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Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis

Journal of Perinatology volume 39, pages 519–532 (2019)Cite this article

Subjects

Abstract

Objective

To assess the effect of intravenous versus oral iron on hematologic indices and clinical outcomes for iron-deficiency anemia (IDA) in pregnancy.

Study design

Searches in Ovid Medline, Embase, SCOPUS, Cochrane Database, and ClinicalTrials.gov identified randomized-controlled trials comparing intravenous to oral iron for treating IDA in pregnancy. Primary outcomes were maternal hematologic indices at delivery. Secondary outcomes were blood transfusion, cesarean delivery, neonatal outcomes, and medication reactions.

Results

Of 15,637 studies, 20 randomized trials met inclusion criteria and were analyzed. Mean hemoglobin at delivery (9 studies: WMD 0.66 g/dL (95% confidence Interval 0.31 –1.02 g/dL)) was significantly higher after intravenous iron therapy. Intravenous iron was associated with higher birthweight (8 studies: WMD 58.25 g (95% CI: 5.57–110.94 g)) but no significant differences in blood transfusion, cesarean delivery, or neonatal hemoglobin. There were fewer medication reactions with intravenous iron (21 studies: RR 0.34% (95% CI: 0.20–0.57)).

Conclusion

Intravenous iron therapy is associated with higher maternal hemoglobin at delivery with no difference in blood transfusion and fewer mild medication reactions.

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Acknowledgments

Dr. Lewkowitz is supported in part by a National Institutes of Health training grant T32-HD-55172-9. Dr. Tuuli is supported by National Institutes of Health U01 (U01HD077384-03) and R01 (1Ro1HD0867001-01) grants. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.

Author contributions

AKL, AG, BAS, EC, RR, and MGT designed the work that led to the submission. AKL, AG, LS, CS, and MGT acquired data and conducted the analyses. AKL and AG drafted the manuscript. All authors revised the manuscript and approved its final submission.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8064, St. Louis, MO, 63110, USA

    Adam K. Lewkowitz, Bethany A. Sabol & Roxanne A. Rampersad

  2. Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Anjlie Gupta & Carrie Stoll

  3. Becker Medical Library, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Laura Simon

  4. Department of Pharmacy, Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, St. Louis, MO, 63110, USA

    Emily Cooke

  5. Department of Obstetrics & Gynecology, Indiana University School of Medicine, 550N. University Boulevard, UH 2440, Indianapolis, IN, 46202, USA

    Methodius G. Tuuli

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  1. Adam K. Lewkowitz
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Correspondence to Adam K. Lewkowitz.

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Lewkowitz, A.K., Gupta, A., Simon, L. et al. Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. J Perinatol 39, 519–532 (2019). https://doi.org/10.1038/s41372-019-0320-2

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