Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review

Abstract

Background: Intravenous (IV) iron in pregnancy is useful where oral iron is not tolerated or a rapid replenishment of iron is required. Aims:To review the literature on the efficacy and safety of different IV iron preparations in the management of antenatal iron-deficiency anaemia (IDA). Materials and methods:We searched MEDLINE, Embase and Scopus from inception to June 2016. Eligible studies were randomised controlled trials (RCTs) and observational studies, involving administration of IV iron (ferric carboxymaltose (FCM), iron polymaltose (IPM) or iron sucrose (IS)), regardless of comparator, to manage antenatal IDA. Two independent reviewers selected studies, extracted data and assessed quality.

UK guidelines on the management of iron deficiency in pregnancy

“…Systematic reviews and meta‐analyses found that pregnant women receiving intravenous (IV) iron, compared with oral iron, achieved the target Hb more often, had an increased Hb after 4 weeks and had fewer side effects (Govindappagari & Burwick, ; Govindappagari & Burwick, ; Qassim et al , ).…”

“…Systematic reviews and meta-analyses found that pregnant women receiving intravenous (IV) iron, compared with oral iron, achieved the target Hb more often, had an increased Hb after 4 weeks and had fewer side effects (Govindappagari & Burwick, 2018;Govindappagari & Burwick, 2019;Qassim et al, 2018). IV iron therapy is indicated when there is absolute noncompliance with, or intolerance of, oral iron therapy or proven malabsorption or when a rapid Hb response is required.…”

“…Its use is limited by the total dose that can be administered in one infusion, requiring multiple infusions. Iron carboxymaltose and iron isomaltoside overcome this problem, allowing single dose administration (Lyseng-Williamson & Keating, 2009;Gozzard, 2011;Qassim et al, 2018).…”

Intravenous iron use in pregnancy: Ironing out the issues and evidence

“…In this issue of ANZJOG , Qassim and colleagues examine the use, safety and efficacy of IV iron polymaltose (IPM; Ferrosig®, Ferrum H®) in the management of iron deficiency in pregnancy . The findings of the current study, together with those of their ANZJOG 2017 systematic review of the safety and efficacy of three commonly used IV iron preparations in pregnancy, are timely and important. Data from the Australian Government Department of Health show that the number of women of reproductive age receiving IV iron more than doubled in Australia between 2014 and 2017 (M. Keaney, personal correspondence).…”

The study of efficacy of injection iron sucrose in treatment of iron deficiency anemia in pregnancy

“…It also showed that none of the preparations are superior to each other; hence iron sucrose has a clear advantage of being cheaper and readily available. 14 Dubey S et al, in a randomized trial used iron sucrose or oral iron in 200 pregnant patients and followed them up at 2,4 and then 4 weeklies till delivery. At all levels, it was shown that iron sucrose increased hemoglobin and iron stores faster than oral iron significantly (p-values of 0.000).…”