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17.01.2019 | Systematic Reviews/Meta-analysis | Ausgabe 1/2019

The Journal of Obstetrics and Gynecology of India 1/2019

Parenteral Versus Oral Iron for Treatment of Iron Deficiency Anaemia During Pregnancy and post-partum: A Systematic Review

Zeitschrift:
The Journal of Obstetrics and Gynecology of India > Ausgabe 1/2019
Autoren:
A. G. Radhika, Aparna Kandala Sharma, Vanamail Perumal, Anju Sinha, Vasumathi Sriganesh, Vidushi Kulshreshtha, Alka Kriplani
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s13224-018-1191-8) contains supplementary material, which is available to authorized users.
Dr. A.G. Radhika is Consultant in O&G, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India; Aparna Kandala Sharma is Associate Professor O&G, All India Institute of Medical Sciences, Delhi, India; Vanamail Perumal is Associate Professor, Biostatistician, All India Institute of Medical Sciences, Delhi, India; Anju Sinha is Scientist E, Indian Council of Medical Research, Delhi, India; Vasumathi Sriganesh is Senior Librarian and CEO, QMed Knowledge Foundation, Mumbai, India; Vidushi Kulshreshtha is Associate Professor, O&G, All India Institute of Medical Sciences, Delhi, India; Alka Kriplani is Professor and Head, O&G, All India Institute of Medical Sciences, Delhi, India.

Abstract

Introduction

The burden of iron deficiency anaemia during pregnancy and post-partum continues to remain high especially in India. Challenges to treatment include gastrointestinal side effects and non compliance to oral iron therapy. Newer parenteral formulations need to be explored as alternatives.

Methods

Meta-analysis of randomized controlled trials published between years 2011 and 2018 comparing anaemic pregnant and post-partum women treated with intravenous iron sucrose versus oral iron was performed. The primary outcomes were mean maternal haemoglobin, serum ferritin and haematocrit at the end of 1st, 2nd, 4th and 6th weeks and comparison of adverse effects.

Results

Eighteen studies including 1633 antenatal women were randomly assigned to intravenous iron sucrose (n = 821) or oral iron [ferrous sulphate, ferrous ascorbate or fumarate] group (n = 812) in ten trials . Another eight studies compared iron sucrose infusion with oral iron in 713 post-partum women who were randomly assigned to intravenous iron sucrose group (n = 351) or oral iron group (n = 362). Cumulative analysis of all the time points indicates that the estimated mean values of Hb in the intravenous iron sucrose and oral iron groups were 10.11 g/dl and 9.33 g/dl, respectively, in antenatal group, while it was 10.57 g/dl and 9.74 g/dl in post-partum. The estimated mean ferritin level from first week to six weeks was 63.1 μg/l and 28.6 μg/l, respectively, in intravenous and oral iron groups. Cumulative estimate of haematocrit in the intravenous sucrose and oral iron over 6 weeks showed that the mean values in the respective groups were 30.5% and 29.5% in antenatal and 33.8% and 31.6%, respectively, in post-partum groups. Sensitivity analysis confirmed the reliability and consistency of the results. Oral iron was associated with significant gastrointestinal side effects. There was no significant difference in birthweight between the groups.

Conclusion

This meta-analysis demonstrates that intravenous iron sucrose is more effective than oral iron therapy for pregnant and post-partum women with iron deficiency anaemia. It is an effective and safe alternative to address the problem of iron deficiency especially in those who require rapid replacement of iron stores though medical personnel for intravenous administration of drug is required.
Trial registration CRD42015024343

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Zusatzmaterial
Supplementary material 1 (PDF 175 kb)
13224_2018_1191_MOESM1_ESM.pdf
Supplementary material 2 (PDF 71 kb)
13224_2018_1191_MOESM2_ESM.pdf
Literatur
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