Iron Deficiency Anemia in Pregnancy: Intravenous Versus Oral Route

Abstract

Objectives The aim of this study was to compare the efficacy and safety of intravenous iron with oral iron in the treatment of iron deficiency anemia of pregnancy. Methods A randomized experimental study was conducted at K. J. Somaiya Hospital involving 200 pregnant women with iron deficiency anemia. In the intravenous group iron dose was calculated from: Total iron dose required (mg) = 2.4 9 weight kg 9 target hemoglobinactual hemoglobin) g/dl ? 500. Target hemoglobin was set at 12 g/dl. In the oral group patients received 200 mg oral ferrous ascorbate daily. Hemoglobin and serum ferritin were reviewed at 2, 4, and 6 weeks. Paired and independent t test was applied. Results The change in hemoglobin and ferritin levels from baseline was significantly higher in the intravenous group than the oral group at each measurement (P = 0.000). Conclusion Intravenous iron elevates hemoglobin and restores iron stores faster than oral iron, with no severe adverse reactions.

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.…”

“…14,16,29,32,34,35,39,50,56 Two studies compared IV to IM administration, noting a higher rate of ADRs in the IM group (27% and 24%) compared with the IV group (3% and 8%).…”

“…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- …”

Is it safe to use intravenous iron sucrose during pregnancy? A randomized controlled trial

“…Few studies [15][16][17][18][19] have compared efficacy and safety of intravenous iron sucrose with oral iron during pregnancy. A recent Cochrane review 20 on treatments for iron deficiency in anemia highlighted the need for good quality randomized controlled trials in this setting, in particular to assess clinical outcomes and adverse events.…”