Iron therapy in obstetrics and gynaecology: a review
DOI:
https://doi.org/10.12809/hkjgom.19.1.06Keywords:
Anemia, iron-deficiency, Ferritins, Postpartum period, PregnancyAbstract
There are three problems in managing iron deficiency anaemia in child-bearing-age women: lack of awareness of the condition by both patient and clinician, inexperience in the diagnosis, and lack of familiarity with available oral and intravenous iron therapy. Iron deficiency is common in women, from menarche, through growth spurt in puberty, pregnancy, and postpartum, and until menopause. To screen for underlying iron deficiency, a haemoglobin cut-off for anaemia is used. Iron deficiency anaemia must be excluded for patients with haemoglobin level below the cutoff. Oral iron therapy is effective in treating iron deficiency anaemia. Low-dose alternate-day oral iron therapy is recommended (rather than daily iron dose). It is crucial to accompany oral iron therapy with vitamin C. Intravenous iron therapy, particularly with third-generation iron compounds, is safe, effective, and faster acting than oral iron therapy.
References
World Health Organization, Food and Agricultural Organization of the United Nations. Vitamin and mineral requirements in human nutrition. 2nd edition; 2004.
Schantz-Dunn J, Barbieri RL. Recognize and treat iron deficiency anemia in pregnant women. OBG Manag 2017;29:8-11,16.
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211-59.
Friedman AJ, Shander A, Martin SR, et al. Iron deficiency anemia in women: a practical guide to detection, diagnosis, and treatment. Obstet Gynecol Surv 2015;70:342-53.
Guideline: Iron supplementation in postpartum women. Geneva: World Health Organization; 2016.
Api O, Breyman C, Çetiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: iron deficiency anemia working group consensus report. Turk J Obstet Gynecol 2015;12:173-81.
Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion 2015;55:2799-806.
Rahmann MM, Abe SK, Rahman MS, et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and metaanalysis. Am J Clin Nutr 2016;103:495-504.
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011.
Pavord S, Myers B, Robinson S, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2012;156:588-600.
Blood Transfusion in Obstetrics. Green-top Guideline No. 47. Royal College of Obstetricians and Gynaecologists; 2015.
Antenatal care for uncomplicated pregnancies (CG62). National Institute for Health and Care Excellence Clinical guideline; 2008.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol 2008;112:201-7.
Clinical Guideline Anaemia in Pregnancy Policy developed by SA Maternal & Neonatal Community of Practice. Approved SA Health Safety & Quality Strategic Governance Committee on 19 April 2016.
Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol 2011;90:1247-53.
Milman N. Postpartum anemia II: prevention and treatment. Ann Hematol 2012;91:143-54.
Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47:1-29.
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011.
Guideline: Daily iron supplementation in adult women and adolescent girls. Geneva: World Health Organization; 2016.
Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva: World Health Organization; 2011.
Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. Geneva: World Health Organization; 2013.
Muñoz M, Peña-Rosas JP, Robinson S, et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the postpartum period: NATA consensus statement. Transfus Med 2018;28:22-39.
Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood 2015;126:1981-9.
Schrier SL. So you know how to treat iron deficiency anemia. Blood 2015;126:1971.
Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol 2017;4:e524-33.
Siegenberg D, Baynes RD, Bothwell TH, et al. Ascorbic acid prevents the dose-dependent inhibitory effects of polyphenols and phytates on nonheme-iron absorption. Am J Clin Nutr 1991;53:537-41.
Cook JD, Monsen ER. Vitamin C, the common cold, and iron absorption. Am J Clin Nutr 1977;30:235-41.
Hallberg L, Brune M, Rossander L. Effect of ascorbic acid on iron absorption from different types of meals. Studies with ascorbic-acid-rich foods and synthetic ascorbic acid given in different amounts with different meals. Hum Nutr Appl Nutr 1986;40:97-113.
Derman DP, Bothwell TH, MacPhail AP, et al. Importance of ascorbic acid in the absorption of iron from infant foods. Scand J Haematol 1980;25:193-201.
Hallberg L, Brune M, Rossander-Hulthén L. Is there a physiological role of vitamin C in iron absorption? Ann N Y Acad Sci 1987;498:324-32.
Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med 2008;121:943-8.
Bhandari S, Pereira DIA, Chappell HF, Drakesmith H. Intravenous irons: from basic science to clinical practice. Pharmaceuticals (Basel) 2018;11.
Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ 2013;347:f4822.
Govindappagari S, Burwick RM. Treatment of iron deficiency anemia in pregnancy with intravenous versus oral iron: systematic review and meta-analysis. Am J Perinatol 2018 [Epub ahead of print].
Hillman RS, Henderson PA. Control of marrow production by level of iron supply. J Clin Invest 1969;48:454-60.
Wang C, Graham DJ, Kane RC, et al. Comparative risk of anaphylactic reactions associated with intravenous iron products. JAMA 2015;314:2062-8.
Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A. The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clin Proc 2015;90:12-23.
Malek A. In vitro studies of ferric carboxymaltose on placental permeability using the dual perfusion model of human placenta. Arzneimittelforschung 2010;60:354-61.
Alejandra L, Gustavo MH, Nelida P. Analysis of relative cost variations and relative effectiveness of anemia treatment via alternate methods of iron administration. J Health Care Finance 2016;42.
Selma A, Skupski B, Prasad N, Tsai T. Intravenous iron infusion as an alternative to blood transfusion in severely anemic gynecologic patients. Obstet Gynecol 2016;127:140S.
Fragoulakis V, Kourlaba G, Goumenos D, Konstantoulakis M, Maniadakis N. Economic evaluation of intravenous iron treatments in the management of anemia patients in Greece. Clinicoecon Outcomes Res 2012;4:127-34.
Brock E, Braunhofer P, Troxler J, Schneider H. Budget impact of parenteral iron treatment of iron deficiency: methodological issues raised by using real-life data. Eur J Health Econ 2014;15:907-16.
Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Pract Res Obstet Gynaecol 2017;40:55-67.
Beris P, Maniatis A; NATA Working Group on Intravenous Iron Therapy. Guidelines on intravenous iron supplementation in surgery and obstetrics/gynecology. Transfus Altern Transfus Med 2007;9(Suppl 1):29.
Aetna Clinical Policy Bulletin Number: 0575. Intravenous iron therapy. Pennsylvania Medicaid; 2017.
Breymann C, Bian XM, Blanco-Capito LR, Chong C, Mahmud G, Rehman R. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med 2011;39:113-21.
Bergmann RL, Dudenhausen JW, Ennen JC, et al. Diagnostik und Behandlung der Anamie und des Eisenmangels in der Schwangerschaft und im Wochenbett. Literaturuberblick und Empfehlungen [in German]. Geburtsh Frauenheilk 2009;69:682-6.
Breymann C, Honegger C, Holzgreve W, Surbek D. Diagnosis and treatment of iron-deficiency anaemia during pregnancy and postpartum. Arch Gynecol Obstet 2010;282:577-80.
Antenatal care anaemia: screening and management during pregnancy. Department of Health Western Australia 2015. CMP 1.14.
Iron Deficiency Anaemia Clinical Practice Guideline | March 2018. Toward Optimized Practice. Alberta, Canada.
Intravenous iron for severe iron deficiency. Therapeutics Initiative. The University of British Columbia; 2016.
Rampton D, Folkersen J, Fishbane S, et al. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica 2014;99:1671-6.
Package leaflet: Information for the user. Monofer® 100 mg/ml solution for injection/infusion. Pharmacosmos, Holbaek,
Denmark.
Package leaflet: Information for the patient. Ferinject 50 mg iron/mL solution for injection/infusion (Ferric carboxymaltose). Vifor Pharma UK Limited, Surrey, UK.
Kitsati N, Liakos D, Ermeidi E, et al. Rapid elevation of transferrin saturation and serum hepcidin concentration in hemodialysis patients after intravenous iron infusion. Haematologica 2015;100:e80-3.
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