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

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-molecularweight 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. (C) 2017 Elsevier Inc. All rights reserved.