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Parenteral Versus Oral Iron for Treatment of Iron Deficiency Anaemia During Pregnancy and post-partum: A Systematic Review

The Journal of Obstetrics and Gynecology of India volume 69, pages 13–24 (2019)Cite this article

Abstract

Introduction

The burden of iron deficiency anaemia during pregnancy and post-partum continues to remain high especially in India. Challenges to treatment include gastrointestinal side effects and non compliance to oral iron therapy. Newer parenteral formulations need to be explored as alternatives.

Methods

Meta-analysis of randomized controlled trials published between years 2011 and 2018 comparing anaemic pregnant and post-partum women treated with intravenous iron sucrose versus oral iron was performed. The primary outcomes were mean maternal haemoglobin, serum ferritin and haematocrit at the end of 1st, 2nd, 4th and 6th weeks and comparison of adverse effects.

Results

Eighteen studies including 1633 antenatal women were randomly assigned to intravenous iron sucrose (n = 821) or oral iron [ferrous sulphate, ferrous ascorbate or fumarate] group (n = 812) in ten trials . Another eight studies compared iron sucrose infusion with oral iron in 713 post-partum women who were randomly assigned to intravenous iron sucrose group (n = 351) or oral iron group (n = 362). Cumulative analysis of all the time points indicates that the estimated mean values of Hb in the intravenous iron sucrose and oral iron groups were 10.11 g/dl and 9.33 g/dl, respectively, in antenatal group, while it was 10.57 g/dl and 9.74 g/dl in post-partum. The estimated mean ferritin level from first week to six weeks was 63.1 μg/l and 28.6 μg/l, respectively, in intravenous and oral iron groups. Cumulative estimate of haematocrit in the intravenous sucrose and oral iron over 6 weeks showed that the mean values in the respective groups were 30.5% and 29.5% in antenatal and 33.8% and 31.6%, respectively, in post-partum groups. Sensitivity analysis confirmed the reliability and consistency of the results. Oral iron was associated with significant gastrointestinal side effects. There was no significant difference in birthweight between the groups.

Conclusion

This meta-analysis demonstrates that intravenous iron sucrose is more effective than oral iron therapy for pregnant and post-partum women with iron deficiency anaemia. It is an effective and safe alternative to address the problem of iron deficiency especially in those who require rapid replacement of iron stores though medical personnel for intravenous administration of drug is required.

Trial registration CRD42015024343

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Abbreviations

IDA:

Iron deficiency anaemia

WHO:

World Health Organization

NFHS-4:

National Family Health Survey-4

OR:

Odds ratio

IVS:

Intravenous iron sucrose

OIG:

Oral iron group

PCV:

Packed cell volume

MD:

Mean difference

CI:

Confidence interval

Hb:

Haemoglobin

ANC:

Antenatal clinic

QOL:

Quality of life

LMIC:

Low–middle-income countries

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Acknowledgements

We wish to acknowledge the Covidence platform in the compilation of this systematic review.

Author information

Affiliations

  1. University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India

    A. G. Radhika

  2. All India Institute of Medical Sciences, Delhi, India

    Aparna Kandala Sharma, Vanamail Perumal, Vidushi Kulshreshtha & Alka Kriplani

  3. Indian Council of Medical Research, Delhi, India

    Anju Sinha

  4. QMed Knowledge Foundation, Mumbai, India

    Vasumathi Sriganesh

  5. Ghaziabad, India

    A. G. Radhika

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  1. A. G. Radhika
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Contributions

AGR contributed to literature search, title and abstract screen, data extraction; AS contributed to data extraction and report writing; VP contributed to title and abstract screen, data extraction, statistical analysis; AS resolved discrepancies in study inclusion, data extraction, guidance on systematic review procedure; VS contributed to literature search; VK contributed to data extraction, report writing; AK contributed to formulation of protocol and finalizing the report. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to A. G. Radhika.

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The authors declare no conflict of interest.

Ethical statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Additional information

Dr. A.G. Radhika is Consultant in O&G, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India; Aparna Kandala Sharma is Associate Professor O&G, All India Institute of Medical Sciences, Delhi, India; Vanamail Perumal is Associate Professor, Biostatistician, All India Institute of Medical Sciences, Delhi, India; Anju Sinha is Scientist E, Indian Council of Medical Research, Delhi, India; Vasumathi Sriganesh is Senior Librarian and CEO, QMed Knowledge Foundation, Mumbai, India; Vidushi Kulshreshtha is Associate Professor, O&G, All India Institute of Medical Sciences, Delhi, India; Alka Kriplani is Professor and Head, O&G, All India Institute of Medical Sciences, Delhi, India.

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Radhika, A.G., Sharma, A.K., Perumal, V. et al. Parenteral Versus Oral Iron for Treatment of Iron Deficiency Anaemia During Pregnancy and post-partum: A Systematic Review. J Obstet Gynecol India 69, 13–24 (2019). https://doi.org/10.1007/s13224-018-1191-8

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  • DOI: https://doi.org/10.1007/s13224-018-1191-8

Keywords

  • Iron deficiency anaemia
  • Intravenous iron
  • Oral iron
  • Pregnancy
  • post-partum