Addition of oral iron bisglycinate to intravenous iron sucrose for the treatment of postpartum anemia—randomized controlled trial

• Published in: American journal of obstetrics and gynecology 2021-12, Vol.225 (6), p.668.e1-668.e9
• Main Authors: Yefet, Enav, Mruat Rabah, Sobhiya, Sela, Nitzan Dana, Hosary Mhamed, Sally, Yossef, Avishag, Nachum, Zohar
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Anemia, Iron-Deficiency - drug therapy; Female; Ferrous Compounds - administration & dosage; Ferrous Compounds - therapeutic use; Hematinics - administration & dosage; Hematinics - therapeutic use; Humans; Infusions, Intravenous; intravenous iron treatment; iron bisglycinate; iron storage; iron sucrose; postpartum anemia; Pregnancy; Prenatal Care; Prospective Studies; Puerperal Disorders - drug therapy; quality of life; symptomatic anemia; Treatment Outcome
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2021.06.069

Studies that have compared the effectiveness of oral with intravenous iron supplements to treat postpartum anemia have shown mixed results. The superiority of one mode of treatment vs the other has yet to be demonstrated. Therefore, despite guidelines and standards of care, treatment approaches vary across practices. A single 500 mg dose of iron sucrose, which is higher than what is usually administered, has not been evaluated to treat postpartum moderate to severe anemia. This study aimed to compare the efficacy of intravenous iron sucrose alone with intravenous iron sucrose in combination with oral iron bisglycinate supplementation in treating moderate to severe postpartum anemia. A randomized controlled trial was conducted between February 2015 and June 2020. Women with postpartum hemoglobin level of ≤9.5 g/dL were treated with 500 mg intravenous iron sucrose after an anemia workup, which ruled out other causes for anemia. In addition to receiving intravenous iron, women were randomly allocated to receive either 60 mg of oral iron bisglycinate for 45 days or no further iron supplementation. The primary outcome was hemoglobin level at 6 weeks after delivery. Secondary outcomes were iron storage parameters and quality of life. Of 158 patients who participated, 63 women receiving intravenous and oral iron, and 44 women receiving intravenous iron-only, completed the study and were included in the analysis. Baseline and obstetrical characteristics were similar between the study cohorts. Although statistically significant, postpartum hemoglobin levels were only 0.4 g/dL higher in the intravenous and oral iron than intravenous iron-only cohort (12.4 g/dL vs 12.0 g/dL, respectively; P=.03), with a respective increase from baseline of 4.2 g/dL vs 3.7 g/dL (P=.03). There was no difference in the rate of women with hemoglobin level of