Iron therapy in iron deficiency anemia in pregnancy: Intravenous route versus oral route

Bayoumeu, F.; Subiran-Buisset, Carole; Baka, Nour-Eddine; Legagneur, Henryse; Monnier‐Barbarino, Patricia; Laxenaire, M

doi:10.1067/mob.2002.121894

Cited by 184 publications

(190 citation statements)

References 15 publications

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“…Five trials [17,18,19,20,21] described adequately how the randomisation sequence generation was performed. Three studies [19,20,21] reported adequate allocation concealment.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 576 pregnant women were randomly assigned to an intravenous iron sucrose group (n = 289) or an oral iron group (n = 287). Three trials [16,17,18] compared ferrous sulphate with iron sucrose. However, the other three studies [19,20,21] compared iron sucrose infusion with iron polymaltose, ferrous ascorbate and ferrous fumarate, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…1). Therefore, data were extracted from the remaining 6 RCTs [16,17,18,19,20,21] and were analysed in the present systematic review. Overall, 576 pregnant women were randomly assigned to an intravenous iron sucrose group (n = 289) or an oral iron group (n = 287).…”

Section: Resultsmentioning

confidence: 99%

“…The posttreatment mean maternal haemoglobin concentration (g/dl) was measured in all 6 [16,17,18,19,20,21] studies, including a total of 576 pregnant women. In 4 studies [16,18,19,20], the mean maternal haemoglobin in the intravenous group showed a statistically significant increase compared with the oral group.…”

Section: Resultsmentioning

confidence: 99%

“…Because all included RCTs were open RCTs, blinding was not used. Intention-to-treat analyses were used in 5 trials [16,17,18,19,20] to assess outcome measures. All studies reported the losses to follow-up and drop-out rates, which were less than 20% in all the studies.…”

Section: Resultsmentioning

confidence: 99%

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Intravenous Iron Sucrose versus Oral Iron in the Treatment of Pregnancy with Iron Deficiency Anaemia: A Systematic Review

Shi

Leng²,

Wazir

et al. 2015

Gynecol Obstet Invest

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Background: Intravenous iron sucrose and oral iron therapy are the main therapies for iron deficiency anaemia (IDA), but there is still a debate regarding their efficacy and especially as to which one is the best choice during pregnancy. Methods: A meta-analysis of randomised controlled trials comparing patients treated with intravenous iron sucrose (intravenous group) with those treated with oral iron (oral group) for IDA during pregnancy was performed. The primary outcomes of interest were mean maternal haemoglobin and serum ferritin levels at the end of treatment. Secondary outcomes were treatment-related adverse events and foetal birth weight. Results: Six randomised controlled trials, involving a total of 576 women, were included in the present review. Significant increases in haemoglobin [mean difference (MD), 0.85; 95% confidence interval (CI), 0.31-1.39; p = 0.002] and ferritin levels (MD, 63.32; 95% CI, 39.46-87.18; p < 0.00001) were observed in the intravenous group. Compared with the oral group, there were fewer adverse events in the intravenous group (risk ratio, 0.50; 95% CI, 0.34-0.73; p = 0.0003). There was no significant difference in birth weight between the two groups. Conclusion: For pregnant women who could not tolerate the side effects of oral treatment or required a rapid replacement of iron stores, intravenous iron sucrose was associated with fewer adverse events and was more effective than regular oral iron therapy.

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“…Five trials [17,18,19,20,21] described adequately how the randomisation sequence generation was performed. Three studies [19,20,21] reported adequate allocation concealment.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Intravenous Iron Sucrose versus Oral Iron in the Treatment of Pregnancy with Iron Deficiency Anaemia: A Systematic Review

Shi

Leng²,

Wazir

et al. 2015

Gynecol Obstet Invest

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Risk of Infection Associated With Administration of Intravenous Iron

et al. 2021

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IMPORTANCEIntravenous iron is recommended by many clinical guidelines based largely on its effectiveness in reducing anemia. However, the association with important safety outcomes, such as infection, remains uncertain. OBJECTIVE To examine the risk of infection associated with intravenous iron compared with oral iron or no iron. DATA SOURCES Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials (RCTs) from 1966 to January 31, 2021. Ongoing trials were sought from ClinicalTrials.gov, CENTRAL, and the World Health Organization International Clinical Trials Search Registry Platform. STUDY SELECTION Pairs of reviewers identified RCTs that compared intravenous iron with oral iron or no iron across all patient populations, excluding healthy volunteers. Nonrandomized studies published since January 1, 2007, were also included. A total of 312 full-text articles were assessed for eligibility. DATA EXTRACTION AND SYNTHESIS Data extraction and risk of bias assessments were performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) and Cochrane recommendations, and the quality of evidence was assessed using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Two reviewers extracted data independently. A random-effects model was used to synthesize data from RCTs. A narrative synthesis was performed to characterize the reporting of infection. MAIN OUTCOMES AND MEASURESThe primary outcome was risk of infection. Secondary outcomes included mortality, hospital length of stay, and changes in hemoglobin and red blood cell transfusion requirements. Measures of association were reported as risk ratios (RRs) or mean differences.RESULTS A total of 154 RCTs (32 920 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR, 1.17; 95% CI, 1.04-1.31; I 2 = 37%; moderate certainty of evidence). Intravenous iron also was associated with an increase in hemoglobin (mean difference, 0.57 g/dL; 95% CI, 0.50-0.64 g/dL; I 2 = 94%) and a reduction in the risk of requiring a red blood cell transfusion (RR, 0.93; 95% CI, 0.76-0.89; I 2 = 15%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay. (continued) Key Points Question In patients who require treatment with intravenous iron, what is the evidence that this intervention increases the risk of developing a new infection? Findings In this systematic review and meta-analysis of 154 randomized clinical trials that included 32 920 participants, intravenous iron was associated with an increased risk of infection. Meaning The results of this study suggest that, despite broad advocacy in clinical guidelines, intravenous iron may increase the risk of infection, which must be balanced with the potential benefits of treating anemia and reducing blood transfusion requirements.

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