Iron deficiency anemia (IDA) during pregnancy is a major global health concern, affecting nearly 37% of pregnant women worldwide. It poses significant risks to both maternal and neonatal health, increasing the likelihood of complications such as preterm birth, low birth weight, and postpartum hemorrhage. To manage IDA, healthcare providers typically prescribe oral iron supplements, but adherence is often compromised due to gastrointestinal side effects. In contrast, intravenous (IV) iron therapy has emerged as an alternative for rapid iron replenishment, particularly in cases of severe anemia or poor tolerance to oral iron. This article examines the effectiveness and safety of oral and IV iron therapies in pregnancy, based on a meta-analysis of clinical trials.
Pregnant women experience an increased demand for iron, especially in the second and third trimesters, to support fetal growth and increased blood volume. If left untreated, IDA can lead to severe maternal complications, including increased susceptibility to infections, fatigue, and prolonged hospital stays. The impact on newborns is equally concerning, with studies linking maternal anemia to developmental delays and impaired immune function in infants.
Traditionally, oral iron therapy has been the first-line treatment due to its affordability and ease of administration. However, many women discontinue treatment due to nausea, constipation, and other gastrointestinal issues. IV iron therapy, while more expensive and requiring medical supervision, allows for faster replenishment of iron stores, potentially leading to better clinical outcomes.
A meta-analysis of 15 randomized controlled trials (RCTs) involving 4,215 pregnant women compared the efficacy of IV and oral iron therapies. The key findings include:
Hemoglobin Improvement: Women receiving IV iron experienced a more rapid and significant increase in hemoglobin levels compared to those on oral iron. On average, hemoglobin levels increased by 2.05 g/dL with IV iron, compared to 1.65 g/dL with oral iron. This suggests that IV iron may be more effective in cases where rapid correction of anemia is needed.
Maternal Complications: The study found a 21% reduction in maternal complications among those receiving IV iron. However, the difference was not statistically significant for specific complications such as postpartum hemorrhage or preeclampsia.
Neonatal Outcomes: Surprisingly, there was no significant difference in neonatal birth weight, cord hemoglobin levels, or incidence of preterm births between the two groups. This indicates that while IV iron may offer benefits for maternal health, its direct impact on neonatal outcomes remains unclear.
Adverse Events: One of the most striking findings was the lower incidence of adverse events in the IV iron group. Women receiving IV iron were significantly less likely to experience gastrointestinal discomfort, nausea, and constipation compared to those on oral iron. However, IV iron carries its own risks, including allergic reactions and, in rare cases, anaphylaxis.
The results of this meta-analysis support the growing preference for IV iron in cases of moderate to severe anemia or when oral iron is poorly tolerated. IV iron therapy offers the advantage of faster anemia correction and fewer gastrointestinal side effects, which may improve treatment adherence. However, due to the higher cost and need for medical supervision, oral iron remains a viable option for mild anemia.
Healthcare providers must weigh the benefits and risks of both therapies based on individual patient needs. In resource-limited settings, oral iron may still be the more practical choice due to its affordability and ease of distribution. Future research should focus on optimizing IV iron dosing regimens and exploring its long-term effects on maternal and neonatal health.
Both oral and IV iron therapies play crucial roles in managing IDA during pregnancy. While IV iron offers faster results and fewer side effects, it is not necessarily superior in improving neonatal outcomes. The choice of therapy should be guided by the severity of anemia, patient tolerance, and healthcare accessibility. Continued research and policy efforts are needed to improve iron supplementation strategies, ensuring better health outcomes for mothers and their babies worldwide.
