DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20210190

Iron therapy in pregnant women with iron deficiency anemia: a meta-analysis

Anusha Natarajan, Priyadarsini Baskaran

Abstract


Background: Pregnancy significantly increases the need for iron. The prevalence of anemia in pregnant women is high, affecting 41.8% of all pregnant women worldwide. In patients with low tolerance to oral iron, it is recommended to start them on parenteral iron therapy but with variable degree of efficacy. Hence this meta-analysis was done with the following aim. This study aimed to assess the efficacy of various iron preparations in pregnant women with iron deficiency anemia (IDA).

Methods: Randomised controlled trials (RCTs) (available as full free text) which included iron therapy in pregnant women with iron deficiency anemia were retrieved from electronic databases viz. PubMed, Google scholar and IndMed, with specific search terms. Qualities of RCTs were assessed using JADAD score and four RCTs with high score were included for analysis using RevMan 5.3 software. Outcome measures were change in hemoglobin levels and serum ferritin concentration after one month of therapy.

Results: In the four RCTs included, a total of 267 patients were treated with oral iron and 267 patients were treated with parenteral iron therapy. Change in the hemoglobin levels between the 2 groups had a standard mean difference of 0.73, 95% CI (-0.05-1.52), with the p-value of 0.07. To assess the change in the serum ferritin concentration a total of 188 patients in oral iron and 197 patients in parenteral iron therapy were included. There was a standard mean difference of 0.88, 95% CI (0.60-1.66), with a p value of<0.00001.

Conclusions: In the present meta-analysis we found that oral and parenteral iron therapy showed similar efficacy in improving the hemoglobin level in pregnant women.


Keywords


Iron therapy, Pregnancy, Meta-analysis

Full Text:

PDF

References


Hercberg S, Galan P, Prual A, Preziosi P. Epidemiology of iron deficiency and iron deficiency anemia in the French population. Ann Biol Clin 1998;56:49-52.

Breymann C, Milman N, Mezzacasa A, Bernard R, Dudenhausen J. Ferric carboxymaltose vs. oral iron in the treatment of pregnant women with iron deficiency anemia: an international, open-label, randomized controlled trial (FER-ASAP). Journal of Perinatal Medicine. 2017;45(4).

de Benoist B, McLean E, Egli I, Cogswell M, (eds). Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia. 2008. Available at: http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf. Accessed on 20 June 2020.

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.

Khalafallah AA, Dennis AE. Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy. 2012;2012:630519.

Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol. 2008;87:949–59.

Jadad Scale>Score Calculator. Tools.farmacologiaclinica.info. Available from: http://tools.farmacologiaclinica.info/index.php?sid=36287. Accessed on 20 May 2020.

Bayoumeu F, Subiran-Buisset C, Baka N, Legagneur H, Monnier-Barbarino P, Laxenaire M. Iron therapy in iron deficiency anemia in pregnancy: Intravenous route versus oral route. American Journal of Obstetrics and Gynecology. 2002;186(3):518-22.