Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia

Mayson, Eleni; Ampt, Amanda; Shand, Antonia; Ford, Jane B.

doi:10.1111/ajo.12417

Cited by 12 publications

(37 citation statements)

References 24 publications

(39 reference statements)

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“…Recombinant activated Factor VII is used in Australia to prevent, slow or stop bleeding [ 32 , 33 ]. Ferric carboxymaltose, introduced in Australia in 2011, is an intravenous infusion given to treat iron deficiency that has advantages over previously available iron treatments including reduced side effects and easier administration [ 34 , 35 ]. The increased use of such treatments could potentially have had an impact on the rate of transfusions administered to mothers in response to anaemia and haemorrhage; however, this information is not collected in routinely collected birth or hospital data.…”

Section: Discussionmentioning

confidence: 99%

Assessing the effect of risk factors on rates of obstetric transfusion over time using two methodological approaches

Jegasothy

Patterson

Randall

et al. 2018

BMC Med Res Methodol

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BackgroundWhile red blood cell transfusion rates have declined in most Australian medical specialties, obstetric transfusion rates have instead been increasing. Obstetric transfusions are mostly linked to postpartum haemorrhage, the rates of which have also increased over time. This study used two methodological approaches to investigate recent trends in obstetric transfusion in New South Wales (NSW) and the extent to which this was influenced by changing maternal and pregnancy characteristics.MethodsLinked birth and hospital records were used to examine rates of red blood cell transfusion in the postpartum period for mothers giving birth in NSW hospitals from 2005 to 2015. Logistic regression models were run to examine the contribution of maternal and pregnancy risk factors to changing rates of transfusion. Risk factors were divided into “pre-pregnancy” and “pregnancy related”. Crude and adjusted estimates of the effect of year of birth on obstetric transfusion rates were compared to assess the effect of risk factors on rates over time using two approaches. The first compared actual and predicted odds ratios of transfusion for each year. The second compared the observed increase in transfusion rate with that predicted after controlling for the risk factors.ResultsAmong 935,659 births, the rate of obstetric transfusion rose from 13 per 1000 births in 2005 to 17 in 2011, and remained stable until 2015. From 2005 to 2015, postpartum haemorrhage increased from 74 to 114 per 1000 births. Compared with the rate in 2005, the available maternal and pregnancy characteristics only partially explained the change in rate of transfusion by 2015 (Method 1, crude odds ratio 1.39 (95% CI 1.25, 1.56); adjusted odds ratio 1.29 (95% CI 1.15, 1.45)). After adjustment for maternal and pregnancy characteristics, obstetric transfusion incidence was predicted to increase by 10.3%, but a 38.7% increase was observed (Method 2).ConclusionRates of obstetric transfusion have stabilised after a period of increase. The trend could not be fully explained by measured maternal and pregnancy characteristics with either of the two approaches. Further investigation of rates and maternal and clinical risk factors will help to inform and improve obstetric blood product use.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0595-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Assessing the effect of risk factors on rates of obstetric transfusion over time using two methodological approaches

Jegasothy

Patterson

Randall

et al. 2018

BMC Med Res Methodol

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“…This resulted in a trial design aiming to prevent IDA, as opposed to treating IDA after manifestation. It is well known that IDA causes morbidity (14)(15)(16)(17)(18)(19)(20)(21)(22). However, previous studies have focused on treatment (29)(30)(31)(32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

“…Severe anaemia may cause dizziness, shortness of breath, palpitation, orthostatism, and syncope (14,15). Iron is an essential part of myoglobin, which explains why ID may compromise contractility in the uterine musculature that in turn may increase the risk for prolonged labour, caesarean section and postpartum haemorrhage (16,17). The consequence of maternal anaemia for the foetus is low birthweight, which can complicate the neonatal period (18)(19)(20)(21).…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Intravenous iron isomaltoside versus oral iron supplementation for treatment of iron deficiency in pregnancy: protocol for a randomised, comparative, open-label trial

Markova

Hansen

Thomsen

et al. 2020

Preprint

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Background: Iron deficiency is common in pregnancy. If left untreated iron deficiency can lead to iron deficiency anaemia. The prevalence of iron deficiency increases through the trimesters which means that women with iron deficiency in the beginning of pregnancy have a great risk of developing iron deficiency anaemia during pregnancy. Standard treatment is oral iron in individualized intensified doses based on screening values in 1st trimester. Maternal symptoms of iron deficiency and iron deficiency anaemia include fatigue, reduced physical performance, and Restless Legs Syndrome. Severe anaemia may cause dizziness, dyspnea, palpitation, orthostatism, syncope and it decreases the woman’s ability to cope with blood loss during delivery. It may compromise contractility in the uterine musculature increasing the risk for prolonged labor, caesarean section and postpartum haemorrhage. Foetal iron deficiency may cause low birthweight and adversely affect foetal and early childhood brain development with long term deficits.Methods: In this randomised comparative, open-label, single-centre, phase IV trial, 200 pregnant women between 14 and 21 weeks of gestation, who have iron deficiency after 4 weeks of standard treatment will be randomised 1:1 to either a single 1000 milligram dose of intravenously administered ferric derisomaltose/iron isomaltoside 1000 or a fixed dose of 100 milligrams oral ferrous fumarate containing 60 milligrams ascorbic acid. The primary endpoint is to prevent iron deficiency anaemia defined by a low level of haemoglobin throughout the trial. Other endpoints include other haematological indices of iron deficiency and anaemia, clinical outcomes by questionnaires and collection of adverse events. Explorative endpoints by medical record follow-up include complications up to 7 days after delivery.Discussion: This trial will contribute evidence on how to prevent iron deficiency anaemia which is a condition related to maternal and neonatal morbidity. The trial population represents a clinical reality, where pregnant women often have sustained iron deficiency despite an increased oral iron dose. Thus, this evidence can be used to consider the optimal 2nd line of treatment in iron deficient pregnant women.Trial registration: This trial is registered 3 May 2017 in European Union Drug Regulating Authorities Clinical Trials Database: 2017-000776-29 and 15 June 2017 at ClinicalTrials.gov: NCT03188445.

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“…19,20 A multidisciplinary team (researchers, obstetrician, hematologist, midwife) developed the interview questions. Specialty-specific prompts were used to explore participants' expertise and knowledge base (Appendix S1; available as supporting information in the online version of this article).…”

Section: Methodsmentioning

confidence: 99%

Single‐unit transfusions in the obstetric setting: a qualitative study

2016

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Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia

Cited by 12 publications

References 24 publications

Assessing the effect of risk factors on rates of obstetric transfusion over time using two methodological approaches

Assessing the effect of risk factors on rates of obstetric transfusion over time using two methodological approaches

Intravenous iron isomaltoside versus oral iron supplementation for treatment of iron deficiency in pregnancy: protocol for a randomised, comparative, open-label trial

Single‐unit transfusions in the obstetric setting: a qualitative study

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