A Comparison of efficacy of I/V Iron V/S Oral Iron for management of iron deficiency anemia in pregnant women in a tertiary care center

Iron deficiency anemia (IDA) during pregnancy arises because of preexisting inadequate stores or complex physiological changes and can lead to serious maternal and fetal complications. Oral iron, either as iron sulfate or fumarate, with or without folic acid, is the most commonly used treatment for IDA in pregnancy. Intravenous (IV) iron has a role in the treatment of IDA in pregnancy, particularly in women who present late, display severe anemia (Hb ≤ 9 g/dL), or risk factors, and are intolerant/noncompliant of oral iron. Previously, administration of IV iron was minimal, owing to potentially serious anaphylactic reactions. Recently, new IV iron products have been developed, offering better compliance, tolerability, efficacy, and a good safety profile. Our study aimed to assess the effectiveness, safety, and tolerability of IV ferric carboxymaltose (FCM) in the treatment of IDA in pregnant women in the UAE. Data from 1001 pregnant women who received at least one administration of FCM (500, 1000, or 1500 mg) during their second or third trimester of pregnancy (2 years backward from study initiation) were collected retrospectively from electronic medical records at Corniche Hospital, Abu Dhabi, UAE. Results showed that 41.4% of the women were able to achieve an increase of ≥2 g/dL in blood hemoglobin overall. A change of ≥2 g/dL was achieved by 27.5% of women administered a dose of 500 mg, 39.2% of women administered a dose of 1000 mg, and 63.9% of women administered a dose of 1500 mg of IV FCM. This indicates a directly proportional relationship between increasing IV FCM dose and the increase of ≥2 g/dL in blood hemoglobin. A total of 7 (0.7%) women reported mild, nonserious adverse events during the study. Within the limits of this retrospective study, IV FCM therapy was safe and effective in increasing the mean hemoglobin of pregnant women with IDA.

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Efficacy and Compliance of Oral Iron Poly-Maltose Complex versus Oral Ferrous Sulfate in the Treatment of Iron Deficiency Anemia in Pregnant Women

Open Journal of Obstetrics and Gynecology ◽

10.4236/ojog.2018.811109 ◽

2018 ◽

Vol 08 (11) ◽

pp. 1084-1093

Author(s):

Mohamed A. Elsenity ◽

Rehab M. Abdelrahman ◽

Ayman M. Abdelkader ◽

Maha M. Kamel

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anemia ◽

Ferrous Sulfate ◽

Oral Iron ◽

Deficiency Anemia ◽

Complex Versus

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Iron deficiency anemia and associated factors among pregnant women in a tertiary care hospital, in Sargodha District, Pakistan

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v18i10.26 ◽

2021 ◽

Vol 18 (10) ◽

pp. 2183-2187

Author(s):

Sumbul Qamar ◽

Saira Azhar ◽

Saadoon Mazhar ◽

Khush Bakht ◽

Ghulam Murtaza

Keyword(s):

Risk Factors ◽

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anemia ◽

Tertiary Care Hospital ◽

Binding Capacity ◽

Tertiary Care ◽

Deficiency Anemia ◽

Care Hospital ◽

Total Blood

Purpose: To evaluate iron deficiency anemia and other concomitant risk factors among pregnant women in a tertiary care hospital in Sargodha District of Pakistan. Methods: An observational cross-sectional study on pregnant women over a six-month period from December 2016, was conducted in the gynaecology and obstetrics department of the District Headquarters Hospital, Sargodha, Pakistan. All women with renal failure, heart disease and surgical history were excluded from the study, while all pregnant women visiting the out-patient department (OPD) were included in the investigation. Blood sampling and analysis were performed, following standard laboratory operating procedures to determine the haemoglobin (Hb) levels of the patients. Results: Fifty pregnant women were enrolled in this study. They had a mean age of 27.85 ± 4.99 years with a range of 20 – 46 years. Almost half, i.e., 26 (52 %), were aged 20 – 30 years; 18 (36 %) 31 – 40 years and six (12 %) > 40 years of age. Regarding occupational status, 45 (90 %) of the respondents were housewives. In total, 86 % of the women were anemic, while the remaining 14 % were non-anemic and had an Hb level slightly > 11 g/dL. Among the anemic women, 13 (26 %) had mild anemia, 33 (66 %) moderate anemia, and 4 (8 %) were severely anemic. Conclusion: Iron deficiency and anemia have major health impacts on pregnant women. Steps should be taken during ante-natal care to monitor Hb levels in pregnant women and apply appropriate remedy where necessary. Other biomarkers and related risk factors such as total iron binding capacity (TIBC) and total blood count (TBC) have previously been found to be linked to anemia

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Iron therapy in pregnant women with iron deficiency anemia: a meta-analysis

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20210190 ◽

2021 ◽

Vol 10 (2) ◽

pp. 193

Author(s):

Anusha Natarajan ◽

Priyadarsini Baskaran

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anemia ◽

Meta Analysis ◽

Oral Iron ◽

Iron Therapy ◽

Deficiency Anemia ◽

Ferritin Concentration ◽

Parenteral Iron ◽

Parenteral Iron Therapy

Background: Pregnancy significantly increases the need for iron. The prevalence of anemia in pregnant women is high, affecting 41.8% of all pregnant women worldwide. In patients with low tolerance to oral iron, it is recommended to start them on parenteral iron therapy but with variable degree of efficacy. Hence this meta-analysis was done with the following aim. This study aimed to assess the efficacy of various iron preparations in pregnant women with iron deficiency anemia (IDA).Methods: Randomised controlled trials (RCTs) (available as full free text) which included iron therapy in pregnant women with iron deficiency anemia were retrieved from electronic databases viz. PubMed, Google scholar and IndMed, with specific search terms. Qualities of RCTs were assessed using JADAD score and four RCTs with high score were included for analysis using RevMan 5.3 software. Outcome measures were change in hemoglobin levels and serum ferritin concentration after one month of therapy.Results: In the four RCTs included, a total of 267 patients were treated with oral iron and 267 patients were treated with parenteral iron therapy. Change in the hemoglobin levels between the 2 groups had a standard mean difference of 0.73, 95% CI (-0.05-1.52), with the p-value of 0.07. To assess the change in the serum ferritin concentration a total of 188 patients in oral iron and 197 patients in parenteral iron therapy were included. There was a standard mean difference of 0.88, 95% CI (0.60-1.66), with a p value of<0.00001.Conclusions: In the present meta-analysis we found that oral and parenteral iron therapy showed similar efficacy in improving the hemoglobin level in pregnant women.

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Economic, Transfusion, and Efficacy Outcomes with the Addition of IV Iron Sucrose to Oral Iron Therapy in Pregnancy Associated Iron Deficiency Anemia

Blood ◽

10.1182/blood.v128.22.4737.4737 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4737-4737

Author(s):

Nilupa Gaspe Mudiyanselage ◽

Tarek Elrafei ◽

Beth Lewis ◽

Mary King ◽

Marianna Strakhan ◽

...

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anemia ◽

Oral Iron ◽

Iron Sucrose ◽

Iron Therapy ◽

Deficiency Anemia ◽

Iron Group ◽

Iv Iron ◽

Iron Replacement

Abstract Background: Prior studies have indicated that transfusion is unusual (2%) in pregnant women with iron deficiency anemia. Nonetheless, compliance with oral iron replacement can be an issue and physicians may wish to use IV iron therapy in markedly anemic pregnant women. Objectives: to evaluate the effectiveness of adding intravenous iron sucrose concentrate (ISC) to pregnant patients already taking oral iron in terms of effect on hemoglobin, effect on ferritin levels, rates of transfusion, and cost. Methods: We analyzed all referrals from Obstetrics to Hematology clinic and Obstetrics consultation (Internal medicine) clinic from January 2014 to June 2016. Of the 176 pregnant patients, 98 were referred for anemia, including 81 patients with Hgb < 12 g/dl and ferritin < 20 ug/L. All had previously been given oral ferrous sulfate prescriptions. Patients with hemoglobinopathy were excluded. All 81 patients were advised to continue on the oral iron, and 40 were given IV iron sucrose (ISC group). Results: The average cumulative dose of iron sucrose was 700 mg, a mean of 5.575 doses (initiated in the third trimester in 38 of 40 patients). The lowest antepartum Hgb was 8.18 g/dl in the ISC group and 9.58 in the oral only group; there was an average Hgb increase of 2.17 vs 1.76 g/dl respectively (p=.107 NS and the 0.41 g/dl difference was considered to be of no clinical consequence). 89% in the ISC group vs 30% in the oral achieved a ferritin >20 (p=0.000015). No adverse events in the IV iron group were reported. There was 1 transfusion in the oral iron group attributable to iron deficiency (2.4%) vs none in the IV iron group (p = 0.107 NS). Two patients were transfused in the antenatal period before IV iron was started and 1 transfused because of post-partum hemorrhage. The total cost of the IV iron therapy would add an average of $1,500 per patient. Thus, and additional cost of $60,000 in IV iron would be required to prevent 1 transfusion [40:1]. Conclusions: ISC corrects ferritin in more patients than oral iron replacement, but did not significantly increase Hgb levels or have a meaningful impact on the transfusion rate. The additional cost and lack of clinically improved outcomes with IV iron argue against its use and in favor of strategies to ensure compliance with oral iron. Disclosures No relevant conflicts of interest to declare.

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