Date Published: 
Friday, 24 May, 2013

Treating iron deficiency in the obstetrics–gynaecology setting

In non-anaemic menstruating women with unexplained fatigue and ferritin levels below 50 μg/L, 12 weeks of oral iron therapy resulted in a significant reduction in symptoms of fatigue, and improvements in biological markers, including haemoglobin, ferritin and soluble transferrin. However, no significant improvements of other measured indicators of quality of life other than fatigue were seen1.

Treatment guidelines referring to iron deficiency in pregnancy recommend that all women be given dietary information to maximise iron intake and absorption2. Women with a serum ferritin level <30 ng/mL should be offered oral iron treatment2.

Oral iron therapy has been shown to significantly improve haematological outcomes in pregnancy, although with a relatively high rate of gastrointestinal side effects that may reduce adherence to treatment3. Giving intravenous iron during pregnancy is associated with greater efficacy, improved quality of life, and lower rates of gastrointestinal events compared with oral iron3,4.

Intravenous iron also offers significant benefits postpartum. A study of iron therapy administered within 10 days of delivery showed that intravenous iron was associated with a more rapid response, and a greater number of patients achieving correction of iron deficiency anaemia compared with oral iron (see figure below)1.

There are concerns about rare but serious anaphylactic reactions3, although these appear to be primarily associated with high-molecular weight dextran-containing formulations and many newer intravenous iron preparation show good tolerability5,6.

Figure 5. Percentage of study participants achieving (A) Hb increase ≥2 g/dL (B) Hb increase ≥3.0 g/dL (C) Hb ≥12.0 g/dL with intravenous versus oral iron1

Copyright permission obtained from Van Wyck et al, 2007.

Intravenous iron is recommended for consideration from the second trimester through to the postpartum period for women with iron deficiency anaemia who fail to respond to, or are intolerant of, oral iron2, and there are a number of other indications where intravenous iron may be the preferred treatment option (see table below)7.

Table 2. Indications for use of intravenous rather than oral iron therapy

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