Intravenous Iron Treatment in Pregnancy: Ferric Carboxymaltose for Correction of Iron Deficiency Anaemia

Abstract

Abstract:Iron deficiency is the most common nutritional deficiency state of women in childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. An effective management is needed to prevent adverse outcomes. Current options for treatment are limited; these include oral iron supplements, which are usually ineffective and poorly tolerated, and whole blood transfusion, which carries an inherent risk, should be avoided during pregnancy. Intravenous ferric carboxymaltose is a new treatment option and it is better tolerated with a good result. The study was designed to assess the safety and efficacy of intravenous ferric carboxymaltose for correction of IDA in pregnant women in third trimester. It was a prospective study; 260 anaemic pregnant women received Injection ferric carboxymaltose, as a total dose of 500-1000 mg between 28 to 36 weeks of pregnancy. Safety was assessed by analyzing adverse drug reactions. Ferric carboxy maltose significantly increased Hb level (p<0.001) in all women in this study group. Increased Hb value was observed 3-4 weeks after infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 34(13%) patients.Our study revealed that the Hb level increased significantly, was well tolerated and without significant side effects.

A study for efficacy and safety of ferric carboxymaltose versus iron sucrose in iron deficiency anemia among pregnant women in tertiary care hospital

“…Iron sucrose was given as 200 mg/ day on alternate days and ferric carboxymaltose as 1000 mg/week up till the desired iron requirement for increase in hemoglobin levels. 2,3,10,23 In the present study, number of required iron sucrose for desired requirement was 4-6 doses and >6 doses in 1 case of severe IDA. Ferric carboxymaltose was required in 1-3 doses and 4-6 doses in 1 case of severe IDA.…”

“…12,14,16,18,23 The causes of anemia during pregnancy are low iron bioavailability in food, inadequate intake, excess coffee/tea, chronic infections, menstrual loss, worm infestation. 10,18,21,23 In this study moderate anemia in pregnant women was more prevalent with 86% and 2 cases of severe anemia were also into the study. As per NFHS 2 and 3 and ICMR 70% of preschool children, pregnant women and adolescent girls are anemic.…”

“…3,13,23 Hence, correction of iron deficiency anemia during pregnancy with parenteral therapy has role in better neonatal outcome with decreased perinatal mortality. 5,10 Ferric carboxymaltose seems to be superior to other parenteral iron formulations due to its high efficacy, safety and compliance revolutionising the management of iron deficiency anemia during pregnancy. 13,14,17,23 The disadvantage with ferric carboxymaltose is its high cost in comparison to other parenteral iron preparations, which is well compensated with lesser number of hospital visits and shorter duration of hospital stay.…”

“…9 Parenteral iron therapy is more compliant, efficacious, better tolerance, rapid replenishment of iron stores and hence used in chronic blood loss, gastrointestinal disorders, impaired iron absorption. 9,10 Type I complex have high incidence of anaphylaxis with slow release of iron, type II complexes are comparatively safer, type III complexes are unstable and leads to tissue toxicity. 10 Iron sucrose (FeS) in Nov, 2000 got FDA approved forming iron hydroxide sucrose complex in water with 34000-60000 Dalton molecular weight.…”

“…9,10 Type I complex have high incidence of anaphylaxis with slow release of iron, type II complexes are comparatively safer, type III complexes are unstable and leads to tissue toxicity. 10 Iron sucrose (FeS) in Nov, 2000 got FDA approved forming iron hydroxide sucrose complex in water with 34000-60000 Dalton molecular weight. 11 It is administered as intravenous bolus injection over 5-10 minutes or as infusion in 100ml normal saline over 15-20 mins with no test dose and maximum daily dosage of 200 mg, not more than thrice a week.…”