Abstract
BackgroundIron deficiency anaemia in pregnancy (IDAP) affects 11–18% of Australian pregnancies and is associated with adverse perinatal outcomes. National prescribing data suggests the use of intravenous iron in pregnancy is increasingly common. This study aimed to: 1) Establish the current patterns of intravenous iron use by Fellows of the Royal Australian and New Zealand College of Obstetricians (FRANZCOG) when treating iron deficiency and IDAP including immediately postpartum and; 2) Assess FRANZCOG opinions regarding potential trial of intravenous iron for first-line treatment of IDAP.MethodsAn online survey of RANZCOG Fellows practicing obstetrics was distributed in September 2018. Results were analysed descriptively and responses compared by clinician demographics using Chi-squared testing.ResultsOf 484 respondents (21% of FRANZCOG), 457 were currently practicing obstetrics. Most prescribed intravenous iron in pregnancy (96%) and/or postpartum (85%). Most intravenous iron was prescribed for IDAP (98%) rather than iron deficiency without anaemia (53%), and for IDAP most commonly second-line to failed oral iron supplementation and first-line in special circumstances (59%). Intravenous iron prescribing was associated with shorter time since FRANZCOG completion (p = 0.01), public hospital practice (p = 0.008) and higher hospital birth numbers (p = 0.01). Most respondents (90%) would consider a randomised controlled trial of first-line intravenous iron for IDAP, although views on appropriate thresholds differed.ConclusionsAlmost all respondents prescribed intravenous iron for IDAP, and while mostly used for second-line treatment over half sometimes used it first-line. With accelerating intravenous iron use, further research is required into its optimal use in pregnancy, recognizing important clinical outcomes and cost effectiveness.
Highlights
Iron deficiency anaemia in pregnancy (IDAP) affects 11–18% of Australian pregnancies and is associated with adverse perinatal outcomes
Overall, 484 fellows responded to the survey, of whom the majority were obstetricians and gynaecologists (n = 388) or obstetricians alone (n = 69)
Most clinicians practiced in New South Wales (26%), Victoria (21%) or Queensland (19%), with the majority working in metropolitan centres (Table 1)
Summary
Iron deficiency anaemia in pregnancy (IDAP) affects 11–18% of Australian pregnancies and is associated with adverse perinatal outcomes. All-cause severe anaemia is associated with increased maternal risks of blood transfusion, prolonged hospitalisation and maternal mortality [4, 5], The treatment of iron deficiency (ID) in pregnancy, with or without anaemia, has undergone significant shifts recently. This is multifactorial, including more screening and greater diagnosis of ID, the introduction of newer intravenous iron preparations [9] and increased recognition of the importance of patient blood management with new national guidelines [10]. Australian guidelines have recently been updated to recommend either lower dose or intermittent dosing of oral iron supplementation to improve tolerability
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