A comparative study of efficacy, safety and compliance of oral iron versus intravenous iron sucrose in treatment of iron deficiency anaemia of pregnancy

Authors

  • Vidya A. Thobbi Department of Obstetrics and Gynecology, Al-Ameen Medical College, Vijayapur, Karnataka, India
  • Zeba Naz M. Bijapur Department of Obstetrics and Gynecology, Al-Ameen Medical College, Vijayapur, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20203495

Keywords:

Ferrous ascorbate, Haemoglobin, Intravenous iron sucrose, Iron deficiency anaemia, Micronutrients deficiency

Abstract

Background: Iron deficiency anemia is the most common form of anemia and nutritional disorder worldwide. Oral iron therapy and blood transfusion has many drawbacks like noncompliance and risk of transmittable infections and transfusion reaction. The modern alternative therapy is treatment with intravenous iron. Present study compares the efficacy, safety and tolerability between intravenous iron sucrose and oral iron in iron deficiency anemia during 20-36 weeks of pregnancy.

Methods: It was a randomized controlled study between December 2017 to September 2019. 200 patients attending antenatal OPD in Al Ameen Medical College, with haemoglobin levels between 7-9.9 gm/dl and serum ferritin of <15 ng/ml were enrolled. In intravenous group, 200 mg iron sucrose in 100ml normal saline was infused alternate day till the required dose was met. The oral group received 200 mg of oral iron ascorbate along with folic acid 1.5 mg per day for 6 weeks.  Treatment efficacy was assessed by Hb and serum ferritin after 3 and 6 weeks.

Results: Out of 200 patients, an increase in Hb was observed in both groups, rising from 9.7 g/dl to 10.3 g/dl and 10.9 g/dl after 3 weeks and 6 weeks respectively in oral group and from 8.6 g/dl to 9.8 g/dl and 10.8 g/dl after 3 weeks and 6 weeks respectively in intravenous group. Similar results were seen in ferritin levels. Rise in Hb and ferritin levels were greater in intravenous group than in oral group.

Conclusions: Intravenous iron sucrose appears to be a better treatment option in comparison with oral iron, without serious side effects, better compliance and improved efficacy in correction of anaemia of pregnancy.

References

Anemia during pregnancy. Available at: https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/anaemia-during- pregnancy-maternal-anemia. Accessed on 27th July 2020.

Iron deficiency anaemia: assessment, prevention and control. A guide for programme managers. 2001. Available at: https://www.who.int/nutrition /publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3/en. Accessed on 27th July 2020.

Kalaivani K. Prevalence and consequences of anemia in pregnancy. Indian J Med Res. 2009;130:627-33.

Low MS, Grigoriadis G. Iron deficiency and new insights into therapy. Med J Aust. 2017;207(2):81-7.

International Institute for Population Sciences-IIPS/India and ICF. National Family Health Survey NFHS-4, 2015-2016. Mumbai, India: India; IIPS; 2017.

Malagi U, Reddy M, Naik R. Evaluation of national nutritional control programme in Dharward (Karnataka). J Hum Ecol. 2006;20(4):279-81.

Helping hematologists conquer blood diseases worldwide. Available at: https://www.hematology.org/education/patients/anemia. Accessed on 27th July 2020.

Yip R. Prevention and control of iron deficiency: policy and strategy issues. The J Nutrit. 2002;132(4):802S-5S.

Kotecha PV. Micronutrient Malnutrition in India: Let Us Say "No" to it Now. Indian J Community Med. 2008;33(1):9-10.

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

Sharma JB, Soni D. Oxidative stress in pregnancy - Role of iron therapy: oral iron therapy and risk of free radicals. Obs Gynac. 2001:6(12):705-6.

De Gruchy’s. Clinical hematology in medical practice. Chapter 3 hypochromic anaemia: iron deficiency and sideroblastic anaemia. 5th edition; 1989:54.

Perewusnyk KG, Huch R, Huch A, Breymann C. Parenteral iron therapy in odstretics: 8 years experience with iron-sucrose complex. Br J Nutr. 2002;88:3-10.

Divakar H, Manyonda I. Battling with rising prevalence of gestational diabetes mellitus: screening and diagnosis. Int J Infertil Fetal Med. 2011;2:96-100.

Al-Momen AK, al-Meshari A, al-Nuaim L, Saddique A, Abutalib Z, Khashogi T, et al. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1996;69:121-4.

Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anemia. An Int J Obstet Gynecol. 2006;113:1248-52.

Beshar S Lundqvist H, Sundin J, Lubberink M, Tolmachev V, Valind S, Antoni G, et al. Pharmacokinetics and red cell utilization of iron (III) hydroxide-sucrose complex in anemic patients: a study using positron emission tomography. Br J Haematol. 1999;104:296-302.

Breymann C. Modern therapy concepts for severe anaemia in pregnancy and postpartum. Prevention and management of anemia in pregnancy and postpartum hemorrhage. Schellenberg Druck AC, Zurich, Switzerland. 1998:107-122.

Hallberg L, Ryttinger L, Solvell. Side effects of oral iron therapy. A double-blind study of different iron compounds in tablet form. Acta Mdd Scand Suppl. 1996;459:3-10.

Singh K, Fong YF, Kuperan P. A comparison between intravenous iron polymaltose complex (Ferrum Haussmann) and oral ferrous fumarate in the treatment of iron deficiency anemia in pregnancy. Eur J Hematol. 1998;60:119-24.

Dede A, Uygur D, Yilmaz B, Mungan T, Ugur Zekai M. Intravenous iron sucrose complex vs. oral ferrous sulfate for postpartum iron deficiency anemia. Int J Gynecol Obstet. 2005;90:238-9.

Downloads

Published

2020-08-27

Issue

Section

Original Research Articles