Clinical outcome post treatment of anemia in pregnancy with intravenous versus oral iron therapy: a systematic review and meta-analysis

Abstract

Oral iron therapy is often the most common way of treating anaemia; however intravenous iron is considered effective due to rapid iron replenishment. We have dearth of evidence on clinical outcomes post treatment of anaemia. We have searched studies published in English in PubMed, Cochrane, Scopus, ProQuest, and Google Scholar. Our study analysed the clinical outcomes amongst neonates and mother and the adverse events post treatment and assessed the mean change in maternal haemoglobin concentration in both the groups. Forest plots for the clinical outcomes are presented. From a total of 370 studies, 34 Randomized and quasi experimental studies comparing clinical outcomes post-treatment of anaemia in pregnancy were included for quantitative evidence synthesis. Pooled results of maternal clinical outcomes using random effect model [OR: 0.79 (95% CI 0.66; 0.95); 10 outcomes; 17 studies] showed statistically significant difference among both the groups [Moderate quality evidence]; however no significant difference [OR: 0.99 (95% CI 0.86; 1.14); 7 outcomes; 8 studies] have been observed for neonatal complications [Low quality evidence]. The study found that pregnant women receiving IV iron were significantly less likely to experience adverse events as compared with those receiving oral iron [OR 0.39; (95% CI 0.26–0.60)]; 34 studies; 13,909 women; [Low quality evidence]. Findings from meta-regression analysis showed that IV iron is more likely to reduce maternal complications by 21% compared to oral iron. Increase in odds of adverse maternal outcomes was observed due to increase in gestational age and publication year but no effect for the type of drug used. IV iron increases Hb more and at a higher pace than oral iron. Intravenous iron is more likely to avert adverse maternal outcomes and adverse reactions. However, there is no conclusive evidence on its effectiveness on individual maternal outcome or neonatal outcome/s. Protocol registered with PROSPERO CRD42022368346).

Intervenciones de enfermería en alteraciones hematológicas en recién nacido

“…El hígado es el principal lugar de almacenamiento del exceso de hierro y se utiliza como un marcador de la carga total de hierro corporal; no obstante, el hierro también se deposita en otros tejidos parenquimatosos, entre los que se encuentran el corazón y el sistema endocrino. Sin un tratamiento adecuado, los efectos acumulativos de la sobrecarga de hierro dan lugar a un grave daño orgánico y, finalmente, a la muerte (19) • Coagulopatías hereditarias: La más frecuente (80% del total; 1/5.000 varones) es la Hemofilia A. Esta es una enfermedad hereditaria, ligada al sexo, en la que una de las proteínas esenciales para la coagulación, el factor VIII, no existe o es deficitario (grave si tasa de FVIII < 1%, moderada del 1-5% y leve del 5-25%). Como consecuencia hay una deficiente formación de fibrina que se manifiesta como tendencia al sangrado (mayor frecuencia y duración), en ocasiones de forma espontánea e incoercible, y que afecta de forma característica al sistema músculoesquelético (hematomas musculares y hemartros).…”