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Contemporary Uses of Erythropoietin in Pregnancy: A Literature Review

Sienas, Laura MD; Wong, Tienne MD; Collins, Rebecca MD; Smith, James MD

Obstetrical & Gynecological Survey: August 2013 - Volume 68 - Issue 8 - p 594–602
doi: 10.1097/OGX.0b013e3182a2d51c
CME Articles: Contemporary Use of Erythropoietin in Pregnancy

Objective The objectives of this study were to survey the current research and provide an update on the uses and benefits of erythropoietin (EPO) in pregnancy and the postpartum period.

Data Sources A review of MEDLINE (1947 to present) was performed. Search terms included “erythropoietin,” “pregnan*,” with subheadings of “administration & dosage,” “pharmacokinetics,” “therapeutic use,” “fetus,” “fertility.”

Method of Study Selection We reviewed relevant articles published from 2002 to 2012. Case reports, observational studies, case-control studies, randomized controlled trials, retrospective analyses, animal studies, and review articles were included. Articles were selected if they discussed a use of EPO in pregnancy or the immediate postpartum period, as well as use of EPO in the neonate.

Tabulation, Integration, and Results Authors independently reviewed and extracted data. Of the 65 articles reviewed, 45 were included. Erythropoietin was used in the treatment of maternal anemia. Because of the molecule’s large size, recombinant EPO does not appear to cross the placenta. No fetal morbidity or mortality was noted. Therefore, this is a safe therapy that can be used in pregnancy. Use of EPO may be especially important for women who decline blood products. Neonatal uses of EPO show benefit in the treatment of anemia due to blood type incompatibility.

Conclusions Erythropoietin is gaining popularity as a therapeutic option during pregnancy and the postpartum period. Further investigation is needed to establish a standard dosage and dosing interval. New studies reviewing its use in the neonate for perinatal-hypoxic injury and anemia due to blood type incompatibility provide exciting opportunities for further therapeutic use.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this CME activity, physicians should be better able to treat anemia in pregnancy, including causes and interventions; assess renal disease in pregnancy, targets of hemoglobin, precautions, and treatment considerations; and evaluate erythropoietin use in neonates and fetuses, including benefits, complications, and areas for upcoming research/uses.

*First Year Resident, UC Davis Medical Center, Sacramento CA; †First Year Resident, Indiana University, Indianapolis, IN; ‡First Year Resident, Exempla St Joseph Hospital, Denver, CO; and §Chairman and Professor, Creighton University School of Medicine, Omaha, NE

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

The authors have disclosed that the US Food and Drug Administration has not approved the use of Erythropoietin as discussed in this article. Please consult the products’ labeling for approved information.

Correspondence requests to: James Smith, MD, Creighton University School of Medicine, 601 N 30th St, Suite 4700, Omaha, NE 68131. E-mail:

© 2013 by Lippincott Williams & Wilkins.