A Prospective Randomised Trial of Intravenous Iron Therapy Versus Oral Iron for Iron Deficiency Anaemia in Pregnant Australian Women

To date, limited data is available regarding prevalence of iron deficiency during pregnancy in Australia. There is little if any data currently available regarding comparative efficacy of IV iron versus oral iron therapy in pregnant women. In Australia the prevalence of iron deficiency anaemia (IDA) is approximately 5% in the general population with higher rates in pregnant women. At a single site, the Launceston General Hospital (LGH), we prospectively investigated 200 pregnant women between January and July 2007 with FBC and iron studies at the first or second antenatal visit. Among those, 40 women (20%) had iron deficiency anaemia, and were recruited to a prospective randomised trial to determine whether intravenous iron therapy (iron polymaltose) is superior to oral iron (ferrous sulphate) for the management of IDA associated with pregnancy. The patients’ median age was 28 years old (range; 19–40) with a median gestational age at recruitment of 27 weeks (range; 13–29) and a median body weight of 74 kg (range; 47–130). At recruitment median Hb was 106 g/L (range; 90–114, normal range; 120–160 g/L), while median serum ferritin was 11.5 μg/L and mean ferritin was 19 μg/L normal range; 30–460). After four weeks of treatment the Hb level increased by a mean of 6g/L on oral iron and by 10.5 g/L after IV iron. Mean/Median serum ferritin did not increase significantly in women on oral iron, but increased to a median of 96.5 μg/L and a mean of 224 μg/L in those received IV iron. Multi-variate analysis using general linear modelling for continuous variables showed a significant increase in serum ferritin after treatment with IV iron versus oral iron (p=0.017). There was no statistically significant difference in terms of Hb increment, patients’ parity, weight, and date of last pregnancy between groups. Analysis of quality of life questionnaires to assess patients’ well-being, ability to perform activities, and symptoms of anaemia showed improvement in both groups of patients with a trend to greater and faster improvement after IV iron. Both treatments were well tolerated without major side effects. The preliminary data indicate IDA is a common finding during pregnancy in the LGH population, and intravenous iron therapy appears a safe and effective treatment in this cohort of patients. This research received a grant from the Clifford Craig Medical Research Trust, Tasmania, Australia.