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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 12-15

Role of intravenous iron sucrose in comparison to oral ferrous sulfate for prophylaxis of anemia in pregnant women


Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission07-Jan-2020
Date of Decision15-Jan-2020
Date of Acceptance30-Jan-2020
Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Nanda Vinayak
Associate Professor, Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_5_20

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  Abstract 


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 Top


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.[1] With severity of anemia ranging from 57% to 96.2% in India among South Asian countries,[2],[3],[4],[5] 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.[6] 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.[7] 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 Top


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].
Figure 1: Administration of intravenous iron sucrose

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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.
Figure 2: Cell Coulter Horiba (ABX Pentra XLR 80)

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  Results Top


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 Top


Severe iron deficiency with anemia is frequent among pregnant women in developing countries such as India.[8] 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.[9] and Gautam et al.[10]

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.[11] on 50 women patients treated for iron deficiency with IV and oral iron therapy and was similar to study performed by El-Ezz.[12]

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,[13] Bhandal and Russell,[14] Bencaiova et al.,[15] and Frossler et al.[16]

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 Top


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.

Acknowledgment

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.



 
  References Top

1.
Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh RP, et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull 2006;27:311-5.  Back to cited text no. 1
    
2.
Bedi R, Acharya R, Gupta R, Pawar S, Sharma R. Maternal factors of anemia in 3rd trimester of Pregnancy and its association with fetal outcome. Int Multispeciality J Health 2015;1:7.  Back to cited text no. 2
    
3.
Menon KC, Ferguson EL, Thomson CD, Gray AR, Zodpey S, Saraf A, et al. Effects of anemia at different stages of gestation on infant outcomes. Nutrition 2016;32:61-5.  Back to cited text no. 3
    
4.
Prevalence of Anemia among Pregnant Women (%) 2016. Available from: http://data.worldbank.org/indicator/SH.PRG.ANEM.11. [Last accessed on 2020 Feb 22].  Back to cited text no. 4
    
5.
District Level Household Survey (DLHS-2) on Reproductive and Child Health. India-2002-04. Nutritional Status of Children and Prevalence of Anaemia among Children, Adolescent Girls and Pregnant Women. Ministry of Health and Family Welfare Government of India. International Institute for Population Sciences; 2006.  Back to cited text no. 5
    
6.
Dev SM, Sharma AN. Food Security in India: Performance, Challenges and Policies. Oxfam India Working Papers Series; 2010. p. 1-42.  Back to cited text no. 6
    
7.
DeMaeyer EM, Dallman P, Gurney JM, Hallberg L, Sood SK, Srikantia SG. Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care: A Guide for Health Administrators and Programme Managers. World Health Organization; 1989.  Back to cited text no. 7
    
8.
Kalaivani K. Prevalence and consequences of anaemia in pregnancy. Indian J Med Res 2009;130:627-33.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Geelhoed D, Agadzi F, Visser L, Ablordeppey E, Asare K, O'Rourke P, et al. Severe anemia in pregnancy in rural Ghana: A case-control study of causes and management. Acta Obstet Gynecol Scand 2006;85:1165-71.  Back to cited text no. 9
    
10.
Gautam VP, Bansal Y, Taneja DK, Saha R. Prevalence of anemia amongst pregnant women and its sociodemographic associates in a rural area of Delhi. Indian J Community Med 2002;27:10-2.  Back to cited text no. 10
    
11.
Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: Intravenous route versus oral route. Am J Obstet Gynecol 2002;186:518-22.  Back to cited text no. 11
    
12.
El-Ezz AA, Abdullah EA. Iron deficiency anemia during pregnancy: Intravenous versus oral route. AAMJ 2013;11:11-3.  Back to cited text no. 12
    
13.
Gogineni S, Vemulapalli P. Comparative study of parenteral iron sucrose vs. oral ferrous ascorbate for prophylactic iron therapy in pregnancy. IOSR JDMS 2015;14:95-7.  Back to cited text no. 13
    
14.
Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anaemia. BJOG 2006;113:1248-52.  Back to cited text no. 14
    
15.
Bencaiova G, von Mandach U, Zimmermann R. Iron prophylaxis in pregnancy: Intravenous route versus oral route. Eur J Obstet Gynecol Reprod Biol 2009;144:135-9.  Back to cited text no. 15
    
16.
Froessler B, Cocchiaro C, Saadat-Gilani K, Hodyl N, Dekker G. Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: A randomized trial. J Matern Fetal Neonatal Med 2013;26:654-9.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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