Iron Deficiency Anaemia in Pregnancy and Postpartum: Pathophysiology and Effect of Oral versus Intravenous Iron Therapy

Department of Haematology, Launceston General Hospital, Launceston, Tasmania 7250, Australia.
Journal of pregnancy 06/2012; 2012(10):630519. DOI: 10.1155/2012/630519
Source: PubMed


Nutritional iron-deficiency anaemia (IDA) is the most common disorder in the world, affecting more than two billion people. The World Health Organization's global database on anaemia has estimated a prevalence of 14% based on a regression-based analysis. Recent data show that the prevalence of IDA in pregnant women in industrialized countries is 17.4% while the incidence of IDA in developing countries increases significantly up to 56%. Although oral iron supplementation is widely used for the treatment of IDA, not all patients respond adequately to oral iron therapy. This is due to several factors including the side effects of oral iron which lead to poor compliance and lack of efficacy. The side effects, predominantly gastrointestinal discomfort, occur in a large cohort of patients taking oral iron preparations. Previously, the use of intravenous iron had been associated with undesirable and sometimes serious side effects and therefore was underutilised. However, in recent years, new type II and III iron complexes have been developed, which offer better compliance and toleration as well as high efficacy with a good safety profile. In summary, intravenous iron can be used safely for a rapid repletion of iron stores and correction of anaemia during and after pregnancy.

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    • "Anemia, defined as a decreased concentration of blood hemoglobin, is one of the most common nutritional deficiency diseases observed globally and affects more than a quarter of the world's population [1] [2] [3] [4] [5] [6] [7] [8]. It is a major public health problem affecting all ages of the population with its highest prevalence among children under five years of age and pregnant women [2] [3]. "
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    ABSTRACT: This research work presents the magnitude of anemia and its determinant factors among pregnant women. As far as this research is done in the eastern part of Ethiopia, where there is a different cultural issue related to pregnancy and dietary habit, it will help the researchers to know the problem in different parts of the country.
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    • "Iron deficiency anemia should be routinely screened in all pregnancies. A number of randomized controlled trials have compared oral and intravenous iron for treatment of anemia during pregnancy and postpartum periods, and they generally support the superiority of intravenous iron therapy for rapid, safe, and well-tolerated repletion of body iron stores in these women, with potentials for long-term benefits and improved quality of life [51] [52] [53] [54] [55]. Nonetheless, these studies commonly use Hb and iron indices as the end points, and they are usually underpowered to establish the impact on the more clinically relevant maternal and fetal outcomes [56]. "
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    ABSTRACT: Despite its high prevalence, anemia often does not receive proper clinical attention and its detection, evaluation, and management of iron deficiency anemia and iron-restricted erythropoiesis can possibly be an unmet medical need. A multidisciplinary panel of clinicians with expertise in anemia management convened and reviewed recent published data on prevalence, etiology, and health implications of anemia as well as current therapeutic options and available guidelines on management of anemia across various patient populations, and made recommendations on the detection, diagnostic approach and management of anemia. The available evidence confirms that the prevalence of anemia is high across all populations, especially in hospitalized patients. Anemia is associated with worse clinical outcomes including longer length of hospital stay, diminished quality of life and increased risk of morbidity and mortality, and it is a modifiable risk factor of allogeneic blood transfusion with its own inherent risks. Iron deficiency is usually present in anemic patients. An algorithm for detection and management of anemia was discussed which incorporated iron study (with primary emphasis on transferrin saturation), serum creatinine and GFR and vitamin B12 and folic acid measurements. Management strategies included iron therapy (oral or intravenous), erythropoiesis stimulating agents and referral as needed.
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    • "Iron sucrose seems to improve haemoglobin faster than oral iron therapy [15]. But there are disdavantages of intravenous iron therapy such as increased cost, need for hospitalisation and the invasive nature of the procedure. "
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    ABSTRACT: Purpose: The aim of this study was to compare the efficacy and safety of intravenous iron sucrose and oral iron administration for the treatment of iron deficiency anaemia in pregnancy. Materials and methods: Hundred women with gestational age between 30 and 34 weeks with established iron deficiency anaemia with Haemoglobin-6-8g/dL were randomised to receive either oral ferrous sulphate 200 mg thrice daily or required dose of intravenous iron sucrose 200 mg in 200 ml NS on alternate days. Haemoglobin, haematocrit, mean corpuscular volume, reticulocyte count were measured at recruitment and on 2(nd) week, 4(th) week and at 37 weeks. Adverse drug reactions were also noted in both the groups. RESULTS were analyzed by student's t-test and Chi-square test. Results: Haemoglobin values varied significantly with time between the two groups at second week, 4(th) week and at term (p<0.005). The mean difference in mean corpuscular volume from the recruitment value was not significant at 2(nd) week. When compared to iron sucrose group, oral iron group had significant gastro-intestinal adverse effects. Conclusion: Intravenous iron sucrose treated iron deficiency anaemia of pregnancy faster, and more effectively than oral iron therapy, with no serious adverse drug reactions.
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