Systematic ReviewResearchMedication SafetyPatient Education

Predelivery hemoglobin was higher with IV ferric carboxymaltose than oral iron in a pregnancy anemia meta-analysis

European Journal of Clinical Pharmacology (PubMed)Jul 10, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

Across 12 studies, pooled hemoglobin and ferritin were higher with intravenous ferric carboxymaltose than oral iron during pregnancy, with the clearest hemoglobin difference before delivery, but substantial between-study heterogeneity limits certainty.

What NurseJet pulled from the source

This systematic review and meta-analysis pooled eight randomized trials and four observational cohorts comparing intravenous ferric carboxymaltose with oral iron for anemia during pregnancy. In the hemoglobin analysis, seven trials and four cohorts included 6,495 patients. Intravenous treatment was associated with hemoglobin that was 0.91 g/dL higher (95% CI 0.30 to 1.51) and ferritin that was 63.8 ng/mL higher (95% CI 37.3 to 90.4). The hemoglobin difference was clearest before delivery, at 1.22 g/dL across eight studies with 1,575 patients, but was not significant postpartum. In smaller safety analyses, intravenous ferric carboxymaltose was associated with fewer drug-related adverse events (RR 0.42) and less nausea (RR 0.27) than oral iron. The authors judged it more effective for hematologic indices and favorably tolerated, while cautioning that substantial heterogeneity across studies limits confidence and does not define the best route for every patient.

Why this matters for nurses

Anemia treatment during pregnancy often requires balancing time to delivery, response to oral therapy, infusion logistics, and medication tolerance. This review matters for obstetric nurses because it quantifies the hematologic difference between routes while making clear that pooled evidence does not determine treatment for an individual patient.

Bedside takeaway

Be aware that pooled predelivery hemoglobin was higher with IV ferric carboxymaltose than oral iron, but heterogeneity and limited safety subsets mean route selection remains individualized.

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Key takeaways

The review included 12 studies: eight randomized trials and four observational cohorts of pregnant patients with anemia.
Pooled hemoglobin was 0.91 g/dL higher with intravenous ferric carboxymaltose than with oral iron.
The predelivery hemoglobin difference was 1.22 g/dL, while the postpartum difference was not statistically significant.
Smaller safety analyses found fewer drug-related adverse events and less nausea, but heterogeneity remained substantial.

Practice implications

For obstetric nurses, the findings support awareness that prescribed intravenous iron was associated with higher predelivery hemoglobin while requiring infusion-specific screening, administration, and observation under local policy. They do not establish that intravenous treatment is appropriate for every patient or replace prescriber-directed selection and follow-up.

Limitations & cautions

The review combined randomized trials with observational cohorts, and substantial heterogeneity existed across studies. Safety estimates came from smaller subsets, the postpartum hemoglobin difference was not significant, and the abstract does not establish comparative effects on transfusion, birth outcomes, maternal symptoms, or longer-term infant outcomes.
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Citations

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European Journal of Clinical Pharmacology (PubMed)

European Journal of Clinical Pharmacology (PubMed). Efficacy and safety of intravenous ferric carboxymaltose versus oral iron in pregnant women with anemia: a systematic review and meta-analysis.

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https://pubmed.ncbi.nlm.nih.gov/42426275/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Antimicrobial Stewardship & Healthcare Epidemiology (PubMed)Jul 6, 2026Research Article

At one family-medicine practice, an EHR-integrated nurse-led UTI triage tool was associated with more symptom documentation, fewer urine cultures without microscopy, and a decline in asymptomatic-bacteriuria antibiotics from 20% to 3%, with no observed increase in pyelonephritis.

Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyInfection ControlAI summary · original source linked below

Researchers used workflow mapping and interviews with 11 nurses to build an EHR-integrated UTI symptom score and triage algorithm for an urban academic family-medicine practice. A 15-month pre-post interrupted time-series evaluation examined adoption, documentation, urine testing, antibiotic prescribing, and 30-day pyelonephritis. All nurses adopted the tool, fidelity was 77.8%, and usability was rated highly. Documentation of at least two UTI-specific symptoms increased at implementation and continued improving by 2.4 percentage points per month (95% CI 0.1 to 4.7). Urine cultures ordered without microscopy had a slope of -5.5 percentage points per month (95% CI -7.9 to -3.2). Antibiotic prescribing for asymptomatic bacteriuria fell from 20% to 3% (P=.003), with no observed increase in 30-day pyelonephritis. The findings support a nurse-led stewardship workflow, but the single-practice pre-post design cannot by itself prove that the tool caused each change.

Key takeaways

The mixed-methods study developed an EHR-integrated symptom score and triage algorithm with 11 family-medicine nurses.
All nurses adopted the tool, with 77.8% fidelity and high reported usability.
Symptom documentation increased while urine cultures ordered without microscopy declined over the 15-month evaluation.
Antibiotic treatment of asymptomatic bacteriuria fell from 20% to 3%, with no observed increase in 30-day pyelonephritis.

Why this matters on shift

Urinary complaints can trigger reflex testing and antibiotics even when defining symptoms are absent. This study matters for nurses because it places structured symptom assessment inside the triage workflow and links better documentation with fewer low-value cultures and less treatment of asymptomatic bacteriuria.

Bedside takeaway

Be aware that after a nurse-led UTI triage tool was introduced, symptom documentation increased and asymptomatic-bacteriuria antibiotic use fell from 20% to 3%, with no observed rise in 30-day pyelonephritis.

Nursing implications

Outpatient triage teams can use this study when evaluating locally approved EHR prompts that require symptom documentation before urine testing. Any tool should preserve assessment and escalation for suspected upper-tract infection and should not replace local diagnostic, prescribing, or scope-of-practice rules.

Limitations & cautions

The study involved one urban academic family-medicine practice and only 11 nurses. Its pre-post design cannot exclude secular trends or prove causation, and results may not transfer to inpatient, emergency, long-term-care, or differently configured EHR settings without local evaluation.
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Citations · exact source links

Antimicrobial Stewardship & Healthcare Epidemiology (PubMed). Development and implementation of a nurse-led clinical decision support tool for urinary tract infection.

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Journal of the American Geriatrics Society (PubMed)Jul 11, 2026Research Article

In Medicare data for 79,417 older surgical patients discharged through skilled nursing before going home, 4% received a new gabapentinoid prescription and 38% of those new users had prolonged use.

Med-Surg GeriatricsAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Researchers linked Medicare hospital, outpatient, clinician, and Part D data from 2013 through 2020 to examine gabapentinoid use after 14 common operations in adults aged 66 or older who moved from the hospital to a skilled nursing facility and then home. Among 79,417 patients, the median skilled-nursing stay was 15 days. A total of 3,182 patients (4%) received a new gabapentinoid prescription, and 1,219 of those new users (38%) met the study definition of prolonged use. Female sex, gabapentinoid days' supply, emergency surgery, nonorthopedic and nonvascular surgery, and greater area deprivation were associated with prolonged use in adjusted analysis. The authors found that prolonged use was more common than previously reported among patients discharged directly home and called for more work on medication continuation after skilled-nursing discharge. The claims-based design did not determine whether an individual patient's prolonged use was clinically appropriate.

Key takeaways

The cohort included 79,417 Medicare patients aged 66 or older who underwent one of 14 operations and transitioned through skilled nursing before returning home.
New gabapentinoid use occurred in 3,182 patients, or 4% of the full cohort.
Among those newly prescribed a gabapentinoid, 1,219 patients, or 38%, had prolonged use.
The study describes prescribing persistence and associated factors but does not establish that prolonged use was inappropriate.

Why this matters on shift

A medication started around surgery can follow a patient across hospital, skilled-nursing, and home settings, making its original purpose and intended duration easy to lose. This study matters for nurses because medication reconciliation and clear handoff documentation can make a new gabapentinoid visible for review at each transition.

Bedside takeaway

Be aware that 38% of the older surgical patients newly prescribed a gabapentinoid during a hospital-to-skilled-nursing-to-home transition had prolonged use, a persistence signal that warrants reconciliation without assuming inappropriateness.

Nursing implications

During medication reconciliation, nurses can clarify and document when a gabapentinoid was started, its current indication, and whether continued use remains intended, then route uncertainty through the prescriber or pharmacist. The study does not support labeling every prolonged prescription inappropriate or independently stopping a patient's medication.

Limitations & cautions

This retrospective claims analysis used 2013 to 2020 Medicare data and cannot establish why a prescription continued or whether continued use was appropriate. It may not generalize to younger patients or newer prescribing patterns, and associations with prolonged use do not establish that the identified factors caused it.
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Citations · exact source links

Journal of the American Geriatrics Society (PubMed). Prolonged Use of Postoperative Gabapentin After Discharge From a Skilled Nursing Facility.

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The Journal of Maternal-Fetal & Neonatal Medicine (PubMed)Jul 8, 2026Research Article

In a secondary analysis of 1,783 nulliparous participants from the 19-center PRIME randomized trial, a biomarker screen-guided, multicomponent care pathway reduced NICU admissions from 16.4% with routine care to 12.8%.

L&D / OB PedsAI summaryReview source

Research ArticleResearchAI summary · original source linked below

The PRIME trial randomized 5,018 otherwise low-risk singleton pregnancies to routine care or a screen-guided strategy using the IGFBP4/SHBG biomarker ratio. This secondary analysis focused on 1,783 nulliparous participants, whose lack of prior obstetric history can make preterm-birth risk harder to identify. Participants in the screen-guided arm who screened as higher risk were offered vaginal progesterone, low-dose aspirin, and weekly telephone nursing support. Composite neonatal morbidity was lower with screen-guided care, and NICU admission occurred in 12.8% of the screen-guided group versus 16.4% with routine care (P=0.039), an adjusted OR of 0.75 (95% CI 0.57 to 0.98). The authors calculated that 28 nulliparous pregnancies would need screening to prevent one NICU admission; reductions were concentrated in spontaneous preterm births. No serious adverse events were reported in the screen-guided subgroup. Because this was a subgroup analysis of a multicomponent pathway, the effect cannot be assigned to screening, medication, or nursing follow-up alone.

Key takeaways

The secondary analysis included 1,783 nulliparous participants from a 5,018-participant, 19-center randomized trial.
Higher-risk participants in the screen-guided arm were offered progesterone, low-dose aspirin, and weekly telephone nursing support.
NICU admission was 12.8% with screen-guided care versus 16.4% with routine care (adjusted OR 0.75, 95% CI 0.57 to 0.98).
The multicomponent pathway and subgroup design prevent attributing the result to any single component.

Why this matters on shift

First-time pregnancies lack a prior obstetric history to help identify preterm-birth risk, while obstetric nurses coordinate monitoring, education, and follow-up across pregnancy. This study matters because it tests a risk-guided pathway in that specific population and reports a neonatal outcome rather than screening performance alone.

Bedside takeaway

Worth knowing that a multicomponent, biomarker screen-guided pathway reduced NICU admission from 16.4% to 12.8% in a nulliparous PRIME subgroup, but the effect cannot be assigned to any one component.

Nursing implications

For labor-and-delivery and prenatal teams, the findings support awareness of locally approved risk-screening pathways and reliable follow-up when a patient screens higher risk. They do not justify adopting this biomarker or changing aspirin or progesterone use outside institutional protocols and prescriber-directed care.

Limitations & cautions

This was a secondary subgroup analysis rather than the trial's full primary analysis. The screen-guided arm combined a biomarker test, progesterone, aspirin, and nursing calls, so the contribution of each component is unknown; findings apply to otherwise low-risk singleton nulliparous pregnancies and may not extend to other populations.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

The Journal of Maternal-Fetal & Neonatal Medicine (PubMed). Biomarker screen-guided care for preterm birth risk in nulliparous pregnancies: a subgroup analysis of the PRIME randomized controlled trial.

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Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Asymptomatic-bacteriuria antibiotic use fell from 20% to 3% after a nurse-led UTI decision tool

Among older surgical patients with a new gabapentinoid prescription, 38% had prolonged use after skilled nursing

Screen-guided care reduced NICU admissions from 16.4% to 12.8% in a nulliparous PRIME trial subgroup