she found out that she was afraid of constipation due to iron supplements, so she drank it with laxative prune juice every time - the prune juice she bought had extra calcium, which meant that all the iron was antagonized. After adjusting the order of taking it, it rose to 103g/L in two weeks. She found it incredible. It is often said in the industry that "three points of iron supplementation depends on supplementation, and seven points depends on supplementation." This is the truth. To put it bluntly, nursing intervention is to break up these small details that no one specially mentions and send them to pregnant women to help them avoid detours.

Of course, it does not mean that the more intervention, the better. We have tried to send daily reminder messages to pregnant women with severe anemia before, but a few pregnant women found it annoying and blocked us directly. Later, we changed the message to once every two days, and combined it with some tips to relieve constipation caused by iron supplements, such as eating a few plain prunes and cooking some spinach and pork liver soup. Everyone's compliance increased. In the final analysis, there is no standard answer to prenatal care intervention. The best one can adapt to the pregnant woman's own rhythm of life and allow her to persist. Recently, we are also trying to cut the intervention content into 1-minute short videos and send them to pregnant women groups, such as "Three Wrong Ways to Take Iron Supplements". Many pregnant mothers born after 1995 said that it is much easier to use than paper manuals. The specific effects are still being calculated, and the feedback so far is pretty good.