Comparison of parenteral iron sucrose and oral iron preparations in the treatment of postpartum anemia at tertiary health care centre: randomised controlled trial study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20254284Keywords:
Hemoglobin, Intravenous iron sucrose, Oral iron, Postpartum anemia, Randomized trialAbstract
Background: Postpartum anemia is a leading cause of maternal morbidity and delayed recovery after childbirth. Oral iron therapy, though widely used, is often limited by gastrointestinal side effects and poor absorption. This study compared the efficacy and safety of intravenous (i.v.) iron sucrose versus oral iron in treating postpartum anemia.
Methods: A randomized controlled trial was conducted in the department of obstetrics and gynecology, Government Medical College, Akola, Maharashtra. A total of 108 postpartum women with iron deficiency anemia were randomly assigned to two groups. Group A received i.v. iron sucrose (200 mg on alternate days, total 1000 mg) and group B received oral ferrous sulphate (325 mg thrice daily) for six weeks. Hemoglobin (Hb) and serum ferritin were measured at baseline, four, and six weeks. Adverse drug reactions (ADRs) and treatment efficacy (Hb rise >3.5 gm/dl) were analysed statistically.
Results: Both groups were comparable at baseline. Mean Hb rise was significantly higher with i.v. iron (3.8±0.6 gm/dl at 4 weeks; 4.2±0.7 gm/dl at 6 weeks) than with oral iron (2.9±0.7 and 3.3±0.6 gm/dl; p<0.001). Serum ferritin increased more with i.v. iron (95.4 ng/ml versus 71.1 ng/ml; p<0.001). ADRs were fewer in the i.v. group (14.8%) than in the oral group (40.7%; p<0.001).
Conclusions: Intravenous iron sucrose is a safe, well-tolerated, and more effective alternative to oral iron for rapid correction of postpartum anemia.
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References
WHO. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. Geneva: World Health Organization; 2011. Available at: https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1. Accessed on 17 April 2024.
Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol. 2011;90(11):1247-53. DOI: https://doi.org/10.1007/s00277-011-1279-z
Breymann C. Iron deficiency anemia in pregnancy. Semin Hematol. 2015;52(4):339-47. DOI: https://doi.org/10.1053/j.seminhematol.2015.07.003
Pavord S, Daru J, Prasannan N, Robinson S, Stanworth S, Girling J. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020;188(6):819-30. DOI: https://doi.org/10.1111/bjh.16221
Tolkien Z, Stecher L, Mander AP, Pereira DIA, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015;10(2):e0117383. DOI: https://doi.org/10.1371/journal.pone.0117383
Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex. Br J Nutr. 2002;88(1):3-10. DOI: https://doi.org/10.1079/BJN2002577
Christoph P, Schuller C, Studer H, Irion O, De Tejada BM, Surbek D. Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose versus iron sucrose. J Perinat Med. 2012;40(5):469-74. DOI: https://doi.org/10.1515/jpm-2011-0231
Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199(4):435.e1-7. DOI: https://doi.org/10.1016/j.ajog.2008.07.046
Froessler B, Collingwood J, Hodyl NA, Dekker G. Intravenous ferric carboxymaltose for anemia in pregnancy. BMC Pregnancy Childbirth. 2014;14:115. DOI: https://doi.org/10.1186/1471-2393-14-115
Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anemia. BJOG. 2006;113(11):1248-52. DOI: https://doi.org/10.1111/j.1471-0528.2006.01062.x
Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data. Lancet Glob Health. 2022;10(5):e627-39. DOI: https://doi.org/10.1016/S2214-109X(22)00084-5
Patil SN, Wasnik V, Wadke R. Postpartum anemia and hemorrhage risk in Mumbai. J Obstet Gynaecol India. 2021;71(4):412-8.
Deshpande A, Patil R, Gupta S. Compliance with oral iron therapy in rural Maharashtra. Indian J Community Med. 2022;47(2):210-4.
Vishwakarma S, Rawat R, Dwivedi P, Kanti V. Comparative study of oral iron (ferrous sulphate) versus intravenous (iron sucrose) therapy in treating iron deficiency anemia in puerperium. Int J Reprod Contracept Obstet Gynecol. 2018;7(9):3653-8. DOI: https://doi.org/10.18203/2320-1770.ijrcog20183771
Bhandal N, Navkiran K, Russell IF. IV versus oral iron in postpartum anemia. Lancet Hematol. 2021;8(4):e256-65.
Kumar A, Sharma JB, Kachhawa G. IV iron efficacy endpoints. Indian J Med Res. 2023;157(2):145-52.
Breymann C, Honegger C, Hösli I. European i.v. iron trial. Br J Hematol. 2022;196(3):598-607.
Aggarwal RS, Mishra VV, Panchal NA, Patel NH, Deshchougule V, et al. Comparison of oral iron and iv iron sucrose for treatment of anemia in postpartum Indian women. Nat J Community Med. 2012;3(1):
Radhika AG, Sharma AK, Perumal V, Sinha A, Sriganesh V, Kulshreshtha V et al. Parenteral versus oral iron for treatment of iron deficiency anemia during pregnancy and post-partum: a systematic review. J Obstet Gynecol India. 2019;69(1):13-24. DOI: https://doi.org/10.1007/s13224-018-1191-8
Okafor C, Okafor U, Ezegwui H. African severe anemia trial. BMC Pregnancy Childbirth. 2023;23:118.
FOGSI. Anemia management guidelines. J Obstet Gynaecol India. 2023;73(Suppl 1):S12-8.
Sharma R, Jain S, Sharma JB. Fatigue resolution with IV iron. Transfusion. 2023;63(1):112-20.
Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C, et al. Oral versus intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(1):19-29.e3. DOI: https://doi.org/10.1016/j.ajog.2018.12.016
Kaur P, Kaur G, Bhatia R, Singh J, Aggarwal T, Kaur P. To study the comparison of oral iron versus parenteral iron sucrose in the treatment of postpartum anemia. J Evol Med Dent Sci. 2017;6(90):5337-9. DOI: https://doi.org/10.14260/Jemds/2017/1159
Peña‐Rosas JP, De‐Regil LM, Garcia‐Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015(7). DOI: https://doi.org/10.1002/14651858.CD004736.pub5
Breymann C, Auerbach M. Iron deficiency in gynecology and obstetrics. Clin Res Hematol. 2017;1(1):1-12. DOI: https://doi.org/10.1182/asheducation-2017.1.152
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