Worldwide, almost 40% of all pregnant women are anemic (hemoglobin < 11 g/dL) with the percentage rising to around 50% for pregnant women in Africa and Southeast Asia. The World Health Organization recommends daily oral iron supplementation for these women despite its side effects. Newer intravenous iron formulations, such as ferric carboxymaltose, require only a single infusion and have a safer profile than older formulations, though large-scale randomized clinical trials are lacking on their efficacy and safety. In Nigeria, researchers screened over 13,000 pregnant women for anemia and excluded those with mild anemia (Hb 10 to 10.9 g/dL) or anemia unrelated to iron deficiency (e.g., those with sickle cell disease or HIV). During the trial, 1,056 pregnant women (aged 15 to 49 years, Hb <10 g/dL at 20 to 32 weeks gestation, and 40% iron deficient) were randomized 1:1 to receive either one infusion of ferric carboxymaltose (20 mg/kg up to 1,000 mg) or oral iron (200 mg; 65 mg elemental iron) three times daily until 6 weeks postpartum. At 36 weeks gestation, no difference in maternal anemia was observed by study arm (58% vs. 61% in the intravenous and oral arms, respectively), but intravenous iron corrected iron deficiency in 98% of women compared to 91% in the oral arm and had a similar safely profile. Intravenous iron may be a safe and effective alternative to oral iron in some settings, but the cost and logistical challenges to ferritin assays may limit its use in low- and middle-income settings.
References:
- Nwagha UI, Nwagha TU. Intravenous ferric carboxymaltose for iron deficiency anaemia in pregnancy. The Lancet Global Health. 2024 Oct 1;12(10):e1567-8
- Afolabi BB, Babah OA, Adeyemo TA, Balogun M, Banke-Thomas A, Abioye AI, Akinajo OR, Galadanci HS, Quao RA, Adelabu H, Sam-Agudu NA. Intravenous versus oral iron for anaemia among pregnant women in Nigeria (IVON): an open-label, randomised controlled trial. The Lancet Global Health. 2024 Oct 1;12(10):e1649-59
