Ferricarboxy maltose to treat iron deficiency anemia in pregnancy: is it a feasible option?

Reema Kumar Bhatt, P. S. Rao, Sanjay Sharma, Chetan Yadav


Background: Iron deficiency is a common cause of anaemia in pregnancy which influences the health of mother and developing fetus. Intravenous (IV) iron preparations are considered, when oral iron therapy is ineffective or intolerant. Ferric carboxymaltose is an IV preparation that can be given with ease of administration and better tolerated. The aim of this study was to assess the efficacy and safety of IV ferric carboxymaltose in pregnant mother with all grades of anemia in the second and third trimester.

Methods: This is a prospective observational study where 44 pregnant women with iron deficiency anemia [IDA] received ferric carboxymaltose up to 15mg/kg in second and third trimester. The parameters that were taken into account, to assess the effectiveness of the treatment was repeat haemoglobin [Hb] measurements and the subjective sense of wellbeing in the patient. The safety of the drug was analysed by continuous fetal heart rate [FHR] monitoring during the infusion and observation of any adverse reactions.

Results: Ferric carboxymaltose intravenous infusion significantly increased Hb levels above baseline values in all women. The Increase in Hb levels were observed at 3- and 6-weeks post infusion therapy. FHR monitoring did not show any drug related unfavourable effect on the fetus. Of the 44 women interviewed, 33 (75%) women reported sense of well-being, 7 (15.9%) women could not feel any difference after the infusion and 4 (9.1%) patients could not comment. No serious adverse effects were noticed but minor side effects occurred in 3 (6.8%) patients.

Conclusions: This prospective study showed safety and efficacy of ferric carboxymaltose in pregnancy with IDA which is consistent with available observational data.


Ferric carboxymaltose, Intravenous iron, Iron deficiency anemia severity, Iron deficiency no anemia, Pregnancy, Safety

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Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135(2):267-72.

WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015

Bergmann RL, Dudenhausen JW, Ennen JC, Kainer F, Rath W, Schmidt S, et al. Diagnosis and treatment of iron deficiency and anaemia during pregnancy and post partum. Obstet Gynecol. 2009;69(08):682-6.

Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low-and middle-income countries: systematic review and meta-analysis. Am J Clin Nut. 2016;103(2):495-504.

Lone FW, Qureshi RN, Emmanuel F. Maternal anaemia and its impact on perinatal outcome in a tertiary care hospital in Pakistan. East Mediterr Health J. 2004;10(6):801-7.

Viteri FE. The consequences of iron deficiency and anaemia in pregnancy on maternal health, the foetus and the infant. Hemoglobin. 1997;90(310):250.

Villar J, Merialdi M, Gulmezoglu AM, Abalos E, Carroli G, Kulier R, et al. Nutritional interventions during pregnancy for the prevention or treatment of maternal morbidity and preterm delivery: an overview of randomized controlled trials. J Nutr. 2003;133(5):1606S-25S.

Reveiz L, Gyte GM, Cuervo LG. Treatments for iron‚Äźdeficiency anaemia in pregnancy. Cochrane Database Syst Rev. 2007(2).

Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133(12):4139-42.

Van Wyck DB, Martens MG, Seid MH, Baker JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstet Gynecol. 2007;110(2):267-78.

Breymann C, Huch R. Anaemia in pregnancy and the puerperium. Uni-Med Verlag; 2008.

Bresani CC, Braga MC, Felisberto DF, Tavares-de-Melo CE, Salvi DB, Batista-Filho M. Accuracy of erythrogram and serum ferritin for the maternal anemia diagnosis (AMA): a phase 3 diagnostic study on prediction of the therapeutic responsiveness to oral iron in pregnancy. BMC Preg Childbirth. 2013;13(1):13.

Bencaiova G, Breymann C. Mild anemia and pregnancy outcome in a swiss collective. J Preg. 2014;2014.

Woteki CE, Earl R, eds. Iron deficiency anemia: recommended guidelines for the prevention, detection, and management among US children and women of childbearing age. National Academies Press; 1994.

Cancelo-Hidalgo MJ, Castelo-Branco C, Palacios S, Haya-Palazuelos J, Ciria-Recasens M, Manasanch J, et al. Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. 2013;29(04):291-303.

Moretti D, Goede JS, Zeder C, Jiskra M, Chatzinakou V, Tjalsma H, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood. 2015;126(17):1981-9.

Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-43.

Chertow GM, Hsu CY, Johansen KL. The enlarging body of evidence: obesity and chronic kidney disease. J Am Soc Nephrol. 2006;17(6):1501-2.

Khalafallah AA, Dennis AE. Iron deficiency anaemia in pregnancy and postpartum: Pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy. 2012;2012:10.

Froessler B, Cocchiaro C, Saadat-Gilani K, Hodyl N, Dekker G. Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: a randomized trial. J Matern Fetal Neonatal Med. 2013;26(7):654-9.

Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anaemia. BJOG. 2006;113(11):1248-52.

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.

Beris P, Maniatis A. On behalf of the NATA working group on intravenous iron therapy. Guidelines on intravenous iron supplementation in surgery and obstetrics/gynecology. Transfus Altern Transfus Med. 2007;9(Suppl 1):29.

Christoph P, Schuller C, Studer H, Irion O, De Tejada BM, Surbek D. Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose vs. iron sucrose. J Perinatal Med. 2012;40(5)469-74.

Naqash A, Ara R, Bader GN. Effectiveness and safety of ferric carboxymaltose compared to iron sucrose in women with iron deficiency anemia: phase IV clinical trials. BMC Women's Health. 2018;18(1):6.

Froessler B, Gajic T, Dekker G, Hodyl N. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet. 2018;298(1):75-82.

Catling S. Blood conservation techniques in obstetrics: a UK perspective. Int J Obstet Anesth. 2007;16(3):241-9.

Roberts CL, Ford JB, Thompson JF, Morris JM. Population rates of haemorrhage and transfusions among obstetric patients in NSW: a short communication. Aus N Z J Obstet Gynaecol. 2009;49(3):296-8.

Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg. 2012;147(1):49-55.

Bonnet MP, Deneux-Tharaux C, Dupont C, Rudigoz RC, Bouvier-Colle MH. Transfusion practices in postpartum hemorrhage: a population-based study. Acta Obstet Gynecol Scand. 2013;92(4):404-13.