Abstract
Preterm Pre-labor Rupture of Membranes (PPROM) is a significant obstetric complication occurring before 36.6 weeks and prior to labor onset, contributing to neonatal and maternal morbidity and increased healthcare costs. Iron deficiency anemia (IDA) is the most common form of anemia during pregnancy and has been associated with impaired oxygen delivery, tissue repair deficits, and weakened amniotic membranes. Although anemia has been previously identified as a risk factor for PPROM, limited data exist regarding this relationship in Hispanic and Puerto Rican populations. This study evaluates the association between maternal anemia and PPROM in southern Puerto Rican patients. Methods: We conducted a retrospective cohort study at Centro Médico Episcopal San Lucas, Ponce, reviewing medical records from 2020 to 2025. A total of 598 patient records were screened using ICD-10 codes related to PPROM, with 171 patients ultimately meeting inclusion criteria of singleton pregnancies with membrane rupture before 36.6 weeks and complete medical records. Data collected included maternal age, BMI, gestational age, anemia status, pre-existing anemia, iron supplementation, comorbidities, and infections. Results: A high prevalence of anemia was observed among patients diagnosed with PPROM, with notable rates across all trimesters. Patients with asthma showed 1.34 times higher odds of developing anemia during pregnancy, suggesting an indirect pathway to increased PPROM risk. Additionally, iron supplementation during pregnancy was inconsistently administered. Hospitalization costs associated with PPROM and maternal anemia ranged from $24,000 to $45,000 per admission, not accounting for delivery or NICU costs. Discussion: Our findings suggest a strong association between maternal iron deficiency anemia and PPROM in the southern Puerto Rican population. The co-occurrence of asthma and anemia highlights the importance of comprehensive prenatal screening and early anemia management to potentially reduce PPROM incidence. Iron supplementation may serve as a cost-eƯective, preventive intervention. Further prospective studies are recommended to evaluate the impact of early treatment of anemia and asthma control on PPROM outcomes.
