Advancing Iron Therapy in Maternal Health: Evolving Strategies for Treating Iron Deficiency Anemia

Abstract

Importance: Iron deficiency anemia (IDA) affects approximately one-third of pregnant women worldwide and is a significant contributor to adverse maternal and fetal outcomes, including preterm delivery, low birth weight, and cognitive impairment in children. Despite advancements in iron therapy, IDA remains prevalent, affecting 29.9% of women globally. This highlights a critical need for more effective management strategies during pregnancy.

Objective: To provide a comprehensive review of the mechanisms governing iron absorption, current guidelines for iron therapy, and the efficacy and safety profiles of various iron salts, with the aim of improving supplementation approaches for the effective management of IDA in pregnancy.

Evidence acquisition: The review evaluates existing literature on intestinal iron absorption and placental transport mechanisms of different iron salts. It also analyzes international guidelines recommending daily administration of oral and intravenous iron, alongside the clinical efficacy and safety profiles.

Results: The absorption and transport of iron are complex processes influenced by intestinal uptake and placental transport, regulated by maternal and fetal iron stores and hepcidin levels. Despite the availability of various iron formulations, none have proven ideal for managing IDA during pregnancy. Clinical trials demonstrate varying efficacy and safety profiles, indicating a significant gap in current treatment strategies.

Conclusion and relevance: Although advancements in iron therapy have been made, no single formulation has emerged as the optimal solution for managing IDA in pregnancy. This review underscores the need for a deeper understanding of iron absorption mechanisms and more effective supplementation approaches to address the ongoing burden of IDA among pregnant women worldwide.

Target audience: Obstetricians and gynecologists, family physicians.

Learning objectives: After participating in this activity, the learner should be better able to explain the complex mechanism of iron absorption and identify the physiological mechanisms governing the absorption of heme and nonheme iron; summarize how to diagnose IDA and apply international guidelines for iron supplementation in pregnancy; and compare the efficacy, bioavailability, and safety profiles of various oral and intravenous iron formulations to identify the most suitable options for managing IDA during pregnancy.