Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy

Abstract

Purpose: To evaluate the efficacy and safety of intravenous ferric carboxymaltose administration to pregnant women with varying severities of iron deficiency anemia and iron deficiency without anemia.

Methods: In this prospective observational study of local obstetric practice, we analyzed data from 863 pregnant women with iron deficiency according to anemia status and severity. All women were treated with intravenous ferric carboxymaltose in pregnancy. Treatment efficacy was assessed by repeat hemoglobin measurements at 3 and 6 week post-infusion and ferritin levels, where available. Safety was assessed by analysis of adverse events, fetal heart rate monitoring, and newborn health outcome data.

Results: Ferric carboxymaltose significantly increased hemoglobin in women with mild, moderate, and severe iron deficiency anemia and women with iron deficiency alone at 3 and 6 week post-infusion (p < 0.01 for all). No hemoconcentration occurred in iron-deficient women without anemia. No serious adverse events were recorded, with minor temporary side effects (including local skin irritation, nausea, and headache) occurring in 96 (11%) women. No adverse fetal or neonatal outcomes were observed.

Conclusions: Ferric carboxymaltose infusion corrects iron deficiency or various degrees of iron deficiency anemia efficaciously and safely pregnant women, and does not cause hemoconcentration.

Keywords: Ferric carboxymaltose; Intravenous iron; Iron deficiency anemia severity; Iron deficiency no anemia; Pregnancy; Safety.

Fig. 1

Hemoglobin levels (mean ± SEM) across the testing period according to the severity of iron deficiency anemia prior to infusion. Dotted line reflects adequate hemoglobin concentration in second and third trimester of pregnancy (110 g/L). No anemia (n = 234), mild anemia 96–110g/L (n = 462), moderate anemia 90–95/L (n = 88), severe anemia < 90 g/L (n = 79)