ABSTRACT
Background: Treatment of iron deficiency anaemia (IDA) involves replenishing body iron stores either intravenously (IV) or orally. Previous studies of IV iron in pregnancy have been unblinded, which creates potential for bias measuring primary outcomes. We aimed to determine the feasibility of blinding pregnant women with IDA to IV iron (brown solution) compared to oral iron. Method(s): Two-arm, placebo-controlled randomised trial, with blinding of patients, clinicians and outcome assessors, at 2 Sydney maternity hospitals, 2021.2022. Pregnant women, .18 years of age, 26.32 + 6 weeks' gestation, with mildmoderate IDA (Haemoglobin 80.104 g/L and Ferritin <30 mug/ L), planning to give birth at one of the study hospitals were included. Women were randomised to either (1) a single IV ferric carboxymaltose 1000 mg infusion plus daily placebo oral capsules, or (2) oral capsules 80 mg elemental iron daily and a single placebo intravenous saline infusion, from treatment allocation to birth. Result(s): The study closed after recruiting 16/50 (32%) planned women, at a median gestation of 30 weeks. The baseline median haemoglobin was 101.5 g/L [interquartile range (IQR) 99.0-103.75 g/L] and baseline median ferritin was 11.5 mug/L [IQR 8.0-17.5 mug/L]. Two thirds of women (69%) correctly determined their treatment allocation on the infusion day, increasing to 87% at 4 weeks post infusion (100% of women IV iron). Median,[IQR] haemoglobin increased to 116 g/L, [113-120] and 110 g/L, [104-114] at 4 weeks in IV and oral iron groups respectively. Compliance, acceptability and side effects were measured. Conclusion(s): Blinding of women to IV iron was not successful at 4 weeks post-infusion. Trial recruitment was delayed and interrupted by COVID.
ABSTRACT
Background: Domestic and family violence (DFV) and mental health screening are core components of antenatal care. However, the COVID-19 pandemic both increased the prevalence of DFV and mental health issues and resulted in many antenatal visits becoming telehealth. DFV and mental health screening were consequently often delayed, potentially resulting in insufficient time to establish support systems before birth. This study assessed pandemic effects on DFV and mental health screening from the perspective of local maternity service providers. Methods: Maternity staff (midwives, doctors, allied health) at three Sydney metropolitan hospitals were surveyed regarding perceived impact of COVID-19 on the delivery, timeliness, and quality of overall pregnancy care, DFV and mental health screening and care, and their telehealth perceptions. Responses by hospital and maternity care provider subtype were compared. Results: Of 109 respondents, most felt the pandemic negatively impacted overall pregnancy care (60%), DFV screening/care (57%), and mental health screening/care (57%), significantly more believing COVID-19 'extremely' negatively impacted DFV screening (p = 0.02). Staff at the hospital with highest sociodemographic diversity were significantly more concerned about DFV screening/ care. Nominated telehealth advantages e.g. reduced travel (69%) and clinic overcrowding (62%) were fewer than disadvantages including no physical examinations (90%), difficulties picking up non-verbal cues (84%), and certain questions unsafe (62%). Fiftysix percent believed telehealth should be used for some antenatal care for select women (low-risk, multiparous). Conclusions: Telehealth may have an ongoing limited role in maternity care in Australia for low-risk women. Staff considered those high-risk for physical and/or psychosocial reasons unsuited to telehealth care.