Single iron infusion in late pregnancy significantly reduces anemia risk

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A recent study found that a single dose of intravenous iron in the third trimester is superior to oral iron in reducing anemia rates in pregnant women, ensuring better outcomes for mother and baby.

Single iron infusion in late pregnancy significantly reduces anemia risk | Image Credit: © Nekrasov - © Nekrasov - stock.adobe.com.

Single iron infusion in late pregnancy significantly reduces anemia risk | Image Credit: © Nekrasov - © Nekrasov - stock.adobe.com.

The odds of anemia in pregnant women are significantly reduced by a single iron transfusion in the third trimester, according to a recent study published in Nature Medicine.1

Poor iron levels during pregnancy have been linked to increased odds of preterm birth, low birth weight, and postpartum depression. Currently, iron tablets are the recommended standard of care.1

“While anemia is one of the most avoidable causes of illness and death in resource-poor nations, any woman across the world can become anemic during pregnancy, highlighting how this remains a global priority,” said co-corresponding author Professor Sant-Rayn Pasricha, PhD.1

Using ferric carboxymaltose (FCM), health care providers may administer up to 1,000 mg of iron formulation intravenously.2 In high-income settings, FCM may be used to avoid transfusion when needing rapid increases in hemoglobin.

Investigators theorized FCM may be ideal for optimizing hemoglobin concentration in the third trimester of pregnancy and conducted a randomized controlled trial to assess this link. Eligibility screening was performed from November 24, 2021, to February 22, 2023, with the final 4-week postpartum visit occurring on June 10, 2023.2

Patients were most often excluded for hemoglobin concentration outside the eligibility range. Capillary hemoglobin measurement was performed in 8196 women during screening, 34.5% of whom were anemic. Mild anemia was reported in 22.5%, moderate in 11.7%, and severe in 0.3%.2

There were 590 participants included in the final analysis with a median gestational age of 30 weeks. Anemia based on venous hemoglobin assessment was reported in 91.3% of these participants, HIV positivity in 20.2%, inflammation in 30.1%, and primigravidae in 35.3% These rates were similar between the intervention and standard-of-care (SOC) oral iron groups.2

Iron deficiency rates were 68.8% in the intervention group vs 74.7% in the SOC group. Patients in the intervention group were treated with a single dose of intravenous FCM vs oral iron in the SOC group.2

At 36 weeks’ gestation, the prevalence of anemia was significantly reduced in FCM patients vs SOC patients, with rates of 46.7% and 62.7%, respectively. Median durations between treatment and hemoglobin assessment in these groups were 55 and 53 days, respectively.2

Six women presented with moderate or severe anemia needed to treat with FCM. Concurrent inflammation was reported in 33% of patients in the FCM group with anemia at 36 weeks’ gestation, vs 25.7% in the SOC group.2

Mean birthweights among infants in the FCM and SOC groups were 2,975.1 g vs 2,958.7 g, respectively. This indicated a mean difference of 10.9 g.2

Anemia rates were reduced in the FCM group vs the SOC group at both delivery and 1 month postpartum. At delivery, rates were 20.7% vs 34.9%, respectively. At 1 month postpartum, rates were 36% vs 57.9%, respectively.2

Safety outcomes were also reported in the trial. Three percent of FCM patients reported an adverse event during or up to 30 minutes after FCM administration, but there were no instances of infusion-related severe adverse events. Maternal adverse events were reported in 18.2% of the FCM group vs 21.9% of the SOC group.2

“This is the first concrete evidence that proves infusions in late pregnancy are the superior treatment for combatting anemia in expectant mothers, boosting iron levels at a critical time that can ensure both mother and baby are better protected during birth,” said Pasricha.1

References

  1. Healthier mothers, healthier babies: Iron infusion trial could transform pregnancy care worldwide. Walter and Eliza Hall Institute. January 6, 2025. Accessed January 21, 2025. https://www.eurekalert.org/news-releases/1069527
  2. Pasricha SR, Moya E, Ataíde R, et al. Ferric carboxymaltose for anemia in late pregnancy: a randomized controlled trial. Nat Med, 2025;31:197–206. doi:10.1038/s41591-024-03385-w
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