IV Iron Sucrose Alone Seems Effective in Treatment of Postpartum Anemia
Introduction
Postpartum anemia is associated with fatigue, poor cognitive performance, emotional instability and increased risk of postpartum depression. Guidelines recommend that moderate to severe postpartum anemia should be treated with intravenous (IV) iron supplements such as iron sucrose. Oral iron supplements are being prescribed for 6 weeks after delivery. However, there are conflicting results regarding the comparative efficacy of oral and IV iron supplements in the treatment of postpartum anemia. The superiority of one mode of treatment vs the other has not yet been established. A single 500 mg dose of iron sucrose, which is higher than what is usually administered, has not been assessed in parturient women with moderate to severe anemia.
Aim
This study evaluated whether addition of oral iron bisglycinate to IV iron sucrose was more effective than IV iron sucrose alone in the treatment of moderate to severe postpartum anemia.
Method
Study Design
- Prospective randomized controlled study.
Patient Profile
- Women aged >18 years
- Postpartum hemoglobin (Hb) level of ≤9.5 g/dL
Treatment Strategy
- The study population underwent anemia workup, including blood tests for vitamin B12 and folic acid, thyroid, liver and kidney function tests.
- The women were randomized into 2 groups
- IV and oral iron group – received a single dose of 500 mg IV iron sucrose followed by oral 60 mg iron bisglycinate daily for 45 days (n=86)
- Only IV group – received 500 mg IV iron sucrose (n=72)
- Hb levels were measured before delivery and in postpartum period.
Endpoints
Primary Endpoints
- Hb level at 6 weeks after delivery.
Secondary Endpoints
- Serum ferritin levels
- Serum free iron levels
- Transferrin levels
- Quality of life (QoL)
- Adverse events (AEs)
Results
- A total of 107 women completed the study: 63 women in IV + oral iron group and 44 women in the IV iron-only group.
- Baseline and obstetrical characteristics were comparable between the groups.
- At 6 weeks, the IV + oral iron group had a higher increase in Hb levels and higher increase in Hb levels from the lowest measure of Hb after delivery as seen in Table 1.
- There was no statistically significant difference in the rate of women with hemoglobin level of <12.0 or 11.0 g/dL as well as the iron storage parameters as seen in Table 1.
|
|
IV-iron only |
IV and oral iron |
P value |
|
Mean Hb (g/dl) |
12 |
12.4 |
0.03 |
|
Hb increase from baseline (g/dl) |
3.7 |
4.2 |
0.03 |
|
Serum ferritin (ng/ml) |
44 |
85 |
0.26 |
|
Serum iron (mcg/dl) |
62 |
61 |
0.52 |
|
Transferrin (mg/dl) |
261 |
258 |
0.8 |
|
Hb level <12 g/dl |
45% |
32% |
0.15 |
|
Hb level <11 g/dl |
5% |
5% |
1.00 |
- QoL was comparable between the groups.
- The incidence of AEs was 29% with the oral iron treatment, with constipation being the most common, 10% discontinued the treatment due to AEs.
- Both the groups reported high compliance and satisfaction from treatment.
Conclusion
- Oral iron supplementation after intravenous (IV) 500 mg iron sucrose treatment resulted in a marginal increase in the hemoglobin levels at 6 weeks after delivery in women with postpartum anemia.
- Addition of oral iron supplement did not improve the iron storage parameters or quality of life, thereby conferring no clinically significant benefits.
- IV iron sucrose 500 mg alone is effective in treating postpartum anemia.
Am J Obstet Gynecol. 2021 Dec;225(6): 668.e1-668.e9.
Doi: 10.1016/j.ajog.2021.06.069.
