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Indian Journal of Hematology and Blood Transfusion
Published in: Indian Journal of Hematology and Blood Transfusion 2/2018

01-04-2018 | Review Article

Management of Iron Deficiency Anemia in Pregnancy in India

Authors: Rimpy Tandon, Arihant Jain, Pankaj Malhotra

Published in: Indian Journal of Hematology and Blood Transfusion | Issue 2/2018

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Abstract

Iron deficiency anemia (IDA) continues to be the commonest etiology of anemia in pregnancy. The prevalence of iron deficiency (ID) in pregnant Indian women is amongst the highest in the world. Untreated iron deficiency (ID) has significant adverse feto-maternal consequences. Plethora of investigations are available for diagnosis of IDA, each having specific advantages and disadvantages when used in the pregnancy setting. Therapy for ID includes dietary modification, oral iron supplementation, intravenous iron and blood transfusion. Newer parenteral iron preparations are safe and there is mounting evidence to suggest their use in frontline settings for pregnancy associated IDA in the second and third trimester. Through this review, we suggest an algorithm for diagnosis and treatment of IDA in pregnancy depending on the severity of anemia and period of gestation suited for widespread use in resource limited settings. Also, we recommend ways for increasing public awareness and tackling this health issue including the observance of “National Anemia Awareness and Treatment Day.”
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Literature
1.
Stevens GA, Finucane MM, De-Regil LM et al (2013) Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health 1(1):e16–e25PubMedPubMedCentralCrossRef
2.
3.
CDC (1989) CDC criteria for anemia in children and childbearing-aged women. MMWR Morbidity and mortality weekly report. 138(22):400–404
4.
WHO (2001) Iron deficiency anemia: assessment, prevention and control. WHO/NHD/01.3, Geneva. World Health Organization, Switzerland
5.
WHO (2011) VMNIS. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System, WHO, Geneva, World Health Organisation, Switerzerland
6.
Daru J, Cooper NA, Khan KS (2016) Systematic review of randomized trials of the effect of iron supplementation on iron stores and oxygen carrying capacity in pregnancy. Acta Obstet Gynecol Scand 95(3):270–279PubMedCrossRef
7.
Malhotra P, Kumari S, Kumar R et al (2004) Prevalence of anemia in adult rural population of North India. J Assoc Phys India 52:18–20
8.
Ministry of Health and Family Welfare (2015–2016) Govt. of India, National Family Health Survey (NFHS-4), State Fact Sheet. Mumbai:International Institute for Population Sciences
9.
Haddad L, Hawkes C, Udomkesmalee E et al (2016) Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. International Food Policy Research Institute, Washington
10.
Rahman MM, Abe SK, Rahman MS et al (2016) Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr 103(2):495–504PubMedCrossRef
11.
Murray-Kolb L (2012) Maternal mortality, child mortality, perinatal mortality, child cognition, and estimates of prevalence of anemia due to iron deficiency. CHERG
12.
13.
Milman N (2011) Anemia–still a major health problem in many parts of the world! Ann Hematol 90(4):369–377PubMedCrossRef
14.
15.
Congdon EL, Westerlund A, Algarin CR et al (2012) Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years. J Pediatr 160(6):1027–1033PubMedPubMedCentralCrossRef
16.
Milman N, Agger AO, Nielsen OJ (1994) Iron status markers and serum erythropoietin in 120 mothers and newborn infants. Effect of iron supplementation in normal pregnancy. Acta Obstet Gynecol Scand 73(3):200–204PubMedCrossRef
17.
Arnold DL, Williams MA, Miller RS et al (2009) Iron deficiency anemia, cigarette smoking and risk of abruptio placentae. J Obstetr Gynaecol Res 35(3):446–452CrossRef
18.
Reveiz L, Gyte GM, Cuervo LG et al (2011) Treatments for iron-deficiency anaemia in pregnancy. The Cochrane database of systematic reviews. 2(10):3094
19.
Goshtasebi A, Alizadeh M, Gandevani SB (2013) Association between maternal anaemia and postpartum depression in an Urban sample of pregnant women in Iran. J Health Popul Nutr 31(3):398–402PubMedPubMedCentralCrossRef
20.
Gambling L, Lang C, McArdle HJ (2011) Fetal regulation of iron transport during pregnancy. Am J Clin Nutr 94(6 Suppl):1903s–1907sPubMedCrossRef
21.
Insel BJ, Schaefer CA, McKeague IW et al (2008) Maternal iron deficiency and the risk of Schizophrenia in offspring. Arch Gen Psychiatry 65(10):1136–1144PubMedPubMedCentralCrossRef
22.
Bothwell TH (2000) Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr 72(1 Suppl):257s–264sPubMedCrossRef
23.
Rammohan A, Awofeso N, Robitaille M-C (2011) Addressing female iron-deficiency anaemia in india: is vegetarianism the major obstacle? ISRN Public Health 2012
24.
McDonagh M, Cantor A, Bougatsos C et al (2015) U.S. preventive services task force evidence syntheses, formerly systematic evidence reviews. routine iron supplementation and screening for iron deficiency anemia in pregnant women: a systematic review to update the US preventive services task force recommendation. Agency for Healthcare Research and Quality (US), Rockville
25.
Sharma JB, Shankar M (2010) Anaemia in pregnancy. J Int Med Sci Acad 23:253–60
26.
27.
Camaschella C (2015) Iron deficiency: new insights into diagnosis and treatment. Hematol Am Soc Hematol Educ Program 2015:8–13
28.
Bermejo F, García-López S (2009) A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol WJG. 15(37):4638–4643PubMedCrossRef
29.
Sultana GS, Haque SA, Sultana T et al (2013) Value of red cell distribution width (RDW) and RBC indices in the detection of iron deficiency anemia. Mymensingh Med J 22:370–376
30.
Van den Broek NR, Letsky EA, White SA et al (1998) Iron status in pregnant women: which measurements are valid? Br J Haematol 103(3):817–824PubMedCrossRef
31.
Tiwari M, Kotwal J, Kotwal A et al (2013) Correlation of haemoglobin and red cell indices with serum ferritin in Indian women in second and third trimester of pregnancy. Medical Journal Armed Forces India 69:31–36CrossRef
32.
Ervasti M, Kotisaari S, Heinonen S et al (2007) Use of advanced red blood cell and reticulocyte indices improves the accuracy in diagnosing iron deficiency in pregnant women at term. Eur J Haematol 79(6):539–545PubMedCrossRef
33.
Goodnough LT, Nemeth E, Ganz T (2010) Detection, evaluation, and management of iron-restricted erythropoiesis. Blood 116(23):4754–4761PubMedCrossRef
34.
Saleem M, Qureshi TZ, Anwar M et al (1995) Evaluation of M/H ratio for screening of beta thalassaemia trait. J Pak Med Assoc 45:84–86PubMed
35.
Pavord S, Myers B, Robinson S et al (2012) UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 156(5):588–600PubMedCrossRef
36.
Romslo I, Haram K, Sagen N et al. (1983) Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations. Br J Obstet Gynaecol 90:101–7PubMedCrossRef
37.
Achebe MM, Gafter-Gvili A (2017) How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood 129(8):940–949PubMedCrossRef
38.
Volpi E, De Grandis T, Alba E et al (1991) Variations in ferritin levels in blood during physiological pregnancy. Minerva Ginecol 43(9):387–391PubMed
39.
Milman N, Agger AO, Nielsen OJ (1991) Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Dan Med Bull 38(6):471–476PubMed
40.
Mast AE, Blinder MA, Gronowski AM et al (1998) Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem 44(1):45–51PubMed
41.
Ayub R, Tariq N, Adil MM et al (2008) Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy. J Coll Phys Surg-Pak 18:424–427
42.
Daru J, Moores R, Dodds J et al (2015) Non-anaemic iron deficiency in pregnancy: the views of health service users and health care professionals. Transfusion Medicine 25:27–32PubMedCrossRef
43.
Lee AI, Okam MM (2011) Anemia in pregnancy. Hematol/Oncol Clin North Am 25(2):241–259CrossRef
44.
Krafft A, Huch R, Breymann C (2003) Impact of parturition on iron status in nonanaemic iron deficiency. Eur J Clin Invest 33(10):919–923PubMedCrossRef
45.
46.
Choi JW, Im MW, Pai SH (2000) Serum transferrin receptor concentrations during normal pregnancy. Clin Chem 46(5):725–727PubMed
47.
Nosratnejad S, Barfar E, Hosseini H et al (2014) Cost-effectiveness of anemia screening in vulnerable groups: a systematic review. Int J Prev Med 5(7):813–819PubMedPubMedCentral
48.
Tietz NW, Rinker AD, Morrison SR (1994) When is a serum iron really a serum iron? the status of serum iron measurements. Clin Chem 40(4):546–551PubMed
49.
Adams PC, Reboussin DM, Press RD et al (2007) Biological variability of transferrin saturation and unsaturated iron-binding capacity. Am J Med 120(11):999.e1-7PubMedCrossRef
50.
Bah A, Wegmuller R, Cerami C et al (2016) A double blind randomised controlled trial comparing standard dose of iron supplementation for pregnant women with two screen-and-treat approaches using hepcidin as a biomarker for ready and safe to receive iron. BMC Pregnancy Childbirth 16(1):157PubMedPubMedCentralCrossRef
51.
Goodlin RC (1989) Role of ferritin supported in diagnosis of anemias of pregnancy. Am J Obstet Gynecol 161(1):258–259PubMedCrossRef
52.
Hershko C, Camaschella C (2014) How I treat unexplained refractory iron deficiency anemia. Blood 123(3):326–333PubMedCrossRef
53.
Centers for Disease Control and Prevention (1998) Recommendations to prevent and control iron deficiency in the United States.MMWR Recomm Rep Morb Mortal Week Rep Recomm Rep 47(Rr-3):1–29
54.
World Health Organization (2016) WHO recommendations on antenatal care for a positive pregnancy experience. Geneva, World Health Organization, Switzerland
55.
World Health Organization (2011) Logic model for micronutrient interventions in public health: vitamin and mineral nutrition information system. Geneva, World Health Organization, Switzerland
56.
Peña-Rosas JP, De-Regil LM, Dowswell T et al (2012) Intermittent oral iron supplementation during pregnancy (Review). The Cochrane Database of Systematic Reviews. 7:CD009997-CD
57.
Kapil U, Singh Bhadoria A (2014) National iron-plus initiative guidelines for control of iron deficiency anaemia in India, 2013. The National Medical Journal of India 27:27–9PubMed
58.
Moretti D, Goede JS, Zeder C et al (2015) Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood 126(17):1981–1989PubMedCrossRef
59.
Stoffel NU, Cercamondi CI, Brittenham G et al (2017) Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol 4(11):524–533CrossRef
60.
Ugwu EO, Olibe AO, Obi SN et al (2014) Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria. Niger J Clin Pract 17(5):608–612PubMedCrossRef
61.
Roth DE, Pezzack B, Al Mahmud A et al (2014) Bioavailability of enteric-coated microencapsulated calcium during pregnancy: a randomized crossover trial in Bangladesh. Am J Clin Nutr 100(6):1587–1595PubMedCrossRef
62.
Lloyd C (2009) Medical disorders associated with pregnancy: Myles Textbook for Midwives, 15th edn. Churchill Livingstone, Edinburgh, pp 361–396
63.
Ortiz R, Toblli JE, Romero JD et al (2011) Efficacy and safety of oral iron (III) polymaltose complex versus ferrous sulfate in pregnant women with iron-deficiency anemia: a multicenter, randomized, controlled study. J Matern-Fetal Neonatal Med 24(11):1347–1352PubMedCrossRef
64.
Tolkien Z, Stecher L, Mander AP et al (2015) Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One 10(2):e0117383PubMedPubMedCentralCrossRef
65.
Beard JL (2000) Effectiveness and strategies of iron supplementation during pregnancy. Am J Clin Nutr 71(5 Suppl):1288s–1294sPubMedCrossRef
66.
67.
Aronoff GR (2004) Safety of intravenous iron in clinical practice: implications for anemia management protocols. J Am Soc Nephrol JASN. 15(Suppl 2):S99–S106PubMed
68.
Chertow GM, Mason PD, Vaage-Nilsen O et al (2006) Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant 21(2):378–382PubMedCrossRef
69.
70.
Atkinson LS, Baxley EG (1994) Postpartum fatigue. Am Fam Physician 50(1):113–118PubMed
71.
Milman N (2011) Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol 90(11):1247–1253PubMedCrossRef
72.
Westad S, Backe B, Salvesen KA et al (2008) A 12-week randomised study comparing intravenous iron sucrose versus oral ferrous sulphate for treatment of postpartum anemia. Acta Obstet Gynecol Scand 87(9):916–923PubMedCrossRef
73.
Sienas L, Wong T, Collins R, Smith J (2013) Contemporary uses of erythropoietin in pregnancy: a literature review. Obstet Gynecol Surv 68(8):594–602PubMedCrossRef
74.
RCOG (2015) Blood transfusion in obstetrics. RCOG green-top guideline 47. Royal College of Obstetricians and Gynaecologists, London
75.
Carson JL, Guyatt G, Heddle NM et al (2016) Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 316(19):2025–2035PubMedCrossRef
76.
Salhan S, Tripathi V, Singh R et al (2012) Evaluation of hematological parameters in partial exchange and packed cell transfusion in treatment of severe anemia in pregnancy. Anemia 2012:7CrossRef
77.
Kriplani A, Sharma A, Radhika A.G., et al (2016) FOGSI general recommendations for clinical practice
78.
IDA (2011) Good clinical practice recommendations for iron deficiency anemia in pregnancy (IDA) in pregnancy in India. J Obstetr Gynaecol India 61(5):569–571CrossRef
79.
Rogers J, Wood J, McCandlish R, Ayers S et al. (1998) Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial 1998. Lancet 351:693–9PubMedCrossRef
80.
Souza AId, Batista Filho M, Bresani CC et al (2009) Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials. Cadernos de Saúde Pública. 25:1225-1233
81.
Froessler B, Cocchiaro C, Saadat-Gilani K et al (2013) Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: a randomized trial. J Matern-fetal Neonatal Med 26(7):654–659PubMedCrossRef
82.
Smita S, Sukhija S, Renu T et al (2009) Pregnancy induced iron deficiency and the evaluation and comparison of the efficacy and safety of ferrous fumarate and carbonyl iron in its treatment. J Obstet Gynecol India 59(6):552–562
83.
Melamed N, Ben-Haroush A, Kaplan B et al (2007) Iron supplementation in pregnancy–does the preparation matter? Arch Gynecol Obstet 276(6):601–604PubMedCrossRef
84.
Panchal PJ, Desai MK (2014) Comparison of efficacy, safety and cost of therapy with oral ferrous ascorbate and ferrous sulphate in patients with iron deficiency anemia. J Drug Discov Ther 2(20)
85.
Gogineni S, Vemulapalli P (2015) Comparative study of parenteral iron sucrose vs oral ferrous ascorbate for prophylactic iron therapy in pregnancy. IOSR-JDMS 14(12):95–97
86.
Fuchs K, Peyser M, Peretz H (1962) Ferrous calcium citrate in the treatment of anemia in pregnancy. Harefuah 62:88–89PubMed
87.
Holmes JM (1071) Ferrous calcium citrate in pregnancy anaemia. The Practitioner 1957(179):295–296
88.
Rajadhyaksha G, Shahani S, Pawar D (2000) Evaluation of efficacy and tolerability of iron polymaltose complex tablets in iron deficiency anaemia during pregnancy. JAMA India 3:53–55
89.
Hasan S, Hashim B, Sultana A (2003) Iron therapy in iron deficiency anemia in Pregnancy: intravenous iron sucrose versus oral iron hydroxide polymaltose complex in anemia. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll Dec 8(2):435–440
90.
Singhal SR, Kadian V, Singh S et al (2015) Comparison of various oral iron salts in the treatment of iron deficiency anemia in pregnancy. Indian J Obstetr Gynaecol Res 2(3):155–158CrossRef
91.
Milman N, Jønsson L, Dyre P et al (2014) Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med 42(2):197–206PubMedCrossRef
92.
Morales-Borges R (2013) Anemia in pregnancy and parenteral iron therapy. J Blood Disord Transf 4(171):2
93.
Al RA, Unlubilgin E, Kandemir O, Yalvac S, Cakir L, Haberal A (2005) Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial. Obstet Gynecol 106(6):1335–1340PubMedCrossRef
94.
Myers B, Myers O, Moore J (2012) Comparative efficacy and safety of intravenous ferric carboxymaltose (Ferinject) and iron(III) hydroxide dextran (Cosmofer) in pregnancy. Obstetric Med 5(3):105–107CrossRef
95.
Schneider J, Krafft A, Manconi M, Hubner A, Baumann C, Werth E et al (2015) Open-label study of the efficacy and safety of intravenous ferric carboxymaltose in pregnant women with restless legs syndrome. Sleep Med 16(11):1342–1347PubMedCrossRef
Metadata
Title
Management of Iron Deficiency Anemia in Pregnancy in India
Authors
Rimpy Tandon
Arihant Jain
Pankaj Malhotra
Publication date
01-04-2018
Publisher
Springer India
Published in
Indian Journal of Hematology and Blood Transfusion / Issue 2/2018
Print ISSN: 0971-4502
Electronic ISSN: 0974-0449
DOI
https://doi.org/10.1007/s12288-018-0949-6

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