Treatment of iron-deficiency anaemia in pregnancy and postpartum
DOI:
https://doi.org/10.31403/rpgo.v58i48Abstract
It is clear that iron-deficiency states and anaemia should be treated. Even in milder forms of anaemia, it is often impossible to predict the course of the condition, or whether the situation is likely to worsen, and maternal and foetal risks increase as anaemia becomes more severe. Factors to be taken into account when deciding on the treatment approach to use include the time remaining until delivery, the severity of the anaemia, additional risks (e.g. premature labour), maternal co morbidity and the patient’s own wishes (e.g. refusal to receive donor blood to treat severe anaemia). Thus, for example, a Jehovah’s Witness with severe anaemia two weeks before term needs different treatment than a woman with moderate anaemia and no additional risk factors during the second trimester. At present, the main treatment options for anaemia include oral iron, parenteral iron, the stimulation of haemopoiesis with growth factors (e.g. recombinant human erythropoietin) and the administration of heterologous blood.
Downloads
References
Al A, Unlubilgin E, Kandemir O, Yalvac S, Cakir L, Haberal A. Intravenous versus oral iron for treatment of anemia in pregnancy. Obstet Gynecol. 2005;106:1335-40.
Bayoumeu F, Vial F, Zaccabri A, Agullès O, Laxenaire MC. Iron therapy in iron deficien- cy anemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol. 2002;186:518-22.
Beguin Y, Lipcsei G, Thoumsin H, Fillet G. Blunted erythropoietin production and de- creased erythropoiesis in early pregnancy. Blood. 1991;78:89–91.
Braga J, Marques R, Branco A, Jorge C.Maternal and perinatal implications of the use of human recombinant erythropoietin. Acta Obstet Gynecol Scand. 1996;75:449–53.
Breymann C, Huch R. Anemia in pregnan- cy and the puerperium. UNI-MED Science, 3rd edition. 2008. ISBN 978-3-8374-1022-8.6. Breymann C, Gliga F, Bejenariu C, Strizho- va N. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. Int J Gynaecol Obstet. 2008;101:67-73.
Breymann C, Visca E, Huch R, Huch A. Efficacy and safety of intravenously admi- nistered iron sucrose with and without adju- vant recombinant human erythropoietin for the treatment of resistant iron-deficiency anemia during pregnancy. Am J Obstet Gy- necol. 2001;184:662–7.
Breymann C, Zimmermann R, Huch R, Huch A. Use of recombinant erythropoie- tin in combination with parenteral iron in the treatment of postpartum anaemia. Eur J Clin Invest. 1996;26:123–30.
Bridges K. Iron imbalance during pregnan- cy. En: Bern M, Frigoletto F (eds) Hema- tologic disorders in maternal-fetal medicine. Wiley & Liss, New York, 1990;113–28.
CDC. CDC Criteria for anemia in children and childbearing-aged women. Morbid Mortal Weekly Rep. 1989;38:400–4.
Charache S. Hemoglobinopathies. In: Bern M, Frigoletto F (eds) Hematologic disorders in maternal-fetal medicine. Wiley & Liss, New York, 1990;171–81.
Ekeroma A, Ansari A, Stirrat G. Blood transfusion in obstetrics and gynaecology. Br J Obstet Gynaecol. 1997;104:278–84.
Hallberg L. Prevention of iron deficiency. Baillieres Clin Haematol. 1994;7:805–14.
Hemminki E, Meriläinen J. Long-term fo- llow-up of mothers and their infants in a randomized trial on iron prophylaxis du- ring pregnancy. Am J Obstet Gynecol. 1995;173:205–9.
Hollan S, Johansen K. Adequate iron stores and the »nil nocere« principle. Haematolo- gia. 1993.
Huch R, Huch A. Erythropoietin in obs- tetrics. Hematol Oncol Clin North Am. 1994;8:1021–40.
Krafft A, Bencaiova B, Breymann C. Selecti- ve use of recombinant human erythropoie- tin in pregnant patients with severe anemia or nonresponsive to iron sucrose alone. Fe- tal Diagn Ther. 2009;25:239-45.
Malek A. In vitro studies of ferric carboxy- maltose on placental permeability using the dual perfusion model of human placenta. Drug Res. 2009;in press.
Seid M, Derman R, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199:435. e 1-7.
Van Wyck D, Martens M, Baker J, Mangio- ne A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized contro- lled trial. Obstet Gynecol. 2007;110:267-78.
Wali A., Mushtaq A. Efficacy, safety and compliance of intravenous iron sucrose and intramuscular iron sorbitol in iron deficien- cy anemia in pregnancy. J Pak Med Assoc. 2002;52:392-5.