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Intravenous Iron Versus Oral Iron in the Treatment of Postpartum Iron Deficiency Anemia

14 August 2010


Background: Postpartum anemia can develop after delivery because of unforeseen medical problems during and after delivery which could complicate a mother’s ability to properly care for her newborn child. The current treatment for postpartum anemia is oral iron supplementation but this treatment has been associated with several gastrointestinal side effects. Alternative treatments include blood transfusions and intravenous (IV) iron therapy. Since blood transfusions are very costly, IV iron treatments have become more popular.

Objectives: The objective of this review is to evaluate the hematological parameters and quality of life of women with postpartum anemia while being treated with IV iron sucrose or IV ferrous carboxymaltose compared to oral ferrous sulfate.

Methods: An exhaustive search of available medical literature was performed using three databases: MEDLINE, EMBASE and CINAHL. All keywords were originally searched individually and then combined to refine the search. The inclusion criteria consisted of randomized control trials (RCT) published in English after January 2000, which looked at hematologic parameters in postpartum anemic women being treated with either an oral iron supplement or IV iron therapy.

Results: Six RCTs involving 1140 women were reviewed. Four of the studies showed that anemia was corrected with iron therapy at some point during the trial regardless of the treatment method. Three studies showed a significantly decreased amount of time to increase hemoglobin (Hb) levels in the women who where treated with IV iron therapy. All of the studies showed a significant increase in ferritin levels in the IV iron therapy group when compared to the oral iron group, with five of the six studies ending their studies with significantly continued ferritin elevation in the IV iron group. The two studies that examined maternal quality-of-life parameters reported non-significant improvements in the IV treatment group. Although both of these studies also assessed maternal fatigue, only one study reported significant declines in physical and total fatigue.

Conclusion: Both ferric carboxymaltose and iron sucrose are safe and effective ways to treat postpartum iron deficiency anemia. Both forms of IV iron are superior to oral ferrous sulfate as they require a shorter treatment period, increase the likelihood of compliance, have no gastrointestinal side effects and rapidly replenish iron stores.


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