NEW YORK (Reuters Health) – A single intravenous (IV) infusion of iron polymaltose added to a standard regimen of oral iron sulfate to treat iron-deficiency anemia in pregnancy improves hemoglobin (Hb) and ferritin levels at the time of delivery, according to an Australian study.

“It remains a challenge to restore the depleted iron and correct the anemia efficiently” with oral iron alone, the authors comment in the Journal of Internal Medicine, published online on May 19.

In a group of 2654 pregnant women, first author Dr. Alhossain Khalafallah, from Launceston General Hospital in Tasmania and colleagues found a 17.4% prevalence of moderate iron deficiency anemia (Hb between 85 and 115 g/L and serum ferritin of < 30 mcg/L). They randomly assigned 91 women to receive only oral iron sulfate (250 mg daily), and 92 to receive the same dose of oral iron plus IV iron polymaltose. They calculated the total dose of IV iron polymaltose as follows: Iron dose in mg (50 mg/mL) = body weight (maximum 90 kg) x target Hb (120 g/L) – actual Hb x 0.24 + iron depot (500) The mean dose was 702 mg. The single dose was safe and well tolerated. The mean Hb levels in the oral group increased from 109.3 g/L at baseline to 121.8 g/dL pre delivery, while those in the combination group increased from 107.4 g/dL to 126.6 g/L (p < 0.001). Furthermore, the proportion of patients with mild-to-moderate anemia (Hb < 116 g/L) before delivery was 16% in the IV plus oral iron group and 29% in the oral iron group only (incidence rate ratio 0.55, p = 0.043). At delivery, there was substantial improvement in mean serum ferritin levels in the IV iron group. The rate of subnormal ferritin levels was 79% in the oral iron group but less than 5% in the IV plus oral iron group. Group assignment had no effect on the newborn’s birth weight, gestational age at delivery, placental cord Hb or iron status. The authors estimate that the cost of oral iron sulfate throughout pregnancy was US$165, while the average cost for iron polymaltose was US$30-40. The outpatient hospital visit and nursing time for the IV infusion adds another $60 to the cost. “Out-patient IV iron therapy in addition to oral iron in pregnant women with (iron deficiency anemia) appeared to be safe, effective and practical in a tertiary referral center in a developed-country health service,” Dr. Khalafallah and associates conclude. Reference:
http://www3.interscience.wiley.com/journal/123447586/abstract

J Intern Med 2010.