Intravenous iron in the 2nd trimester: An innovative way to address anemia in pregnancy

Public health has long sought novel ways to address anemia, including anemia in pregnancy.  Anemia in pregnancy takes a toll on both mother and fetus and if untreated can result in premature labor as well as make a woman more vulnerable in cases of hemorrhage.  

The taste and side effects of iron pills have been an anethema to progress in reducing anemia.

Multiple studies are showing that intravenous iron is a very promising intervention.  Findings from meta-regression analysis showed that IV iron is more likely to reduce maternal complications by 21% compared to oral iron.  Pandey et al find that at the population level, "IV iron increases Hb more and at a higher pace than oral iron. Intravenous iron is more likely to avert adverse maternal outcomes and adverse reactions."

A new study in India study looked enrolled 4,368 women in a study to determine how effective intravenous iron was in 1) reducing anemia to zero by the time of delivery 2) avoiding low birthweight.  Importantly, this study administered the supplemental iron in the second trimester rather than the third.

Three different forms of iron supplementation were compared: 1) iron pills (60 mg oral ferrous sulfate twice daily) 2)  intravenous injection of ferric carboxymaltose (FCM) and 3) intravenous injection of ferric derisomaltose (FDM). 

In short, the results of the trial were positive for IV iron in the second trimester: "First-line treatment of moderate maternal iron deficiency anemia with single-dose infusion of intravenous iron results in a reduced incidence of low birth weight infants (intravenous ferric carboxymaltose vs oral) and a higher incidence of attaining maternal nonanemic state without use of additional iron or blood transfusion (intravenous ferric carboxymaltose and ferric derisomaltose vs oral)."

Sources:

Single-dose intravenous iron vs oral iron for treatment of maternal iron deficiency anemia: a randomized clinical trial