"Evaluation of Intravenous Iron Versus Oral Iron in Management of Iron Deficiency Anemia in Pregnancy With Specific Reference to Body Iron Store”

Abstract

INTRODUCTION:Anemia is the most common Nutritional deficiency disorder in the World. Iron-deficient anemia (IDA) is responsible for 95% of anemia during pregnancy. Parenteral iron is a useful treatment, although iron dextran use decreased due to anaphylaxis. Iron sucrose is a newer agent that has overcome the shortcomings of iron dextran. OBJECTIVE: The aim of this study was to compare the efficacy and tolerance of intravenous iron sucrose (IVIS) therapy with oral iron (OI) therapy in pregnant women with IDA with specific emphasis on body iron stores. MATERIALS AND METHODS: This prospective, randomized clinical trial included 100 pregnant women between < 32 weeks with established IDA who were treated with IVIS or OI (ferrous ascorbate). All patients were monitored for laboratory response and adverse effects. Independent sample-t test was used for statistical analysis. P < 0.05 was considered significant. RESULTS: Although hemoglobin increased in both the groups, increase in the reticulocyte count and percentage increase in hemoglobin was significantly higher in the IVIS group than in the OI group. Serum ferritin was significantly higher in the IVIS group than in the OI group (P = 0.000). The IVIS group had no major side-effects. Compliance was good with OI, although majority had gastrointestinal side-effects. CONCLUSION: IVIS is safe and effective in the treatment of IDA during pregnancy. Iron stores increased better with IVIS compared with OI.

Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review

“…The majority of studies involved a comparison group of some kind including oral iron (n = 17; 36%), 11,14,16,19,24,26,27,29,31,32,34,35,37,39,50,56,57 IV iron (n = 4; 9%), 13 [14][15][16]18,20,24,26,28,31,[33][34][35][36][37][38][39]41,42,44,49,50,53 Only one study was identified that directly compared the administration of a full replacement dose of IV iron to a dose that was 300 mg less than the calculated full replacement dose. In comparing the two groups, administration of the full replacement dose was associated with a greater increase of 8 g/L 3-4 weeks after administration and 14 g/L at delivery.…”

“…11,13,16,20,[22][23][24][25]27,31,32,34,36,38,40,44,49 Across all studies, the median reported prevalence of ADRs was similar among prospective (4.5%) 11,16,19,20,22,23,27,29,31,32,34,36,38,40,44,49,53,[55][56][57] and retrospective (5%) 13,52,54 studies. Eighteen studies administered a test dose, 15,23,[25][26][27][28][29][30][31]34,37,…”

“…The prevalence of moderate or severe adverse reactions requiring treatment or discontinuation of IV iron was slightly higher in observational studies (13/1352; 9.6 per 1000 women; n = 20 studies) 12,13,19,20,22,23,32,33,40,41,44- [11][12][13][14][15][16]19,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][44][45][46][47][49][50][51] or FCM (1/276; 3.6 per 1000).…”

“…Compared to oral iron, use of IV iron was associated with a greater increase in haemoglobin at 2-4 weeks following the infusion (median: 6 g/L; range: 1-20 g/L) 11,16,26,27,29,31,34,35,37,39,50,56 and at delivery (median: 6.8 g/L; range: 6-19 g/L). 14,16,32,56 When examining ferritin at 4 weeks, seven of eight studies demonstrated a greater median increase of 38 μg/L (range: 25-222 μg/L) among the group receiving IV rather than oral therapy.…”

“…14,16,32,56 When examining ferritin at 4 weeks, seven of eight studies demonstrated a greater median increase of 38 μg/L (range: 25-222 μg/L) among the group receiving IV rather than oral therapy. 11,24,26,27,35,37,50,56 Only two studies reported on difference in ferritin at deliv- …”