Results of the First American Prospective Study of Intravenous Iron in Oral Iron-Intolerant Iron-Deficient Gravidas

Michael Auerbach, Michael Auerbach, Huzefa F. Bahrain, Stephanie E. James, Melissa Nicoletti, Steven Lenowitz, Nicola London, Samuel Smith, Richard Derman

Research output: Contribution to journalArticle

Abstract

Background Anemia affects up to 42% of gravidas. Neonatal iron deficiency is associated with low birth weight, delayed growth and development, and increased cognitive and behavioral abnormalities. While oral iron is convenient, up to 70% report significant gastrointestinal toxicity. Intravenous iron formulations allowing replacement in one visit with favorable side-effect profiles decrease rates of anemia with improved hemoglobin responses and maternal fetal outcomes. Methods Seventy-four oral iron-intolerant, second- and third-trimester iron-deficient gravidas were questioned for oral iron intolerance and treated with intravenous iron. All received 1000 mg of low-molecular-weight iron dextran in 250 mL normal saline. Fifteen minutes after a test dose, the remainder was infused over the balance of 1 hour. Subjects were called at 1, 2, and 7 days to assess delayed reactions. Four weeks postinfusion or postpartum, hemoglobin levels and iron parameters were measured. Paired t test was used for hemoglobin and iron; 58/73 women were questioned about interval growth and development of their babies. Results Seventy-three of 74 enrolled subjects completed treatment. Sixty had paired pre- and posttreatment data. The mean pre- and posthemoglobin concentrations were 9.7 and 10.8 g/dL (P <.00001), transferrin saturations 11.7% and 22.6% (P =.0003), and ferritins 14.5 and 126.3 ng/mL, respectively (P <.000001). Six experienced minor infusion reactions. All resolved. Data for 58 infants were available; one was low on its growth charts for 11 months. The remaining 57 were normal. None were diagnosed with iron deficiency anemia. Conclusion Intravenous iron has less toxicity and is more effective, supporting moving it closer to frontline therapy.

Original languageEnglish (US)
Pages (from-to)1402-1407
Number of pages6
JournalAmerican Journal of Medicine
Volume130
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Iron
Prospective Studies
Hemoglobins
Growth and Development
Anemia
Growth Charts
Iron-Deficiency Anemias
Third Pregnancy Trimester
Low Birth Weight Infant
Second Pregnancy Trimester
Transferrin
Ferritins
Dextrans
Postpartum Period
Molecular Weight
Mothers
Therapeutics

Keywords

  • Intravenous iron
  • Iron deficiency anemia
  • Pregnancy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Auerbach, M., Auerbach, M., Bahrain, H. F., James, S. E., Nicoletti, M., Lenowitz, S., ... Derman, R. (2017). Results of the First American Prospective Study of Intravenous Iron in Oral Iron-Intolerant Iron-Deficient Gravidas. American Journal of Medicine, 130(12), 1402-1407. https://doi.org/10.1016/j.amjmed.2017.06.025

Results of the First American Prospective Study of Intravenous Iron in Oral Iron-Intolerant Iron-Deficient Gravidas. / Auerbach, Michael; Auerbach, Michael; Bahrain, Huzefa F.; James, Stephanie E.; Nicoletti, Melissa; Lenowitz, Steven; London, Nicola; Smith, Samuel; Derman, Richard.

In: American Journal of Medicine, Vol. 130, No. 12, 01.12.2017, p. 1402-1407.

Research output: Contribution to journalArticle

Auerbach, M, Auerbach, M, Bahrain, HF, James, SE, Nicoletti, M, Lenowitz, S, London, N, Smith, S & Derman, R 2017, 'Results of the First American Prospective Study of Intravenous Iron in Oral Iron-Intolerant Iron-Deficient Gravidas', American Journal of Medicine, vol. 130, no. 12, pp. 1402-1407. https://doi.org/10.1016/j.amjmed.2017.06.025
Auerbach, Michael ; Auerbach, Michael ; Bahrain, Huzefa F. ; James, Stephanie E. ; Nicoletti, Melissa ; Lenowitz, Steven ; London, Nicola ; Smith, Samuel ; Derman, Richard. / Results of the First American Prospective Study of Intravenous Iron in Oral Iron-Intolerant Iron-Deficient Gravidas. In: American Journal of Medicine. 2017 ; Vol. 130, No. 12. pp. 1402-1407.
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abstract = "Background Anemia affects up to 42{\%} of gravidas. Neonatal iron deficiency is associated with low birth weight, delayed growth and development, and increased cognitive and behavioral abnormalities. While oral iron is convenient, up to 70{\%} report significant gastrointestinal toxicity. Intravenous iron formulations allowing replacement in one visit with favorable side-effect profiles decrease rates of anemia with improved hemoglobin responses and maternal fetal outcomes. Methods Seventy-four oral iron-intolerant, second- and third-trimester iron-deficient gravidas were questioned for oral iron intolerance and treated with intravenous iron. All received 1000 mg of low-molecular-weight iron dextran in 250 mL normal saline. Fifteen minutes after a test dose, the remainder was infused over the balance of 1 hour. Subjects were called at 1, 2, and 7 days to assess delayed reactions. Four weeks postinfusion or postpartum, hemoglobin levels and iron parameters were measured. Paired t test was used for hemoglobin and iron; 58/73 women were questioned about interval growth and development of their babies. Results Seventy-three of 74 enrolled subjects completed treatment. Sixty had paired pre- and posttreatment data. The mean pre- and posthemoglobin concentrations were 9.7 and 10.8 g/dL (P <.00001), transferrin saturations 11.7{\%} and 22.6{\%} (P =.0003), and ferritins 14.5 and 126.3 ng/mL, respectively (P <.000001). Six experienced minor infusion reactions. All resolved. Data for 58 infants were available; one was low on its growth charts for 11 months. The remaining 57 were normal. None were diagnosed with iron deficiency anemia. Conclusion Intravenous iron has less toxicity and is more effective, supporting moving it closer to frontline therapy.",
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N2 - Background Anemia affects up to 42% of gravidas. Neonatal iron deficiency is associated with low birth weight, delayed growth and development, and increased cognitive and behavioral abnormalities. While oral iron is convenient, up to 70% report significant gastrointestinal toxicity. Intravenous iron formulations allowing replacement in one visit with favorable side-effect profiles decrease rates of anemia with improved hemoglobin responses and maternal fetal outcomes. Methods Seventy-four oral iron-intolerant, second- and third-trimester iron-deficient gravidas were questioned for oral iron intolerance and treated with intravenous iron. All received 1000 mg of low-molecular-weight iron dextran in 250 mL normal saline. Fifteen minutes after a test dose, the remainder was infused over the balance of 1 hour. Subjects were called at 1, 2, and 7 days to assess delayed reactions. Four weeks postinfusion or postpartum, hemoglobin levels and iron parameters were measured. Paired t test was used for hemoglobin and iron; 58/73 women were questioned about interval growth and development of their babies. Results Seventy-three of 74 enrolled subjects completed treatment. Sixty had paired pre- and posttreatment data. The mean pre- and posthemoglobin concentrations were 9.7 and 10.8 g/dL (P <.00001), transferrin saturations 11.7% and 22.6% (P =.0003), and ferritins 14.5 and 126.3 ng/mL, respectively (P <.000001). Six experienced minor infusion reactions. All resolved. Data for 58 infants were available; one was low on its growth charts for 11 months. The remaining 57 were normal. None were diagnosed with iron deficiency anemia. Conclusion Intravenous iron has less toxicity and is more effective, supporting moving it closer to frontline therapy.

AB - Background Anemia affects up to 42% of gravidas. Neonatal iron deficiency is associated with low birth weight, delayed growth and development, and increased cognitive and behavioral abnormalities. While oral iron is convenient, up to 70% report significant gastrointestinal toxicity. Intravenous iron formulations allowing replacement in one visit with favorable side-effect profiles decrease rates of anemia with improved hemoglobin responses and maternal fetal outcomes. Methods Seventy-four oral iron-intolerant, second- and third-trimester iron-deficient gravidas were questioned for oral iron intolerance and treated with intravenous iron. All received 1000 mg of low-molecular-weight iron dextran in 250 mL normal saline. Fifteen minutes after a test dose, the remainder was infused over the balance of 1 hour. Subjects were called at 1, 2, and 7 days to assess delayed reactions. Four weeks postinfusion or postpartum, hemoglobin levels and iron parameters were measured. Paired t test was used for hemoglobin and iron; 58/73 women were questioned about interval growth and development of their babies. Results Seventy-three of 74 enrolled subjects completed treatment. Sixty had paired pre- and posttreatment data. The mean pre- and posthemoglobin concentrations were 9.7 and 10.8 g/dL (P <.00001), transferrin saturations 11.7% and 22.6% (P =.0003), and ferritins 14.5 and 126.3 ng/mL, respectively (P <.000001). Six experienced minor infusion reactions. All resolved. Data for 58 infants were available; one was low on its growth charts for 11 months. The remaining 57 were normal. None were diagnosed with iron deficiency anemia. Conclusion Intravenous iron has less toxicity and is more effective, supporting moving it closer to frontline therapy.

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