Effect of Administering Recombinant Erythropoietin to Women with Postpartum Anemia: A Meta-analysis

Kotto-Kome, Anne C; Calhoun, Darlene A; Montenegro, Raul; Sosa, Roberto; Maldonado, Luis; Christensen, Robert D.

doi:10.1038/sj.jp.7211017

Cited by 20 publications

(17 citation statements)

References 25 publications

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“…All were published between 1994 and 2011, with the majority (n = 21) being published from 2000 to 2011 (see Additional file 4: Table S2). Only three reviews exclusively included RCTs from the developed world [13-15]. The largest number covered antenatal nutritional supplementation for the prevention of anaemia (n = 19), including the use of iron and folic acid.…”

Section: Resultsmentioning

confidence: 99%

“…Two systematic reviews (one high quality [14] and one low quality [15]) addressed the role of erythropoietin in combination with iron supplementation in tackling maternal anaemia in the first six weeks postpartum. They included nine RCTs, conducted in developed countries.…”

Section: Resultsmentioning

confidence: 99%

“…Three systematic reviews addressed clinical outcomes in the treatment of maternal anaemia postpartum [14,15,30], yet only one was of high quality [14]. Two reviews [14,15] showed that women receiving erythropoietin were more likely to be lactating on discharge (two RCTs), with a decrease in postnatal depression scores in the erythropoietin treatment arm.…”

Section: Resultsmentioning

confidence: 99%

“…Two reviews [14,15] showed that women receiving erythropoietin were more likely to be lactating on discharge (two RCTs), with a decrease in postnatal depression scores in the erythropoietin treatment arm. No adverse events were recorded.…”

Section: Resultsmentioning

confidence: 99%

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Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Parker

Barroso

Stanworth

et al. 2012

BMC Pregnancy Childbirth

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BackgroundAnaemia, in particular due to iron deficiency, is common in pregnancy with associated negative outcomes for mother and infant. However, there is evidence of significant variation in management. The objectives of this review of systematic reviews were to analyse and summarise the evidence base, identify gaps in the evidence and develop a research agenda for this important component of maternity care.MethodsMultiple databases were searched, including MEDLINE, EMBASE and The Cochrane Library. All systematic reviews relating to interventions to prevent and treat anaemia in the antenatal and postnatal period were eligible. Two reviewers independently assessed data inclusion, extraction and quality of methodology.Results27 reviews were included, all reporting on the prevention and treatment of anaemia in the antenatal (n = 24) and postnatal periods (n = 3). Using AMSTAR as the assessment tool for methodological quality, only 12 of the 27 were rated as high quality reviews. The greatest number of reviews covered antenatal nutritional supplementation for the prevention of anaemia (n = 19). Iron supplementation was the most extensively researched, but with ongoing uncertainty about optimal dose and regimen. Few identified reviews addressed anaemia management post-partum or correlations between laboratory and clinical outcomes, and no reviews reported on clinical symptoms of anaemia.ConclusionsThe review highlights evidence gaps including the management of anaemia in the postnatal period, screening for anaemia, and optimal interventions for treatment. Research priorities include developing standardised approaches to reporting of laboratory outcomes, and information on clinical outcomes relevant to the experiences of pregnant women.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Parker

Barroso

Stanworth

et al. 2012

BMC Pregnancy Childbirth

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“…9 Partly attributable to an iron deficit during pregnancy caused by the increased iron demands of the fetoplacental unit and an increased maternal red cell mass. 10 Irrespective of mode of delivery, blood loss is a contributing factor, with 5% of deliveries involving loss of more than 1 L. 11,12 Iron deficiency anemia (IDA) is thought to contribute to a variety of morbidities such as lethargy, lactation failure and postpartum depression. 13 , 14. The standard approach to treatment in the majority of UK institutions is oral iron supplementation, with blood transfusion reserved for more severe or symptomatic cases.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Iron Versus Oral Iron Therapy in Postpartum Anaemia in Rural India

Vijayalakshmi¹,

Mahendra²,

Pukale³

et al. 2015

jemds

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ABSTRACT:To compare effectiveness of intravenous iron-sucrose versus oral ferrous sulphate in pospartum anemia in rural area. METHODS AND MATERIAL: In this study, 120 women with postpartum anemia with hemoglobin (Hb) less than 10 g/dl within 48 h postpartum were randomised into two groups. Group I consisted of 60 women who received 300-600 mg of intravenous iron-sucrose every alternate day for 3 days. Group II consisted of 60 women who were given 300 mg ferrous sulphate orally daily for a month. Data collected after 1 month for Hb estimation and other postpartum parameters are assessed. RESULTS: The mean Hb was significantly increased in the intravenous iron sucrose group in 4th week of treatment but there was minimal change observed in mean Hb in patients treated with oral ferrous sulphate. Women treated with intravenous iron sucrose has shown significantly higher Hb as compared to those treated with oral iron. CONCLUSIONS: Overall intravenous iron sucrose appears to be an effective and safe mode of treatment in postpartum patients with no serious side effects than oral iron therapy.

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Postpartum anemia II: prevention and treatment

Milman

2011

Ann Hematol

121

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This review focuses on the prevention and treatment of anemia in women who have just given childbirth (postpartum anemia). The problem of anemia both prepartum and postpartum is far more prevalent in developing countries than in the Western societies. The conditions for mother and child in the postpartum, nursing, and lactation period should be as favorable as possible. Many young mothers have a troublesome life due to iron deficiency and iron deficiency anemia (IDA) causing a plethora of symptoms including fatigue, physical disability, cognitive problems, and psychiatric disorders. Routine screening for postpartum anemia should be considered as part of the national maternal health programs. Major causes of postpartum anemia are prepartum iron deficiency and IDA in combination with excessive blood losses at delivery. Postpartum anemia should be defined as a hemoglobin level of <110 g/l at 1 week postpartum and <120 g/l at 8 weeks postpartum. Bleeding exceeding normal blood losses of approximately 300 ml may lead to rapid depletion of body iron reserves and may, unless treated, elicit long-standing iron deficiency and IDA in the postpartum period. The prophylaxis of postpartum anemia should begin already in early pregnancy in order to ensure a good iron status prior to delivery. The most reliable way to obtain this goal is to give prophylactic oral ferrous iron supplements 30-50 mg daily from early pregnancy and take obstetric precautions in pregnancies at risk for complications. In the treatment of slight-to-moderate postpartum IDA, the first choice should be oral ferrous iron 100 to 200 mg daily; it is essential to analyze hemoglobin after approximately 2 weeks in order to check whether treatment works. In severe IDA, intravenous ferric iron in doses ranging from 800 to 1,500 mg should be considered as first choice. In a few women with severe anemia and blunted erythropoiesis due to infection and/or inflammation, additional recombinant human erythropoietin may be considered. Blood transfusion should be restricted to women who develop circulatory instability due to postpartum hemorrhage. National health authorities should establish guidelines to combat iron deficiency in pregnancy and postpartum in order to facilitate a prosperous future for both mothers and children in a continuing globalized world.

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Effect of Administering Recombinant Erythropoietin to Women with Postpartum Anemia: A Meta-analysis

Abstract: Administration of rEpo to women with postpartum anemia appears to be safe, and is associated with a trend toward a faster increase in hemoglobin concentration. However, its efficacy in terms of diminishing postpartum transfusions is unproven.

Cited by 20 publications

References 25 publications

Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Intravenous Iron Versus Oral Iron Therapy in Postpartum Anaemia in Rural India

Postpartum anemia II: prevention and treatment

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