Anaemia in pregnancy in rural new South Wales: a retrospective study of prevalence, risk factors, and guideline adherence.

AIM: To determine the prevalence of anaemia in pregnancy in rural New South Wales (NSW) and assess the alignment of screening and treatment practices with the 2020 Australian Pregnancy Care Guidelines (APCG). METHODS: A retrospective cohort study at the Regional Hospital using records from 301 women who gave birth between 1st January and 4th September 2024. Data were sourced from eMaternity and PowerChart systems, focusing on haemoglobin and ferritin levels, demographic factors, iron deficiency risk factors, and birth outcomes. RESULTS: Iron deficiency was identified in 61.8% of women, with 6.0% diagnosed with iron deficiency anaemia (IDA). These rates were lower than previously reported under alternative guidelines using a smaller sample size (97.1% and 16.5%, respectively). Chi-square analysis revealed that having a history of IDA (p = 0.018), unplanned pregnancies (p = 0.011), and hospital-based antenatal care (χ² (2, n = 301) = 23.3, p < 0.001) were significantly associated with iron deficiency. Aboriginal and Torres Strait Islander women had disproportionately higher rates of IDA (χ² (1, n = 301) = 12.4, p < 0.001) and no woman with obesity had IDA. Screening adherence was highest in the first trimester (88.7%) but declined in subsequent trimesters (79.1% and 77.1%). Iron supplementation was inconsistently prescribed, with only 32.1% of eligible women receiving treatment in the first trimester, and modest improvements in later trimesters (52.0% and 46.9%). CONCLUSION: While anaemia screening rates in early pregnancy were relatively high, declining follow-up and inconsistent iron supplementation highlight important gaps in care. This underscores the need for system-level improvements in guideline adherence in later trimesters.