Reproductive
Anemia on Admission for Childbirth and Perinatal Mood and Anxiety Disorders –Modification by Intravenous Iron Katharine E. Bruce* Katharine E. Bruce Bruce Bruce Bruce University of North Carolina at Chapel Hill
Background: Perinatal anemia is common and may increase risk of Perinatal Mood and Anxiety Disorders (PMADs). Prior association studies have been mixed, and none have examined the role of IV iron in modifying this association.
Methods: This retrospective cohort study evaluated the relationship between hemoglobin (Hb) on admission for childbirth and PMADs within 3 months postpartum using medical records data from UNC Health System. Participants gave birth at ³20 weeks gestation from April 1, 2016 to June 12, 2024. Hb, collected from complete blood count labs, was categorized as severe (<9mg/dL), moderate (9-<11 mg/dL), or none (≥11mg/dL). Patients were considered to have PMAD symptoms if they screened positive on the Edinburgh Postnatal Depression Scale (cutoff: 10), Patient Health Questionnaire 9 (cutoff: 5), and/or General Anxiety Disorder 7 (cutoff: 5). Generalized Estimated Equations calculated risk ratios, adjusting for age, race/ethnicity, insurance, parity, multifetal gestation, comorbidities, and Area Deprivation Index of home address.
Results: Among 26,186 participants, 24% met criteria for 3rd trimester anemia, 3% received IV iron before discharge, and 16% had PMADs. Compared to those without anemia, those with severe anemia had 1.24 times the risk of PMADs (95% Confidence Interval (CI): 1.02-1.52), and those with moderate anemia had 1.10 times the risk of PMADs (CI: 1.03-1.17). The relationship between anemia and PMADs persisted in those who did not receive IV iron (Severe: relative risk (RR): 1.21, CI: 0.97-1.52; Moderate: RR: 1.08, CI: 1.01-1.16), but there was less evidence of an association in those who did (Severe: RR: 1.05, CI: 0.60-1.87; Moderate: RR: 1.14, CI: 0.77-1.70).
Conclusion: Anemia on admission for childbirth was associated with an increased risk of PMADs. The stronger relationship between anemia and PMADs among those who did not receive IV iron compared to those who did suggests that treating anemia before discharge may mitigate this risk.
