The role of intravenous iron sucrose treatment in patients with iron deficiency anemia in pregnancy: A prospective controlled cohort study

Yıl 2019, , 78 - 81, 27.01.2019

Mefkure Eraslan Şahin , İlknur Çöl Madendağ

https://doi.org/10.28982/josam.516563

Cited By: 1

Öz

Aim: Iron deficiency anemia is the most common nutritional disorder in pregnancy and approximately 40% of all pregnant women are complicated with perinatal morbidity and mortality. In this work, the efficacy of intravenous iron sucrose and oral iron hydroxypolymaltose is compared in third-trimester pregnancies with iron deficiency anemia.

Methods: A prospective cohort study is planned. A total of 140 pregnant women were enrolled in the study in two groups. The first group consisted of patients who could not tolerate oral iron therapy and were treated with intravenous iron sucrose and the second group was composed of patients who used oral iron III hydroxy polymaltose for anemia treatment in third trimester.. The treatment effects of blood count parameters were compared between groups.

Results: Demographic and baseline characteristics were similar in both groups. Mean hemoglobin levels before treatment were 9.03±0.47 g/L in the intravenous treatment group and 8.82±0.39 g/L in the oral treatment group. 30 days after treatment, the mean hemoglobin levels were 10.7±0.55 g/L in the intravenous treatment group and 10.9±0.58 g/L in the oral treatment group. Before delivery, the mean hemoglobin levels were 11.38±0.56 g/L in the intravenous treatment group and 11.35±0.47 g/L in the oral treatment group. There was no significant difference between groups for hemoglobin levels before treatment, 30 days after treatment, and before delivery (p=0.355, p=0.513, and p=0.975, respectively). The mean mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) levels were not statistically different between groups before treatment, 30 days after treatment, and before delivery.

Conclusions: Intravenous administration of iron sucrose is an alternative to blood transfusion for the treatment of pregnant women with iron deficiency anemia during the third trimester.

Anahtar Kelimeler

Iron sucrose, Iron deficiency anemia, Third-trimester pregnancy

Gebelikte demir eksikliği anemisi olan hastalarda intravenöz demir sükroz tedavisinin rolü: Prospektif kontrollü kohort çalışması

Öz

Amaç: Demir eksikliği anemisi gebelikte en sık görülen beslenme bozukluğudur ve tüm gebelerin yaklaşık% 40'ı anemi nedeni ile perinatal morbidite ve mortalite ile komplikedir. Bu çalışmada, demir eksikliği anemisi olan üçüncü trimester gebeliklerde intravenöz demir sukroz ve oral demir hidroksipolizmaltozun etkinliği karşılaştırıldı.

Yöntemler: Prospektif bir kohort çalışması planlandı. Çalışmaya iki grupta toplam 140 hamile kadın alındı. Birinci grup oral demir tedavisini tolere edemeyen ve intravenöz demir sukroz ile tedavi edilen ve ikinci grup üçüncü trimesterde anemi tedavisi için oral demir III hidroksi polmaltoz kullanan hastalardan oluşuyordu. Kan sayımı parametrelerinin tedavi etkileri. gruplar arasında karşılaştırıldı.

Bulgular: Demografik ve bazal özellikler her iki grupta da benzerdi. Tedavi öncesi ortalama hemoglobin düzeyleri intravenöz tedavi grubunda 9.03±0.47 g / L, oral tedavi grubunda 8.82±0.39 g / L idi. Tedaviden 30 gün sonra, ortalama hemoglobin düzeyleri intravenöz tedavi grubunda 10.7±0.55 g / L, oral tedavi grubunda 10.9±0.58 g / L idi. Doğum öncesi ortalama hemoglobin düzeyleri intravenöz tedavi grubunda 11.38±0.56 g / L, oral tedavi grubunda 11.35±0.47 g / L idi. Gruplar arasında hemoglobin düzeyleri açısından tedaviden önce, tedaviden 30 gün sonra ve doğumdan önce anlamlı fark yoktu (sırasıyla p = 0.355, p = 0.513 ve p = 0.975). Ortalama korpüsküler hakim (MCV), ortalama korpüsküler hemoglobin (MCH) ve ortalama korpüsküler hemoglobin konsantrasyonu (MCHC) seviyeleri, tedaviden önce, tedaviden 30 gün sonra ve doğumdan önce gruplar arasında istatistiksel olarak farklı değildi.

Sonuçlar: İntravenöz demir sukroz uygulaması, üçüncü trimesterde demir eksikliği anemili gebelerin tedavisinde kan transfüzyonuna bir alternatiftir

Anahtar Kelimeler

Demir sukroz, Demir eksikliği anemisi, Üçüncü trimester gebelik

Kaynakça

• 1. Stevens GA, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013 Jul;1(1):e16-25. doi: 10.1016/S2214-109X(13)70001-9. PubMed PMID: 25103581; PubMed Central PMCID: PMC4547326.
• 2. Haider BA, Olofin I, Wang M, et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ (Clinical research ed). 2013 Jun 21;346:f3443. doi: 10.1136/bmj.f3443. PubMed PMID: 23794316; PubMed Central PMCID: PMC3689887. eng.
• 3. Steer P, Alam MA, Wadsworth J, et al. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ (Clinical research ed). 1995 Feb 25;310(6978):489-91. PubMed PMID: 7888886; PubMed Central PMCID: PMC2548871. eng.
• 4. Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth. 2017 May 8;17(1):137. doi: 10.1186/s12884-017-1313-9. PubMed PMID: 28482869; PubMed Central PMCID: PMC5422878.
• 5. Qassim A, Mol BW, Grivell RM, et al. Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review. Aust N Z J Obstet Gynaecol. 2018 Feb;58(1):22-39. doi: 10.1111/ajo.12695. PubMed PMID: 28921558.
• 6. Froessler B, Cocchiaro C, Saadat-Gilani K, et al. Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: a randomized trial. J Matern Fetal Neonatal Med. 2013 May;26(7):654-9. doi: 10.3109/14767058.2012.746299. PubMed PMID: 23130909.
• 7. Gupta A, Manaktala U, Rathore AM. A randomised controlled trial to compare intravenous iron sucrose and oral iron in treatment of iron deficiency anemia in pregnancy. Indian J Hematol Blood Transfus. 2014 Jun;30(2):120-5. doi: 10.1007/s12288-012-0224-1. PubMed PMID: 24839366; PubMed Central PMCID: PMC4022911.
• 8. Dhanani JV, Ganguly BP, Chauhan LN. Comparison of efficacy and safety of two parenteral iron preparations in pregnant women. J Pharmacol Pharmacother. 2012 Oct;3(4):314-9. doi: 10.4103/0976-500X.103688. PubMed PMID: 23326102; PubMed Central PMCID: PMC3543551.
• 9. Singla PN, Tyagi M, Shankar R, et al. Fetal iron status in maternal anemia. Acta Paediatr. 1996 Nov;85(11):1327-30. PubMed PMID: 8955460.
• 10. Blot I, Diallo D, Tchernia G. Iron deficiency in pregnancy: effects on the newborn. Curr Opin Hematol. 1999 Mar;6(2):65-70. PubMed PMID: 10088634.
• 11. Patra S, Pasrija S, Trivedi SS, et al. Maternal and perinatal outcome in patients with severe anemia in pregnancy. Int J Gynaecol Obstet. 2005 Nov;91(2):164-5. doi: 10.1016/j.ijgo.2005.07.008. PubMed PMID: 16125707.
• 12. Khalafallah A, Dennis A, Bates J, et al. A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Intern Med. 2010 Sep;268(3):286-95. doi: 10.1111/j.1365-2796.2010.02251.x. PubMed PMID: 20546462.
• 13. Kalaivani K. Prevalence & consequences of anaemia in pregnancy. The Indian journal of medical research. 2009 Nov;130(5):627-33. PubMed PMID: 20090119; eng.
• 14. Bashiri A, Burstein E, Sheiner E, et al. Anemia during pregnancy and treatment with intravenous iron: review of the literature. Eur J Obstet Gynecol Reprod Biol. 2003 Sep 10;110(1):2-7. PubMed PMID: 12932861.
• 15. Stein J, Hartmann F, Dignass AU. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010 Nov;7(11):599-610. doi: 10.1038/nrgastro.2010.151. PubMed PMID: 20924367.
• 16. Gupta A, Rathore AM, Manaktala U, et al. Role of intravenous iron sucrose in correction of anemia in antenatal women with advanced pregnancy. Indian J Hematol Blood Transfus. 2015 Jun;31(2):251-4. doi: 10.1007/s12288-014-0443-8. PubMed PMID: 25825567; PubMed Central PMCID: PMC4375145.
• 17. Kriplani A, Mahey R, Dash BB, et al. Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy. The Indian journal of medical research. 2013;138:78-82. PubMed PMID: 24056559; PubMed Central PMCID: PMC3767254.
• 18. Kochhar PK, Kaundal A, Ghosh P. Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. The journal of obstetrics and gynaecology research. 2013 Feb;39(2):504-10. doi: 10.1111/j.1447-0756.2012.01982.x. PubMed PMID: 22925176.
• 19. Al RA, Unlubilgin E, Kandemir O, et al. Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial. Obstet Gynecol. 2005 Dec;106(6):1335-40. doi: 10.1097/01.AOG.0000185260.82466.b4. PubMed PMID: 16319260.
• 20. Shafi D, Purandare SV, Sathe AV. Iron deficiency anemia in pregnancy: intravenous versus oral route. J Obstet Gynaecol India. 2012 Jun;62(3):317-21. doi: 10.1007/s13224-012-0222-0. PubMed PMID: 23730037; PubMed Central PMCID: PMC3444565.
• 21. Bencaiova G, von Mandach U, Zimmermann R. Iron prophylaxis in pregnancy: intravenous route versus oral route. Eur J Obstet Gynecol Reprod Biol. 2009 Jun;144(2):135-9. doi: 10.1016/j.ejogrb.2009.03.006. PubMed PMID: 19406557.
• 22. Johnson CA, Mason NA, Bailie GR. Intravenous iron products. ANNA J. 1999 Oct;26(5):522-4. PubMed PMID: 10776081.
• 23. Silverstein SB, Rodgers GM. Parenteral iron therapy options. Am J Hematol. 2004 May;76(1):74-8. doi: 10.1002/ajh.20056. PubMed PMID: 15114602.
• 24. 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 (Clinical research ed). 2013 Aug 15;347:f4822. doi: 10.1136/bmj.f4822. PubMed PMID: 23950195; PubMed Central PMCID: PMC3805480.