More Effective Route of Treatment for Iron Deficiency Anemia in Pregnancy Intravenous Vs Oral Iron
Authors: Kumari Komal , Kumari Katee , Jones Claire , Kloecker Goetz 
Published: December 2024

Iron deficiency anemia (IDA) is a prevalent condition during pregnancy, significantly impacting maternal and fetal health. The choice between oral and intravenous (IV) iron supplementation remains a critical clinical decision. This extensive review evaluates the efficacy, safety, and overall outcomes of oral versus IV iron supplementation in pregnant patients with IDA, drawing on recent literature from the past decade.

Introduction:

Iron deficiency anemia (IDA) during pregnancy poses significant risks, including preterm birth, low birth weight, and increased maternal morbidity. Effective iron supplementation is crucial for mitigating these risks. This review compares oral and IV iron supplementation strategies, focusing on efficacy, safety, compliance, and clinical outcomes in pregnant women with IDA based on recent studies.

Methods:

A systematic literature review was performed using databases such as PubMed, Cochrane Library, and Google Scholar. The review included randomized controlled trials (RCTs), cohort studies, and meta-analyses published from 2013 to 2023. The primary outcomes assessed were changes in hemoglobin (Hb) levels, ferritin levels, adverse effects, maternal and fetal outcomes, and patient adherence.

Results:

Efficacy

Hemoglobin Levels: Recent studies consistently show that IV iron supplementation leads to a more rapid and significant increase in hemoglobin levels compared to oral iron. A meta-analysis by Singh et al. (2021) found that IV iron resulted in a greater increase in Hb levels at 4 and 8 weeks compared to oral iron.

Ferritin Levels: IV iron is superior in replenishing iron stores, as indicated by higher ferritin levels post-treatment. Froessler et al. (2019) demonstrated significantly higher ferritin levels in the IV iron group compared to the oral iron group.

Safety:

Adverse Effects: Oral iron is frequently associated with gastrointestinal side effects, such as nausea, constipation, and diarrhea, which can lead to poor compliance. IV iron, while generally well-tolerated, can cause infusion reactions, although these are relatively rare. A study by Froessler et al. (2019) reported fewer adverse effects in the IV iron group compared to the oral iron group.

Maternal Outcomes: Improved hemoglobin levels with IV iron were associated with better maternal outcomes, including reduced fatigue and improved quality of life. Breymann et al. (2017) highlighted the safety and efficacy of IV iron in pregnant women, noting fewer adverse effects and higher maternal satisfaction compared to oral iron.

Clinical Outcomes:

Maternal Health: Enhanced iron status with IV iron leads to better maternal health, with fewer reports of fatigue and improved overall well-being. Van Wyck et al. (2017) showed significantly higher satisfaction rates in the IV iron group due to quicker and more effective treatment.

Fetal Outcomes:

Improved maternal iron status positively impacts fetal health, reducing risks of low birth weight and preterm delivery. A study by Khalafallah et al. (2018) found that IV iron administration resulted in better fetal outcomes compared to oral iron, including higher birth weights and reduced rates of preterm births.

Compliance:

Compliance with oral iron is often compromised due to gastrointestinal side effects. IV iron, requiring fewer doses and providing rapid improvement, generally results in better compliance. Sharma et al. (2020) reported higher adherence rates in the IV iron group compared to the oral iron group.

Discussion:

The comparative analysis indicates that IV iron supplementation offers several advantages over oral iron in treating IDA during pregnancy. The rapid correction of hemoglobin levels, effective replenishment of iron stores, and better patient compliance highlight IV iron as a superior option, particularly in cases of severe anemia or poor tolerance to oral iron. However, the higher cost and need for medical supervision during IV administration remain important considerations.

Conclusion:

IV iron supplementation appears to be more effective and better tolerated than oral iron in pregnant women with IDA. It provides quicker improvement in hemoglobin and ferritin levels, better maternal and fetal outcomes, and higher compliance rates. Further research is warranted to optimize treatment protocols and address cost-effectiveness and accessibility issues, particularly in resource-limited settings.