Abstract
BackgroundIron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a new treatment option that may be better tolerated.The study was designed to assess the safety and efficacy of iron deficiency anaemia (IDA) correction with intravenous ferric carboxymaltose in pregnant women with mild, moderate and severe anaemia in the second and third trimester.MethodsProspective observational study; 65 anaemic pregnant women received ferric carboxymaltose up to 15 mg/kg between 24 and 40 weeks of pregnancy (median 35 weeks gestational age, SD 3.6). Treatment effectiveness was assessed by repeat haemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion.ResultsIntravenous ferric carboxymaltose infusion significantly increased Hb values (p < 0.01) above baseline levels in all women. Increased Hb values were observed at 3 and 6 weeks post infusion and up to 8 weeks post-infusion. Ferritin values increased significantly after the infusion. Only 4 women had repeat ferritin values post-partum which remained above baseline levels. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. Of the 29 (44.6%) women interviewed, 19 (65.5%) women reported an improvement in their well-being and 9 (31%) felt no different after the infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 13 (20%) patients.ConclusionsOur prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anaemia in pregnancy.
Highlights
Iron deficiency is a common nutritional deficiency amongst women of childbearing age
The primary aim of this study was to assess the use of intravenous ferric carboxymaltose in the correction of iron deficiency anaemia in pregnant women
Haemoglobin values were repeated by the obstetric team as required and data were available for 88% of women: 31 women (48%) at visit 1 (3 weeks post infusion), 26 women (40%) at visit 2 (6 weeks post infusion) and a total of 20 (31%) women had a blood test at visit 3 (8 weeks post infusion; postpartum)
Summary
Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Poor outcomes for the Progression from iron deficiency to iron deficiency anaemia (IDA) in pregnancy is common, due to the increased demand for iron during pregnancy, required to support maternal haemoglobin mass expansion, as well as the growing fetus and placenta [7] This is further aggravated by blood loss associated with delivery. Deliveries by both caesarean section and vaginal deliveries that require instrumentation/intervention represent an even greater risk [4] increasing a woman’s vulnerability for peri-partum blood transfusion [3], chronic iron deficiency anaemia and iron store depletion, all compromising maternal wellbeing This recognition has not resulted in a universal approach of iron supplementation [8]
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