TY - JOUR
T1 - Results of the First American Prospective Study of Intravenous Iron in Oral Iron-Intolerant Iron-Deficient Gravidas
AU - Auerbach, Michael
AU - Auerbach, Michael
AU - Bahrain, Huzefa F.
AU - James, Stephanie E.
AU - Nicoletti, Melissa
AU - Lenowitz, Steven
AU - London, Nicola
AU - Smith, Samuel
AU - Derman, Richard
N1 - Funding Information:
Funding: Funding for this study was from Pharmacosmos, Halbaek, Denmark, for data management only. Any travel related to the study was paid for by the investigator.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/12
Y1 - 2017/12
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.
KW - Intravenous iron
KW - Iron deficiency anemia
KW - Pregnancy
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U2 - 10.1016/j.amjmed.2017.06.025
DO - 10.1016/j.amjmed.2017.06.025
M3 - Article
C2 - 28739199
AN - SCOPUS:85027971607
VL - 130
SP - 1402
EP - 1407
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 12
ER -