DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222309
Published: 2022-08-29

A comparative study of intravenous ferricarboxymaltose and double dose oral iron therapy in treatment of anemia in pregnancy

Greeshma G., Beeresh C. S.

Abstract


Background: During pregnancy, iron deficiency is due to an imbalance between demand and supply, this worsens as pregnancy advances, according to CDC (centres for disease control and prevention) anemia is defined as Hb concentration lesser than 11 gm/dl in the first and third trimesters, and/or lesser than 10.5 gm/dl in the second trimester.

Methods: The prospective comparative study was planned with the objective to assess the effectiveness of intravenous ferricarboxymaltose and oral double dose iron in treating anaemia in pregnant women. This study was conducted from January 2019 to June 2020 among 100 (50 in each group) pregnant anemic women attending a rural tertiary care centre.

Results: This comparative study between double dose oral iron and i.v. iron treatment showed, hemoglobin levels improved at comparable rate across both treatments, however significantly more women achieved anemia correction with ferric carboxymaltose than oral iron More women achieved significant improvement in Hb with single dose of ferric carboxymaltose, whereas with oral iron additional dose of iron supplementation was required. Treatment related adverse reactions were seen more which oral iron treatment than with FCM. With markedly higher rates of gastrointestinal disorders.

Conclusions: FCM is comparable more effective and better tolerated than oral iron treatment in pregnant women. Rapid correction of anemia was seen with i.v. FCM, thus in late stage pregnancy, when time to delivery is a limiting step, administration of FCM may be a more appropriate option than oral iron for rapid and effective anemia correction.


Keywords


Double dose oral iron treatment outcome, Iron deficiency anemia, I.V. ferricarboxymaltose treatment outcome

Full Text:

PDF

References


Laros RK Jr, ed. Blood disorders in pregnancy. Philadelphia, PA: Lea and Febiger; 1986.

Centers for Disease Control and Prevention. CDC criteria for anemia in children and childbearing-aged women. Morb Mort Wkly Rep. 1989;38:400-4.

Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123:615-24.

Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013;121:2607-17.

Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population representative data. Lancet Glob Health. 2013;1:e16-25.

Cusick SE, Mei Z, Freedman DS, Looker AC, Ogden CL, Gunter E, et al. Unexplained decline in the prevalence of anemia among US children and women between 1988-1994 and 1999-2002. Am J Clin Nutr. 2008;88:1611-7.

Barroso F, Allard S, Kahan BC, Barroso F, Allard S, Kahan BC, et al. Prevalence of maternal anaemia and its predictors: a multi-centre study. Eur J Obstet Gynecol Reprod Biol. 2011;159:99 -105.

Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Eur J Obstet Gynecol Reprod Biol. 2005;123:S15-9.

Breymann C. Iron deficiency and anaemia in pregnancy: modern aspects of diagnosis and therapy. Blood Cells Mol Dis. 2002;29:506-16.

Bothwell TH. (2000) Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72:257S-64S.

Van Wyck DB, Martens MG, Seid MH, Baker JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of post-partum anaemia. A randomised controlled trial. Obstet Gynecol. 2007;110(2 Pt 1):267-78

Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of post-partum iron deficiency anaemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199(4):435.e1-7.

Mishra VV, Chaudhary S, Gandhi K, Sharma U, Patel U. Study of intravenous ferric carboxy maltose in iron deficiency anaemia during pregnancy and Postpartum period safety and efficacy. Int J Obstet Gynecol Reprod. 2015;2(2):69-72.

Shim JY, Kim MY, Kim YJ, Lee Y, Lee JJ, Jun JK, et al. Efficacy and safety of ferric carboxymaltose versus ferrous sulfate for iron deficiency anemia during pregnancy: subgroup analysis of Korean women. BMC Pregnanc Childbirth. 2018;18(1):1-8.

Breymann C, Milman N, Mezzacasa A, Bernard R, Dudenhausen J. Ferric carboxymaltose versus oral iron in the treatment of pregnant women with iron deficiency anemia: an international, open-label, randomized controlled trial (FER-ASAP). J Perinat Med. 2017;45(4):443-53.