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February 1, 2025
Anemia during pregnancy, primarily caused by iron deficiency, remains a significant global health issue. Affecting an estimated 37% of pregnant individuals worldwide, according to the World Health Organization, it is associated with increased risks of complications such as preterm labor, hemorrhaging, and, in some cases, even maternal mortality. Iron deficiency can also have long-term effects on the child’s health and development.
Currently, obstetric guidelines recommend daily oral iron supplements for pregnant individuals with iron deficiency anemia. In more severe cases, iron can be administered intravenously, typically in the third trimester. However, anemia during pregnancy remains a pressing challenge, particularly in countries with high prevalence rates like India.
A new clinical trial presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting offers promising new insights. The study, conducted across multiple sites in India, demonstrates that a single dose of intravenous (IV) iron during the early second trimester is not only safe but also an effective intervention for anemia during pregnancy. This large-scale trial involved 4,368 participants and is one of the most comprehensive studies to date utilizing IV iron to treat anemia in pregnant individuals.
According to Dr. Richard Derman, lead author and vice provost of global affairs at Thomas Jefferson University in Philadelphia, India was chosen as the study location due to its high rates of anemia. The study randomized participants with moderate anemia and iron deficiency before 17 weeks of gestation into three groups. One group received the standard daily oral iron supplement, while two others were administered either ferric carboxymaltose (FCM) or ferric derisomaltose (FDM)—the only two IV iron formulations approved for use in India.
The study’s primary outcomes were the incidence of low birthweight infants and the rate of participants who returned to a non-anemic state by the time of delivery. Remarkably, while all three groups achieved similar rates of normal blood counts by delivery, those who received IV iron required significantly fewer additional treatments like blood transfusions or further IV iron doses. Furthermore, the FCM group showed a notably lower rate of low birthweight infants compared to the oral iron cohort.
Dr. Rupsa C. Boelig, co-author of the study, emphasized the importance of intervening early in the second trimester. “Iron requirements during pregnancy increase significantly, particularly in the second trimester, making it harder to catch up if intervention occurs too late,” she explained. “Intervening early, rather than waiting until the third trimester, addresses the root of the problem more effectively, preventing potential complications for both the mother and the child.”
The study also points to the long-term impacts of early maternal iron deficiency anemia, which has been correlated with adverse outcomes such as low birthweight, as well as longer-term childhood conditions like autism and schizophrenia.
Dr. Mrutyunjaya B. Bellad, a key contributor to the study, reiterated the importance of this research. “This trial confirms that single-dose IV iron is not only safe but also feasible under proper supervision. Our hope is that these findings will help mitigate the complications related to anemia during pregnancy, improving outcomes for both mothers and their children globally.”
Based on these promising findings, researchers are calling for updated clinical guidelines to consider single-dose IV iron as a primary treatment for moderate iron deficiency anemia during pregnancy. These findings will be fully published in the American Journal of Obstetrics and Gynecology in the coming months.
Disclaimer: The findings from this study represent the views of the researchers involved and may not reflect standard practice or approval in all countries. Pregnant individuals should consult their healthcare providers for personalized medical advice.
