DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20220179
Published: 2022-01-28

Comparative study of intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy

Ferdousi Khatun, Chandralekha Biswas

Abstract


Background: Iron deficiency anaemia is the most common anaemia with significant effect over health status. It is a major hematological, nutritional deficiency but manageable health problem among the pregnant women. Anaemia during pregnancy is associated with increased morbidity and mortality of pregnant women and their developing foetuses. In pregnant women, oral iron is often used for prophylaxis and is recommended as first-line treatment for iron deficiency anaemia in pregnancy. Intravenous (i.v.) iron preparations provide greater and more rapid repletion of iron stores than oral iron.

Methods: This is a prospective, single center, comparative interventional randomized hospital based study carried among antenatal mother admitted in antenatal ward in the department Obstetrics and Gynaecology, Medical college and hospital, Kolkata from 1st January 2019 to 30th June 2020 (one and half year duration), comprised of 180 pregnant women divided two groups. Group- A (90) received ferric carboxymaltose (FCM), group- B (90) received iron sucrose. All pregnant women between 16 to 34 weeks of gestation with iron deficiency anaemia with hemoglobin values between 7-10 gm%, were counselled and included. Medical eligibility criteria were used for client selection.

Results: In FCM group 3 week post treatment hemoglobin level was 9.87±0.77 and in iron sucrose group it was 9.39±0.72 (p=0.001). 6 week post treatment hemoglobin level in FCM group was 11.51±0.76 and in iron sucrose group it was 10.78±0.61 (p=0.001). Mean change in hemoglobin in FCM group after 3 week post treatment was 1.51±0.63   and after 6 week it was 3.15±0.79. In iron sucrose group at 3 week it was 1.16±0.43 and at 6 week it was 2.55±0.52. The mean change in hemoglobin level was higher among patients of FCM compared to Iron sucrose group.

Conclusions: Ferric carboxymaltose was safer and more efficient in treatment of iron deficiency anaemia in pregnant women as compared to iron sucrose with lesser adverse effect and better patient compliance.


Keywords


Ferric carboxymaltose, Iron deficiency anaemia, Iron sucrose

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References


FOGSI General Clinical Practice Recommendations. Management of iron deficiency anaemia in pregnancy. 2016. Available from: https://www.fogsi.org/wp-content/uploads/2016/05/The-evidence-base_IDA-Pregnancy-24-May-2016-Clean.pdf. Accessed on 3 May 2020.

Ezatti M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL. Comparative risk assessment collaborating group. Selected major risk factors and global and regional burden of disease. Lancet Lond Engl. 2002;360(9343):1347-60.

Singh P, Tuteja GS. Micronutrient profile of Indian children and women: summary of available data for iron and vitamin A. Indian Pediatr. 2003;40(5):477-9.

Galan P, Yoon HC, Preziosi P, Viteri F, Valeix P, Fieux B, et al. Determining factors in the iron status of adult women in the SU. VI. MAX study. Eur J Clin Nutr. 1998;52(6):383-8.

Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N. Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation, Acta Obstet Gynecol Scand. 1999;78(9):749-57.

Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005;81(5):218s-1222s.

Arnold DL, Williams MA, Miller RS, Qiu C, Sorensen TK. Iron deficiency anemia, cigarette smoking and risk of abrupti placentae. J Obstet Gynaecol Res. 2009;35(3):446-52.

Breymann C, Honegger C, Holzgreve W, Surbek D. Diagnosis and treatment of iron-deficiency anemia during pregnancy and postpartum. Arch Gynecol Obstet. 2010;282(5):577-80.

Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol. 2008;87(12):949-59.

Beris P, Maniatis A. Guidelines on intravenous iron supplementation in surgery and obstetrics/gynecology. Transfus Alternat Transfus Med. 2007;9:29-30.

Kriplani A, Mahey R, Dash BB, Kulshreshta V, Agarwal N, Bhatia N, Intravenous iron sucrose therapy for moderate anemia to severe anemia in pregnancy. Indian J Med Res. 2013;38:78.

Geisser P. The pharmacology and safety profile of ferric carboxymaltose (Ferinject): structure/reactivity relationships of iron preparations. Portuguese J Nephrol Hypertens. 2009;23(1):11-21.

Bhavi SB, Jaju PB. Intravenous iron sucrose versus oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth. 2017;17(1):1-6.

Mekonnen FA, Ambaw YA, Neri GT. Socio-economic determinants of anemia in pregnancy in North Shoa Zone, Ethiopia. PLoS One. 2018;13(8).

Uche-Nwachi EO, Odekunle A, Jacinto S, Burnett M, Clapperton M, David Y, et al. Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago. Afr Health Sci. 2010;10(1):66-70.

Lazović N, Pocekovac P. The importance of time intervals between childbirth and anemia in pregnancy. Srp Arh Celok Lek. 1996;124(11-12):307-10.

Lunagariya M, Nakum KD, Vithal A, Patel J, Patel M. Iron sucrose versus ferric carboxymaltose: in search of better treatment option in cases of post-partum iron deficiency anemia. Int J Contemp Med Res. 2018;5(1):12-6.

Noronha JA, Bhaduri A, Bhat HV. Prevalence of anaemia among pregnant women: a community based study in Udupi District. Health Popul Perspect Issues. 2008;31(1):31-40.

Singh H. Pregnancy-how effective is intravenous iron sucrose therapy? Int J Rec Scient. 2015;6(7):4900-7.

Garg R, Nigam A, Agrawal P, Nigam A, Agrawal R. Iron carboxymaltose: a safe and effective molecule to combat anaemia in pregnancy. Int J Curr Res Aca. 2016;4(2):124-30.

Kumari S, Singh SHK. Iron sucrose or ferric carboxy maltose: comparative study for treatment of post-partum iron deficiency anemia. Int J Med Res Prof. 2019;5(1):157-62.

Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: Intravenous route verses oral route. Am J Obstet Gynecol. 2002;186(3):518-22.

VanWyck DB, Martens MG, Seid MH, Baker JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anaemia: a randomized controlled trial. Obstet Gynecol. 2007;110:267-78.

Jose A, Mahey R, Sharma JB, Bhatla N, Saxena R, Kalaivani M, et al. Comparison of ferric Carboxymaltose and iron sucrose complex for treatment of iron deficiency anemia in pregnancy-randomised controlled trial. BMC Pregnancy Childbirth. 2019;19(1):1-8.

Khan S, Gupta S. A comparative study of injection ferric carboxymaltose and iron sucrose in anaemia complicating pregnancy. Int J Contemp Med Res. 2019;6(8).

Sumathy C, Arulmozhi V. Comparative study of intravenous ferric carboxymaltose and iron sucrose in the management of iron deficiency anemia. Paripex Indian J Res. 2017;6(4):91-4.

Giannoulis C, Danniilides A, Tantanasis T, Dinas K, Tzafettas J. Intravenous administration of iron sucrose for treating anaemia in postpartum women. Hippokratia. 2009;13(1):38-40.

Patel J, Patel K, Patel J, Sharma A, Date SK. Comparison of intravenous iron sucrose and ferric carboxymaltose therapy in iron deficiency anemia during pregnancy and postpartum period. J Pharm Sci Bioscient Res. 2015;5(3):239-43.

Kharde PS, Bangal BV, Panicker KK. Comparative study of intravenous iron sucrose versus oral iron therapy in iron deficiency anemia during postpartum period. IJBAR. 2012;3(4):238-43.

Neogi SB, Devasenapathy N, Singh R, Bhushan H, Shah D, Divakar H, et al. Safety and effectiveness of intravenous iron sucrose vs standard oral iron therapy in pregnant women with moderate to severe anemia in India. Lancet. 2019;7(12):1706-16.

Malek A. In vitro studies of ferric carboxymaltose on placenta permeability using the dual perfusion model of human placenta. Arzneimittelforschung. 2010;60(6a):354.61

Khalafallah A, Dennis A, Bates J, Bates G, Robertson IK, Smith L, et al. A prospective randomized controlled trial on intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Intern Med. 2010;268:286-95.

Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anaemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199(4):435.e1-7.