|Year : 2020 | Volume
| Issue : 1 | Page : 12-15
Role of intravenous iron sucrose in comparison to oral ferrous sulfate for prophylaxis of anemia in pregnant women
Ashishkumar Bhatt, Nanda Vinayak, Neema Acharya
Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
|Date of Submission||07-Jan-2020|
|Date of Decision||15-Jan-2020|
|Date of Acceptance||30-Jan-2020|
|Date of Web Publication||13-Oct-2020|
Dr. Nanda Vinayak
Associate Professor, Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
Purpose: The aim of our study is to compare intravenous (IV) iron sucrose with ferrous sulfate for prophylactic iron therapy in pregnancy in terms of hemoglobin percent (Hb%) rise. Materials and Methods: One hundred and fifty-four pregnant women fulfilling the inclusion criteria, with Hb >10gm/dl, between 20 and 24 weeks were selected and divided into two groups, 77 each. Group A was allotted to use three doses of iron sucrose, each dose 200 mg in 100 ml normal saline as infusion over 15–20 min at 20–24, 25–28, and 29–32 weeks, respectively, and Group B was allotted to use oral ferrous sulfate 200 mg tablet once daily at bed time. All pregnant women were followed till 32 weeks. Hb% was estimated for both the groups at 20–24 weeks, 25–28 weeks, and 29–32 weeks, and statistical analysis was carried out using the Chi-square test, Student's paired, and unpaired t-test with the SPSS software version 24.0 and Graph Pad Prism 7.0 version, and P < 0.05 is considered as level of statistical significance. Results: Mean Hb% at 20–24 weeks in patients of Group A was 11.11 ± 0.89, and in Group B, it was 11.04 ± 0.80; mean Hb% at 29–32 weeks in patients of Group A was 12.39 ± 0.99, and in Group B, it was 12.23 ± 0.89. Conclusions: IV iron sucrose can be used as prophylaxis for anemia in pregnant women as it requires less follow-up and causes a rapid increase in hemoglobin.
Keywords: Intravenous iron sucrose, iron prophylaxis in pregnancy, oral ferrous sulfate
|How to cite this article:|
Bhatt A, Vinayak N, Acharya N. Role of intravenous iron sucrose in comparison to oral ferrous sulfate for prophylaxis of anemia in pregnant women. J Datta Meghe Inst Med Sci Univ 2020;15:12-5
|How to cite this URL:|
Bhatt A, Vinayak N, Acharya N. Role of intravenous iron sucrose in comparison to oral ferrous sulfate for prophylaxis of anemia in pregnant women. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 20];15:12-5. Available from: http://www.journaldmims.com/text.asp?2020/15/1/12/297988
| Introduction|| |
Anemia in women during pregnancy is a serious threat, and severe anemia is associated with increased risk of maternal mortality, which is unacceptably high in developing countries. The incidence of iron-deficiency anemia (IDA) in India was estimated at 60.0% in the urban population and 69.0% in the rural population. With severity of anemia ranging from 57% to 96.2% in India among South Asian countries,,,, it becomes important to diagnose iron deficiency anemia at an early age.
Recent literature supports the significance of lifestyle and dietary habits during pregnancy as the physiological demands are three times higher than in nonpregnant women. Iron requirement substantially increases during the third trimester of about 10 mg/day from the second trimester (4–6 mg/day) and first trimester. Low iron bioavailability is the main etiological factor of anemia in pregnant women in India. Hence, regular iron supplementation is necessary for pregnant women to prevent IDA.
Oral iron supplementation is the first choice of treatment for IDA because of easy availability at all primary health centers. Ferrous salts are preferred over ferric salts by the WHO due their effectiveness, better absorption, and low cost. Therefore, ferrous sulfate was used in the present study.
Parenteral iron preparations are useful in cases noncompliant to oral iron. Intravenous (IV) iron sucrose preparation was found to be safe, effective in a single large dose with high availability for erythropoiesis, with less renal excretion, minimal tissue accumulation, and toxicity, hence used in our study.
The aim of our study was to compare the effect of prophylactic IV iron sucrose versus oral ferrous sulfate when used for the prevention of anemia in pregnancy.
| Materials and Methods|| |
This is a cross-sectional study carried out after obtaining consent from the Ethical Committee in the Department of Obstetrics and Gynecology, Acharya Vinoba Bhave Rural Hospital (AVBRH), a tertiary care teaching hospital in the rural area of Wardha district. One hundred and fifty-four pregnant women were selected, visiting the outpatient and inpatient department of obstetrics and gynecology, after fulfilling the selection criteria. Initial hemoglobin values were assessed by the laboratory examinations. Women having hemoglobin value more than 10 gm/dl were included in the study, and they were randomly divided into two groups: Group A –77 women and Group B – 77 women by random color coin method. Tablet albendazole 400 mg was given at the beginning of the study to all pregnant women.
Seventy-seven pregnant women who received three doses of injection iron sucrose 200 mg in 100 ml normal saline as infusion over 1–20 min at 20–24 weeks, 25–28 weeks, and 29–32 weeks of gestation, respectively, were allocated in Group A. IV iron sucrose 200 mg was diluted in 100 ml isotonic sodium chloride solution and was given over a period of 20 min in the form of slow IV injection, after IV iron sucrose-sensitivity testing [Figure 1].
Seventy-seven pregnant women who received oral ferrous sulfate 200 mg, containing elemental iron of 65 mg, daily at bed time, one hour before food up to 32 weeks were allocated in Group B. The patient was advised for follow-up every 4 weeks and up to 32 weeks of gestation.
Hemoglobin percentage was estimated for both the groups at 20–24 weeks, 25–28 weeks, and 29–32 weeks using cell coulter Horiba (ABX Pentra XLR 80) [Figure 2]. Women that developed pregnancy complication in the course of study were excluded from the study.
| Results|| |
Statistical analysis was performed using the descriptive and inferential statistics using the Chi-square test, student's paired and unpaired t-test, and software used in the analysis was SPSS 24.0 version (Chicago, Illinois, USA) and Graph Pad Prism 7.0 version (San Diego, CA), and P < 0.05 is considered as level of statistical significance [Table 1], [Table 2], [Table 3], [Table 4], [Table 5].
|Table 1: Legend-Graphical representation of age-wise distribution of patients|
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|Table 2: Comparison of hemoglobin percent at 20-24 weeks, 25-28 weeks, and 29-32 weeks in Group A using Student's paired t-test|
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|Table 3: Comparison of hemoglobin percent at 20-24 weeks, 25-28 weeks, and 29-32 weeks in Group B using Student's paired t-test|
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|Table 4: Comparison of hemoglobin percent at 20-24 weeks, 25-28 weeks, and 29-32 weeks in Group A and Group B using Student's unpaired t-test|
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|Table 5: Graphical representation of comparison of hemoglobin % at 20–24 weeks, 25–28 weeks, and 29–32 weeks in Group A and Group B|
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| Discussion|| |
Severe iron deficiency with anemia is frequent among pregnant women in developing countries such as India. Iron prophylaxis aims to curb the deficiency and its dire effects on the mother and fetus.
In the present study, about 48.7% of the pregnant women belonged to the age group of 2–28 years, indicating that teenage pregnancy is toward decreasing trend in our area due to lot of adolescent family life, awareness through education programs. Similar results were noted in studies by Geelhoed et al. and Gautam et al.
Both forms of prophylactic iron therapy led to increased hemoglobin over the testing period in our study, which was comparable to a study by Bayoumeu et al. on 50 women patients treated for iron deficiency with IV and oral iron therapy and was similar to study performed by El-Ezz.
There was no significant difference in hemoglobin values between the groups at any measured time point in the study. Such similar results were noted in studies done by Gogineni and Vemulapalli, Bhandal and Russell, Bencaiova et al., and Frossler et al.
The present study performed was successful in increasing the hemoglobin of both the prophylactic treatment groups, preventing IDA in pregnant women. Although patients of oral iron treatment group required regular visits, IV iron sucrose needed minimal reinforcement by the investigator. This study was limited to hemoglobin levels; other parameters of iron deficiency such as serum ferritin, total iron-binding capacity were not calculated.
| Conclusion|| |
IV iron sucrose can be used as prophylaxis for anemia in pregnant women as it requires less follow-up and causes rapid increase in hemoglobin. The present study conducted was confined to a rural tertiary care hospital in the Vidarbha region of Central India. Further studies should be carried out using injection iron sucrose as prophylaxis in preventing anemia in pregnant women at the national level and also at the larger scale.
My sincere gratitudes to Datta Meghe Institute of Medical Sciences for allowing me to carry out the study and for technical support.
Financial support and sponsorship
This study was financially supported by the Central Lab, AVBRH, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]