Antepartum Intravenous Iron Reduces Peripartum Blood Transfusions [27B]

Abstract

INTRODUCTION: Studies have demonstrated that antepartum intravenous iron sucrose infusion (IVFe) is safe and improves pre-delivery hemoglobin (Hb). Yet, the effect of IVFe on maternal morbidity is unknown. We sought to determine whether antepartum IVFe could reduce peripartum packed red blood cell (pRBC) transfusions. METHODS: This is a retrospective cohort study. In 6/2015, our institution began recommending IVFe for patients with Hb<9.5 g/dL who failed oral ferrous sulfate, as determined by persistent severe anemia in the third trimester. Patients who obtained prenatal care and delivered at our institution from 10/1/2015-10/1/2016 with third trimester Hb<9.5g/dL were included. Hemoglobinopathies were excluded. Decision to proceed with IVFe, timing, and number of doses was left up to patient and provider. Patients receiving ≥1 antepartum dose of 300mg of IVFe at least 48 hours before delivery were included in the IVFe group. Our primary outcome was rate of blood transfusions among those who did vs. did not receive IVFe. Fisher’s exact test was used to compare proportions. RESULTS: 389 of 3961 (9.8%) delivering patients met Hb criteria and were included. Of those, 25 (6.4%) were in the IVFe group. Third trimester Hb was lower in the IVFe group compared to the No IVFe group (8.6g/dL vs. 9.4g/dL; p<0.0001). Patients in the IVFe group significantly increased their Hb from third trimester to pre-delivery compared to those in the No IVFe group (Δ1.6g/dL vs Δ-0.1g/dL, p<0.0001). 57 of 389 (14.7%) received ≥1 unit of pRBCs during delivery admission. IVFe decreased the rate of peripartum blood transfusion compared to those who did not get IVFe (0% vs. 15.7%, p=0.035). The 57 transfused patients, none of whom received IVFe, required an average of 2.39 units of pRBCs per person. CONCLUSION: Despite lower starting Hb in the IVFe group, antepartum IVFe reduced transfusions in patients with a third trimester Hb<9.5g/dL. Future hemorrhage bundle work should highlight the use of IVFe to reduce peripartum pRBC transfusion and maternal morbidity.

Iron Sucrose: A Wealth of Experience in Treating Iron Deficiency

“… Significant Hb increase versus baseline in both groups Mild anemia (16.2%), infections (6.9%), muscle pains (2.3%), pruritus (2.3%), cough (1.5%), breast disorders (1.5%) with IS; GI events only with FeS (17.7%), 14 SAEs in IS group (preterm contractions n = 3, premature rupture of the membranes n = 3, moderate anemia after delivery n = 2, threatened preterm delivery because of cervical insufficiency n = 2, intrauterine growth restriction n = 2, infection n = 1, injury n = 1), seven SAEs in FeS group (preterm contractions n = 2, vaginal bleeding n = 1, premature rupture of the membrane n = 1, infection n = 1, gestational diabetes mellitus n = 1, postpartum pulmonary embolism n = 1) Tariq et al (2015) [ 82 ] Gest. age > 12 weeks Hb < 10.5 g/dL SF < 12 µg/L IS: 93 Iron dextran: 105 ≥ 1 antepartum 300 mg IS dose IS and iron dextran were equally effective in treatment of IDA during pregnancy No major side effects were observed in either group Hamm et al (2018) [ 83 ] Third trimester Hb < 9.5 g/dL IS: 25 No IS: 364 ≥ 1 antepartum 300 mg IS dose The earlier IS was received before delivery, the greater the median Hb increase. Only those receiving IS > 2 weeks before delivery had a significant increase in Hb level from third trimester to delivery.…”

“…Administering iron sucrose from the third trimester to pre-delivery can significantly increase Hb levels and reduce blood transfusion rates in pregnant women with third trimester Hb levels below 9.5 g/dL, compared with patients who did not receive iron sucrose [ 83 ]. Treatment with a minimum of three iron sucrose doses at least 2 weeks prior to delivery appears optimal for increasing Hb levels and treating antepartum anemia [ 84 ].…”