Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial

Froessler, Bernd; Schubert, Klaus Oliver; Palm, Peter; Church, Rachel J.; Aboustate, N.; Kelly, Thu‐Lan; Dekker, Gustaaf A.; Hodyl, Nicolette A.

doi:10.1111/1471-0528.17288

Cited by 5 publications

(1 citation statement)

References 38 publications

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“…Accordingly, all pregnant women with an iron deficiency in the second trimester who have Hb-values <10.5 g/dl, and all women in the third trimester could be treated with intravenous iron. Administration of 1000 mg ferric carboxymaltose in the second or third trimester of pregnancy maintains iron stores more consistently and reduces the need for repeat infusion or subsequent monitoring [ 44 ▪ ].…”

Section: Treatment Of Iron Deficiency and Iron Deficiency Anemia Duri...mentioning

confidence: 99%

Current concepts in preoperative anemia management in obstetrics

Wiesenack

Meybohm

Neef

et al. 2023

Current Opinion in Anaesthesiology

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Purpose of reviewThe purpose of this article is to provide an overview of currently recommended treatment approaches for anemia during pregnancy, with a special focus on iron deficiency and iron deficiency anemia (IDA).Recent findingsAs consistent patient blood management (PBM) guidelines in obstetrics are still lacking, recommendations regarding the timing of anemia screening and the treatment recommendations for iron deficiency and IDA during pregnancy are still controversial. Based on increasing evidence, early screening for anemia and iron deficiency should be recommended at the beginning of each pregnancy. To reduce maternal and fetal burden, any iron deficiency, even without anemia, should be treated as early as possible during pregnancy. While oral iron supplements administered every other day are the standard treatment in the first trimester, the use of intravenous iron supplements is increasingly suggested from the second trimester onwards.SummaryThe treatment of anemia, and more specifically iron deficiency anemia during pregnancy, holds many possibilities for improvement. The fact that the period of risk is known well in advance and thus there is a long optimization phase is per se an ideal prerequisite for the best possible therapy of treatable causes of anemia. Standardization of recommendations and guidelines for screening and treatment of IDA in obstetrics is required for the future. In any case, a multidisciplinary consent is the precondition for a successfully implementation of anemia management in obstetrics to establish an approved algorithm easily enabling detection and treatment of IDA during pregnancy.

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Section: Treatment Of Iron Deficiency and Iron Deficiency Anemia Duri...mentioning

confidence: 99%

Current concepts in preoperative anemia management in obstetrics

Wiesenack

Meybohm

Neef

et al. 2023

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

show abstract

Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial

Froessler

Schubert

Palm

et al. 2022

BJOG

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Objective: To test the equivalence of two doses of intravenous iron (ferric carboxymaltose) in pregnancy.Design: Parallel, two-arm equivalence randomised controlled trial with an equivalence margin of 5%.Setting: Single centre in Australia.Population: 278 pregnant women with iron deficiency.Methods: Participants received either 500 mg (n = 152) or 1000 mg (n = 126) of intravenous ferric carboxymaltose in the second or third trimester. Main outcome measures:The proportion of participants requiring additional intravenous iron (500 mg) to achieve and maintain ferritin >30 microg/L (diagnostic threshold for iron deficiency) at 4 weeks post-infusion, and at 6 weeks, and 3-, 6-and 12-months postpartum. Secondary endpoints included repeat infusion rate, iron status, birth and safety outcomes. Results:The two doses were not equivalent within a 5% margin at any time point. At 4 weeks post infusion, 26/73 (36%) participants required a repeat infusion in the 500mg group compared with 5/67 (8%) in the 1000-mg group: difference in proportions, 0.283 (95% confidence interval [CI] 0.177-0.389). Overall, participants in the 500-mg arm received twice the repeat infusion rate (0.81 [SD = 0.824] versus 0.40 [SD = 0.69], rate ratio 2.05, 95% CI 1.45-2.91).Conclusions: Administration of 1000 mg ferric carboxymaltose in pregnancy maintains iron stores and reduces the need for repeat infusions. A 500-mg dose requires ongoing monitoring to ensure adequate iron stores are reached and sustained.

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