Daily oral iron supplementation during pregnancy

Peña-Rosas, Juan Pablo; De-Regil, Luz María; Garcı́a-Casal, Marı́a Nieves; Dowswell, Therese

doi:10.1002/14651858.cd004736.pub5

Cited by 333 publications

(320 citation statements)

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“…4 There are very few studies that suggest an alternative to those who are non-compliant with oral iron supplementation. One such study was conducted by Gogineni et al in 2015 which compared oral iron prophylaxis to parenteral iron prophylaxis in 100 patients.…”

Section: Resultsmentioning

confidence: 99%

“…3 Recent Cochrane review suggests there is an increased risk of maternal anemia in those antenatal women who do not consume oral iron supplementation. 4 2015 Cochrane database suggests even intermittent oral iron prophylaxis can prevent anemia in pregnancy. 5,6 But many antenatal women are not able to consume iron by oral route even intermittently due to its well-known and common side effects.…”

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confidence: 99%

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Parenteral iron prophylaxis: a convenient alternative for antenatal women who do not consume oral iron

Rai

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPregnancy is a delicate stage in a woman's life where her nutritional demands completely change. She has to keep up to the increased requirement of several nutrients. Of a special mention is iron which plays a pivotal role in maintaining the health of both mother and the fetus. The daily iron requirement for an antenatal woman is 4-6mg/day in second trimester and that in third trimester is 10-12mg/day. 1 This high requirement is difficult to meet ABSTRACT Background: A large number of antenatal women have difficulty consuming oral iron due to its well-known side effects. A simple alternative for it needs to be found. Aim and objective was to study the efficacy of parenteral iron prophylaxis as an alternative for antenatal women who are not able to consume oral iron. Methods: A prospective case control study was conducted at a tertiary care centre in Hyderabad city, India from March 2016-March 2017. 73 non-anemic antenatal women between 14-24 weeks who were not taking oral iron supplementation were identified. 39 of them were willing for parenteral iron supplementation were included in Cases group and 34 who were not taking iron supplementation in any form were controls. Cases were administered three doses of IV Iron sucrose 200mg in 100 ml normal saline between 24-28 weeks, 28 -32 weeks and 35-37 weeks Hemoglobin was checked again at 32weeks, 36 weeks, just prior to and on 3 rd day post-delivery. Data obtained was analyzed using SPSS software. Results: 67% of antenatal women discontinued oral iron due to its gastric side effects. No bias took place during selection of cases and controls. 7.69% of the 'cases group' developed anemia despite parenteral prophylaxis. All of them were diagnosed as mild anemia. 70.59% of the 'controls group' developed anemia eventually of which 8 were mild, 13 were moderate, 3 were severe and none were very severe. Mostly women became anemic after delivery. About 59% of antenatal women in cases group had no adverse effects with Iron Sucrose Injections, 8 of them had itching or rash and 9 of them complained of brownish discoloration of urine.11 of them had pain at the infusion site and only 1 of them had fever on administering parenteral therapy. None of these were severe enough to cause discontinuation of parenteral iron administration. No statistically significant difference could be found in maternal and perinatal morbidity and mortality between the two groups. The mean cost of parenteral iron prophylaxis was Rs. 1650. Conclusions: Women who do not take oral Iron supplementation in pregnancy are more prone to develop anemia subsequently. The commonest cause of non-compliance to oral iron is gastric intolerance. 3 doses of Intravenous Iron Sucrose 200mg prevents anemia in antenatal women who do not take oral iron supplementation. Hence, it can now be considered a convenient option for them.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Parenteral iron prophylaxis: a convenient alternative for antenatal women who do not consume oral iron

Rai

2017

Int J Reprod Contracept Obstet Gynecol

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“…Notably, the reduction in the number of circulating red blood cells decreases the lifespan of these cells from 18% to 33% [23][24][25][26][27][28]. Thus, red blood cell depletion may lead to a reduction in iron in the blood [29]. A persistent decrease in iron ions can promote iron deficiency anemia because unavailability of this metal prevents the formation of new hemoglobin [17,18].…”

Section: Biological Mechanisms and Diagnostic Criteria For Anemia In mentioning

confidence: 99%

“…Studies indicate that the cut-off for the diagnosis of maternal anemia in the second trimester should be in the range of 10 to 10.5 g/dL or two or less standard deviations from the mean of hemoglobin and/or hematocrit [25,26]. Iron deficiency anemia is characterized by ferritin levels of less than 15 fL and is related to low levels of hemoglobin (<11 g/dL) [4,29]. When iron deficiency anemia occurs, serum ferritin is decreased and/or transferrin is increased [4,29].…”

Section: Biological Mechanisms and Diagnostic Criteria For Anemia In mentioning

confidence: 99%

“…Iron deficiency anemia is characterized by ferritin levels of less than 15 fL and is related to low levels of hemoglobin (<11 g/dL) [4,29]. When iron deficiency anemia occurs, serum ferritin is decreased and/or transferrin is increased [4,29]. Other types of anemia can be diagnosed during pregnancy, even if blood iron levels are normal, such as anemia of chronic disease, also known as anemia of inflammation [30].…”

Section: Biological Mechanisms and Diagnostic Criteria For Anemia In mentioning

confidence: 99%

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Maternal Anemia and Iron Deficiency Anemia: Similarities and Singularities

Acmg¹,

Filho²,

Rb³

et al. 2018

Health Care Current Reviews

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Maternal anemia is a major global public health problem, and although widely discussed, there are few studies investigating the condition in pregnant women. In this article, issues related to the diagnosis, biological mechanism and prevalence of maternal anemia. In addition, iron deficiency anemia will be considered a proxy for maternal anemia. In previous studies, the concepts of maternal anemia have been controversial. It is also noted that isolated actions are not sufficient to combat this disease, and policies to address the primary causes of the associated nutritional deficiencies are necessary. Maternal Search strategiesMesh and similar terms were combined using Boolean operators (AND, OR), and the search strategy below was primarily used for Studies selectionAfter duplicate removal, titles and abstracts were screened for eligible articles independently by two reviewers (ACMGF and SSC). Two reviewers selected articles by reading titles and abstracts. During the process of selecting the articles the researchers were not aware of the decisions made by their colleague. After that, full text articles were assessed for eligibility. Discordant events were resolved by consensus. Data extractionData extraction was performed independently by two researchars (ACMGF and RBS) and discordant events resolved by consensus. We used a standardized electronic spreadsheet to extract the following information: author's name, year of publication, year of data collection and geographic region, study design, sample size, anemia diagnosis criteria, frequency of maternal anemia and iron deficiency anemia. Authors were contacted for additional information considered important for this review.

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Direct Dispensation of Prenatal Supplements With Iron and Anemia Among Pregnant People

Thiele,

Duryea,

Ragsdale

et al. 2023

JAMA Netw Open

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ImportancePostpartum transfusion is the most common indicator of severe maternal morbidity in the US. Higher rates of anemia are associated with a higher blood transfusion rate.ObjectiveTo determine if providing, rather than recommending, supplements with iron at prenatal visits in a medically underserved community is associated with improved hematologic indices and reduced blood transfusion.Design, Setting, and ParticipantsIn this quality improvement study, patients who delivered between May 13 and December 13, 2020, and thus were provided a prenatal supplement with iron throughout pregnancy were compared with those who delivered between January 1 and August 1, 2019, before supplements were dispensed. The study was conducted at Parkland Health, a safety net hospital in Dallas, Texas, with a 95% Medicaid-funded or self-pay population and included all patients who delivered at our institution during the study period with available hematologic data.ExposuresIn the earlier cohort, all patients were recommended to obtain and take iron supplements. In the later cohort, prenatal supplements with iron were dispensed via clinic pharmacy to all patients during prenatal visits.Main Outcomes and MeasuresMaternal hematocrit levels (28-32 weeks, delivery admission, and discharge), rates of anemia (hematocrit &lt;30%), and postpartum transfusion for acute blood loss anemia were compared using χ2 and analysis of variance methods with P &lt; .05 considered significant. The analysis took place in July of 2022.ResultsOverall, 13 910 patients (98%) met inclusion criteria (mean age [SD], 27.9 [6.5] and 27.6 [6.5] years, mean [SD] body mass index at first visit, 29.2 [6.6] and 29.3 [6.6]). Mosty of the patients in both cohorts were of Hispanic ethnicity (76%). Providing iron-containing prenatal supplements was associated with higher average hematocrit levels at all time points including a mean difference of 1.27% (95% CI, 1.13%-1.42%) on admission for delivery, when compared with those who were not directly dispensed iron. Among patients prior to providing supplements, 18% had anemia on admission compared with 11% with iron-containing supplements dispensed (risk ratio [RR], 0.61; 95% CI, 0.56-0.66). Postpartum transfusion for acute blood loss anemia was reduced by one-third in patients after program implementation from 10 per 1000 to 6.6 per 1000 (RR, 0.62; 95% CI, 0.43-0.91).Conclusions and RelevanceIn this quality improvement study, providing supplements with iron to patients at prenatal visits was associated with improved hematocrit levels, rates of anemia, and reduced transfusions unrelated to obstetric catastrophes among a predominantly Medicaid population.

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Daily oral iron supplementation during pregnancy

Cited by 333 publications

References 243 publications

Parenteral iron prophylaxis: a convenient alternative for antenatal women who do not consume oral iron

Parenteral iron prophylaxis: a convenient alternative for antenatal women who do not consume oral iron

Maternal Anemia and Iron Deficiency Anemia: Similarities and Singularities

Direct Dispensation of Prenatal Supplements With Iron and Anemia Among Pregnant People

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