Reducing Perinatal Anemia through Patient Centered Community and Clinical Approaches

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The problem of maternal iron deficiency anemia is vastly under-recognized yet it affects approximately 16 percent of pregnancies in the U.S. Rates are 3 to 4 times higher among Black people and 1.5 to 2 times higher among Latinx people compared to their white counterparts. This translates to higher rates of postpartum hemorrhage-related severe maternal morbidity. By effectively addressing antenatal iron deficiency anemia and these disparities, we have the potential to reduce postpartum hemorrhage-related severe maternal morbidity and maternal deaths related to postpartum hemorrhage.

Aim 1.  Develop an Anemia Prevention Toolkit that aligns evidence-based practice with patient-centered care, incorporating patients lived experience, community assets, and clinical/hospital workflows.

Aim 1A

In Year 2 of the PRIHSM grant, the Project 1 team conducted

• Several patient focus groups  
• Several  focus groups with healthcare support personnel such as doulas and community-based organization staff and
• Semi-structured  with licensed healthcare professionals.

From a research perspective, the team – including our CAB (ACLG) developed

• a preliminary qualitative codebook
• preliminary analysis of codes and themes
• preliminary planning of abstracts and manuscripts.

Aims 1B

In this aim, we collaborate with two advisory boards, once community-based and one clinician-based: the Anemia Community Leadership Group (ACLG) and the Clinical Collaborative Leadership Group (CCLG).

The ACLG includes leaders from WIC, Black Infant Health, and other key stakeholder organizations, while the CCLG consists of clinicians from hospitals across California, Oregon, Washington, and Texas. To date, we have held regular ACLG meetings and CCLG meetings that have enabled us to:

• Describe the problems of anemia and postpartum hemorrhage, and opportunities for improvement by correcting anemia
• Refine the anemia protocol
• Create patient education materials
  • Partnership with BWPC and Fuzzy Synapse
  • Materials provided in more than one language
• Create provider education materials
• Develop and agree on process and implementation metrics to track success

Our team also supported community events such as

• Black Maternal Health Week
• California Birth Equity Conference
• 15 questions answered by health care providers – BWPC
• Deliver Birth Justice- Perinatal Equity Initiative

Year 3 goals

Our goals in Year 3 are to complete recruitment across all participant groups, including Spanish-speaking and licensed health care worker participants. All transcripts will be coded and analyzed using qualitative analysis software, with our small coding workgroup identifying and refining key themes. These analyses will inform the finalization of the qualitative codebook, and findings will further refine and enhance the toolkit for broader dissemination and implementation across participating sites.

Aim 2. Optimize and assess the toolkit’s ability to increase hemoglobin (a measure of anemia) at birth admission at 11 pilot sites, modifying it as needed based on data and feedback from the pilot sites and our community partners.

Measure hemoglobin at birth admission and report it to pilot sites, with rapid, nearly real-time reporting via the CMQCC Maternal Data Center.

In Year 2 of the PRIHSM grant, the Anemia Initiative Collaborative launched in April 2025 and meets monthly with up to 11 pilot sites recruited across California and Oregon. Early successes include improved system integration across inpatient and outpatient sites, expanded clinical education, and initial improvements in ferritin testing, diagnosis, and IV iron workflows.

The Stanford Anemia Subcommittee, including LPCH and partner departments such as nursing and MFM/OB, led efforts to integrate EPIC order sets, develop a Best Practices for IV Infusion Guide, and expand infusion options for pregnant patients. The team also developed project materials to guide clinical teams in their QI efforts. To date, we created new partnership with infusion site to serve as additional option for pregnant patients.

The goal in Year 3 is assess the usability, practicality, and adoption of developed materials, which will be used to inform the Anemia Prevention Toolkit.

Aim 3. Implement and disseminate the modified toolkit across hospitals in California, Oregon, and Washington to reduce postpartum hemorrhage-related severe maternal morbidity.

Not in progress yet as Aim 2 is ongoing. Timeframe is Years 4-7