Women with postpartum anemia do not present with different rates of postpartum depression (PPD) based on treatment with intravenous ferric carboxymaltose, intravenous ferric derisomaltose or oral ferrous sulphate, according to a recent study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.1
Takeaways
- The study found no significant differences in postpartum depression (PPD) rates among women treated with intravenous ferric carboxymaltose, intravenous ferric derisomaltose, or oral ferrous sulphate for postpartum anemia.
- There were no differences in baseline characteristics among the study groups, ensuring a fair comparison of treatment effects.
- Edinburgh Postnatal Depression Scale scores at 6 weeks postpartum did not significantly differ based on the type of iron supplementation used.
- A notable difference was observed in the presence of suicidal ideation, with higher rates in the ferric carboxymaltose group compared to the other groups.
- Regardless of the iron preparation used, diagnosing and treating postpartum anemia can help reduce the incidence of PPD.
Postpartum anemia, defined as blood hemoglobin (Hb) level under 100 g/L, has been estimated in 10% to 30% of postpartum women. It is associated with PPD, fatigue, and reduced maternal cognitive abilities.
PPD is defined as a depressive episode developing within 1 year postpartum, and commonly develops within 4 weeks after birth. Severe depression or anxiety has been reported among 10% to 20% of postpartum women in Slovenia and is a common factor for maternal mortality worldwide.
There are multiple risks associated with PPD, including mood swings, difficulty bonding with infant, withdrawal from family and friends, loss of appetite, and more.2 Mothers with PPD may stop breastfeeding and be at increased risk of suicide, making treatment crucial.
Treatment options for PPD among women with postpartum anemia include intravenous iron therapy, oral iron medication, and blood transfusion.1 However, data comparing PPD following administration of oral vs intravenous therapy is lacking.
Investigators conducted a study to determine whether the type of iron preparation used to treat postpartum anemia impacts PPD. Women delivering at the Ljubljana Maternity Hospital between September 2020 and March 2022 with Hb under 100 g/L within 48 hours after childbirth were included in the analysis.1
Women with a history of anemia, hypersensitivity to study medications, active infection, and renal or hepatic impairment were excluded from the analysis. Participants were randomized 1:1:1 to determine the iron supplementation they would receive. At baseline, participants completed the Edinburgh Postnatal Depression Scale (EPDS) questionnaire.
Patients in the first group received ferric carboxymaltose up to 1000 mg, while those in the second group received ferric derisomaltose up to 1500 mg. Those in the third group received 2 oral tablets of 80 mg ferrous sulphate every 24 hours for up to 6 weeks postpartum. Participants retook the EPDS questionnaire at 6 weeks follow-up.
There were 278 participants included in the final analysis, with no differences in baseline characteristics reported between groups. A statistically different EPDS at week 6 was not observed based on treatment method, nor did EPDS scores differ before vs after treatment.1
An EPDS score of 10 or more was reported in 10% of the ferric carboxymaltose group, 4% of the ferric derisomaltose group, and 3% of the ferrous sulphate group. A statistically significant difference in EPDS score at 6 weeks postpartum was not reported.
Significant differences in the presence of suicidal ideation were reported between groups, at 3% in the ferric carboxymaltose group vs 1% in both the ferric derisomaltose group and ferrous sulphate group.
These results indicated no significant change in PPD based on the choice of iron supplementation among women with postpartum anemia. Investigators concluded diagnosing and treating postpartum anemia can reduce PPD incidence regardless of the iron preparation used.1
References
- Bombač Tavčar L, Hrobat H, Gornik L, Globevnik Velikonja V, Lučovnik M. Incidence of postpartum depression after treatment of postpartum anaemia with intravenous ferric carboxymaltose, intravenous ferric derisomaltose or oral ferrous sulphate: A randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2023;20(100247). doi:10.1016/j.eurox.2023.100247
- Postpartum depression. Mayo Clinic. Accessed June 19, 2024. https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
