Recent updates in the management of iron deficiency anemia in Indian patients: literature review and expert opinion

Authors

  • Chandrika Anand PCOS Centre, Saraswati Clinic, Padmashree Institute of Clinical Research, Bangalore, Karnataka, India
  • Rakhi Singh Abalone Clinic and IVF Center, Noida, Uttar Pradesh, India
  • Varsha Tiwari Department of Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India
  • Monil Gala Department of Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India
  • Snehal Muchhala Department of Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India
  • Bhavesh Kotak Department of Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20250217

Keywords:

Ferric carboxymaltose, Intravenous iron, Iron deficiency anemia, Oral iron, Pregnancy

Abstract

Iron deficiency anemia (IDA) is a global issue, particularly affecting pregnant women and children in India. It can lead to severe outcomes such as preterm birth, low birth weight, and increased maternal and perinatal risks. An expert panel of Indian obstetrics and gynecology specialists reviewed the literature and proposed recommendations on IDA's prevalence, diagnosis, management, and challenges such as healthcare access, patient education, and awareness. Management strategies for IDA include dietary adjustments and lifestyle changes, alongside pharmacological treatments, including oral and parenteral iron therapy. Oral iron, though accessible, can cause gastrointestinal side effects, and prevailing misconceptions about its impact on fetal growth affect adherence. Intravenous (IV) iron administration should be considered for patients who experience intolerance, poor adherence, or lack of efficacy with oral iron. Ferric carboxymaltose, a newer IV formulation, is gaining popularity due to its rapid iron replenishment, efficacy and safety, single infusion convenience, and cost-effectiveness in treating pregnant women. Public health initiatives in India like National Nutritional Anemia Control Program and Anemia Mukt Bharat aim to reduce IDA through supplementation programs and education. However, challenges like low adherence to iron supplementation, parasitic infections, and micronutrient deficiencies remain. Overcoming these requires a comprehensive approach, including patient education and effective public health strategies. According to the expert recommendations, managing IDA during pregnancy is vital for maternal and fetal health. A combination of dietary modifications, pharmacological treatments, and public health interventions is crucial to combat this prevalent condition in India and improve maternal and fetal health outcomes.

 

Metrics

Metrics Loading ...

References

World Health Organization. Anemia. 2023. Available at: https://www.who.int/news-room/fact-sheets/ detail/anaemia. Accessed on 11 November 2024.

Belali TM. Iron deficiency anaemia: prevalence and associated factors among residents of northern Asir Region, Saudi Arabia. Sci Rep. 2022;12(1):19170. DOI: https://doi.org/10.1038/s41598-022-23969-1

Collaborators GBD 2021. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9):e713-34.

Natekar P, Deshmukh C, Limaye D, Ramanathan V, Pawar A. A micro review of a nutritional public health challenge: iron deficiency anemia in India. Clin Epidemiol Glob Health. 2022;14:100992. DOI: https://doi.org/10.1016/j.cegh.2022.100992

Maji I, Randhawa JK, Bakshi D, Gautam D, Mishra SS. Status of Anaemia amongst women in India: trend analysis of NFHS data. Indian J Community Health. 2023;35(3):354-8. DOI: https://doi.org/10.47203/IJCH.2023.v35i03.019

Ministry of Health and Family Welfare. Anaemia Mukt Bharat. 2022. Available at: Https://Pib.Gov.in /PressReleasePage.Aspx?PRID=1795421#:~:Text=The%20prevalence%20of%20anaemia%20among,(15%2D49%20years). Accessed on 11 July 2024.

Garzon S, Cacciato PM, Certelli C, Salvaggio C, Magliarditi M, Rizzo G. Iron deficiency anemia in pregnancy: Novel approaches for an old problem. Oman Med J. 2020;35(5):e166. DOI: https://doi.org/10.5001/omj.2020.108

Tandon R, Jain A, Malhotra P. Management of iron deficiency anemia in pregnancy in India. Indian J Hematol Blood Transfus. 2018;34:204-15. DOI: https://doi.org/10.1007/s12288-018-0949-6

Talin IA, Abid MH, Samad MA, Domínguez Azpíroz I, de la Torre Diez I, Ashraf I, et al. Exploring factors influencing the severity of pregnancy anemia in India: a study using proportional odds model. Sci Rep. 2023;13(1):22816. DOI: https://doi.org/10.1038/s41598-023-49872-x

Hess SY, Owais A, Jefferds MED, Young MF, Cahill A, Rogers LM. Accelerating action to reduce anemia: Review of causes and risk factors and related data needs. Ann N Y Acad Sci. 2023;1523(1):11-23. DOI: https://doi.org/10.1111/nyas.14985

Player J. Healthcare Access in Rural Communities in India. Ballard Brief. 2019;2019(3):1.

Gupta P, Paul V. A review on causes of micronutrient (Iron) deficiency in India and it’s treatments. J Pharmacogn Phytochem. 2018;7(4):2417-20.

Kumar SB, Arnipalli SR, Mehta P, Carrau S, Ziouzenkova O. Iron deficiency anemia: efficacy and limitations of nutritional and comprehensive mitigation strategies. Nutrients. 2022;14(14):2976. DOI: https://doi.org/10.3390/nu14142976

Zaman B, Rasool S, Jasim S, Abdulah D. Hepcidin as a diagnostic biomarker of iron deficiency anemia during pregnancy. J Maternal-Fetal Neonatal Med. 2021;34(8):1288-96. DOI: https://doi.org/10.1080/14767058.2019.1635112

Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ Open Gastroenterol. 2022;9(1):e000759. DOI: https://doi.org/10.1136/bmjgast-2021-000759

Knovich MA, Storey JA, Coffman LG, Torti S V, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95-104. DOI: https://doi.org/10.1016/j.blre.2008.08.001

Al-Naseem A, Sallam A, Choudhury S, Thachil J. Iron deficiency without anaemia: a diagnosis that matters. Clin Med. 2021;21(2):107-13. DOI: https://doi.org/10.7861/clinmed.2020-0582

Dev S, Babitt JL. Overview of iron metabolism in health and disease. Hemodialysis Int. 2017;21:S6-20. DOI: https://doi.org/10.1111/hdi.12542

Andrews NC, Schmidt PJ. Iron homeostasis. Annu Rev Physiol. 2007;69(1):69-85. DOI: https://doi.org/10.1146/annurev.physiol.69.031905.164337

Andrews NC. Disorders of iron metabolism. N Engl J Med. 1999;341(26):1986-95. DOI: https://doi.org/10.1056/NEJM199912233412607

Anderson GJ, Frazer DM. Hepatic iron metabolism. In: Seminars in Liver Disease. Thieme Medical Publishers, Inc. 2005;420-32. DOI: https://doi.org/10.1055/s-2005-923314

Roy CN, Andrews NC. Anemia of inflammation: the hepcidin link. Curr Opin Hematol. 2005;12(2):107-11. DOI: https://doi.org/10.1097/00062752-200503000-00001

Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013;87(2):98-104.

Warner MJ, Kamran MT. Iron Deficiency Anemia. StatPearls Publishing, Treasure Island (FL). 2023.

Iron Deficiency Anaemia: Managing Symptoms and Supporting Self-Care: A Handbook for Pharmacists 2024 FIP Development Goals. 2024. Available at: www.fip.org. Accessed on 18 September 2024.

Alka Kriplani C, Professor F, Teg Bahadur Hospital G, Ali Rizvi Z. PFOGSI General Clinical Practice Recommendations Management of Iron Deficiency Anemia in Pregnancy. 2017. Available at: Https://Www.Fogsi.Org/Wp-Content/Uploads/2017/ 07/Gcpr-Recommendation-Ida-02.Pdf. Accessed on 18 September 2024.

Cappellini MD, Musallam KM, Taher AT. Iron deficiency anaemia revisited. J Intern Med. 2020;287(2):153-70. DOI: https://doi.org/10.1111/joim.13004

Boone S, Powers JM, Goodgame B, Peacock WF. Identification and management of iron deficiency anemia in the emergency department. J Emerg Med. 2019;57(5):637-45. DOI: https://doi.org/10.1016/j.jemermed.2019.08.052

Okam MM, Koch TA, Tran MH. Iron supplementation, response in iron-deficiency anemia: analysis of five trials. Am J Med. 2017;130(8):991. DOI: https://doi.org/10.1016/j.amjmed.2017.03.045

Snook J, Bhala N, Beales ILP, Cannings D, Kightley C, Logan RP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021;70(11):2030-51. DOI: https://doi.org/10.1136/gutjnl-2021-325210

NHS Oxford University Hospitals-NHS Foundation Trust. Taking Iron Supplements Information for Patients. 2024. Available at: https://www.ouh.nhs. uk/patient-guide/leaflets/files/11903Piron.pdf. Accessed on 18 September 2024.

Govindappagari S, Burwick RM. Treatment of iron deficiency anemia in pregnancy with intravenous versus oral iron: systematic review and meta-analysis. Am J Perinatol. 2019;36(04):366-76. DOI: https://doi.org/10.1055/s-0038-1668555

Numan S, Kaluza K. Systematic review of guidelines for the diagnosis and treatment of iron deficiency anemia using intravenous iron across multiple indications. Curr Med Res Opin. 2020;36(11):1769-82. DOI: https://doi.org/10.1080/03007995.2020.1824898

Bharadwaj MK, Patrikar S, Singh Y. Comparative Analysis of Injection Ferric Carboxymaltose vs Iron Sucrose for Treatment of Iron-deficiency Anemia in Pregnancy: Systematic Review and Meta-analysis. J South Asian Federation Obstet Gynaecol. 2023;15(5):629-36. DOI: https://doi.org/10.5005/jp-journals-10006-2311

Parikh A, Agarwal S. Intravenous ferric carboxymaltose versus iron sucrose in iron deficiency anemia of pregnancy. IJOGR. 2022;9:10-4. DOI: https://doi.org/10.18231/j.ijogr.2022.003

Trivedi P, Chitra S, Natarajan S, Amin V, Sud S, Vyas P, et al. Ferric Carboxymaltose in the Management of Iron Deficiency Anemia in Pregnancy: A Subgroup Analysis of a Multicenter Real‐World Study Involving 1191 Pregnant Women. Obstet Gynecol Int. 2022;2022(1):5759740. DOI: https://doi.org/10.1155/2022/5759740

Mahapatra PC, Gupte S, Gopinath PM. Ferric carboxymaltose for the treatment of anemia during antenatal and postpartum period: expert opinion. J South Asian Federation Obstet Gynaecol. 2022;14(3):292-301. DOI: https://doi.org/10.5005/jp-journals-10006-2026

Kapil U, Kapil R, Gupta A. National Iron Plus Initiative: Current status & future strategy. Indian J Med Res. 2019;150(3):239-47.

Rai RK, Fawzi WW, Barik A, Chowdhury A. The burden of iron-deficiency anaemia among women in India: how have iron and folic acid interventions fared? WHO South East Asia J Public Health. 2018;7(1):18-23. DOI: https://doi.org/10.4103/2224-3151.228423

Kapil U, Kapil R, Gupta A. National Iron Plus Initiative: current status & future strategy. Indian J Med Res. 2019;150(3):239-47. DOI: https://doi.org/10.4103/ijmr.IJMR_1782_18

Sedlander E, Long MW, Mohanty S, Munjral A, Bingenheimer JB, Yilma H, et al. Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India. BMC Public Health. 2020;20(1):457. DOI: https://doi.org/10.1186/s12889-020-08574-z

Rakanita Y, Sinuraya RK, Suradji EW, Suwantika AA, Syamsunarno MRAA, Abdulah R. The Challenges in Eradication of Iron Deficiency Anemia in Developing Countries. Systemat Rev Pharm. 2020;11(5).

Banerjee S. Empowering Women through Awareness of Consuming More Traditional Food for Reduction of Iron-Deficiency Anemia. J Women Empowerment Stud. 2023;3(1):31-5. DOI: https://doi.org/10.55529/jwes.31.31.35

Mishra A, Marwah S, Divedi P, Dewan R, Ahluwalia H. A cross-sectional study of barriers in prevention of anemia in pregnancy. Cureus. 2021;13(1):e12802. DOI: https://doi.org/10.7759/cureus.12802

Besarab A, Hemmerich S. Iron-deficiency anemia. Management of Anemia: A Comprehensive Guide for Clinicians. 2018;11-29. DOI: https://doi.org/10.1007/978-1-4939-7360-6_2

Camaschella C. Iron deficiency. Blood. J Am Soc Hematol. 2019;133(1):30-9. DOI: https://doi.org/10.1182/blood-2018-05-815944

Alharbi AA, Alharbi AA, Bashen DS, Owaidah T. Evaluation of Minimal Optimal Dose of Intravenous Ferric Carboxymaltose for Treatment of Iron Deficiency Anemia and Risk of Transient Hyperferritinemia. J Blood Med. 2022;681-90. DOI: https://doi.org/10.2147/JBM.S374780

An R, Huang Y, Man Y, Valentine RW, Kucukal E, Goreke U, et al. Emerging point-of-care technologies for anemia detection. Lab Chip. 2021;21(10):1843-65. DOI: https://doi.org/10.1039/D0LC01235A

Downloads

Published

2025-01-29

How to Cite

Anand, C., Singh, R., Tiwari, V., Gala, M., Muchhala, S., & Kotak, B. (2025). Recent updates in the management of iron deficiency anemia in Indian patients: literature review and expert opinion. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(2), 677–687. https://doi.org/10.18203/2320-1770.ijrcog20250217

Issue

Section

Review Articles