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Treatment of Iron Deficiency Anemia in Pregnancy With Intravenous Versus Oral Iron: A Meta-Analysis of RCTs [10OP]

Govindappagari, Shravya, MD; Burwick, Richard M., MD, MPH

doi: 10.1097/01.AOG.0000533298.46904.df
Saturday, April 28, 2018

INTRODUCTION: According to the World Health Organization, anemia affects 42% of pregnancies globally. Oral (PO) iron is standard of care, but poor absorption limits efficacy. Thus, intravenous (IV) iron has been compared to PO iron in randomized control trials (RCTs). We performed an RCT meta-analysis to assess the benefits of IV iron in pregnancy.

METHODS: This meta-analysis was performed according to Meta-analysis of Observational studies in Epidemiology (MOOSE) guidelines. We searched PUBMED,, Google scholar, and Cochrane library. 297 articles were reviewed, and after exclusions, 10 RCTs comparing IV to PO iron in pregnancy were included. Studies confirmed iron-deficiency anemia before treatment. Endpoints were: 1) Subjects achieving target hemoglobin; 2) Hemoglobin increase at 4 weeks and; 3) Subjects experiencing adverse effects. Meta-analyses were performed with Stata (College Station, TX), with summary odds ratios by Mantel-Haenszel method and pooled risk difference by Cohen's method.

RESULTS: Data from 10 RCTs were utilized for pooled meta-analysis. Pregnant women were more likely to achieve target hemoglobin with IV versus PO iron (7 studies), summary OR 2.7 (95% CI 2.0–3.6), P<.001. Hemoglobin levels increased more at 4 weeks with IV iron (8 studies), mean difference 1.2 g/dL (95% CI 1.0–1.3), P<.001. Adverse reactions were lower with IV versus PO iron (10 studies), summary OR 0.54 (95% CI 0.41–0.72), P<.001.

CONCLUSION: In this RCT meta-analysis, IV iron is superior to oral iron for treatment of iron-deficiency anemia in pregnancy. Women receiving IV iron more often achieve desired hemoglobin targets, faster, with less side effects.

Cedars-Sinai Medical Center, Los Angeles, CA

Financial Disclosure: The authors did not report any potential conflicts of interest.

© 2018 by American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.