Addition of oral iron bisglycinate to intravenous iron sucrose for the treatment of postpartum anemia-randomized controlled trial.
Study Goal
The researchers aimed to compare the efficacy of intravenous iron sucrose alone versus intravenous iron sucrose combined with oral iron bisglycinate for treating moderate to severe postpartum anemia.
Results Summary
The study found that intravenous iron sucrose alone was sufficient to treat postpartum anemia, with only a modest (0.4 g/dL) hemoglobin increase when oral iron was added. Adverse effects occurred in 29% of the oral iron group, but compliance and satisfaction were high in both cohorts.
Population
Women with postpartum hemoglobin levels ≤9.5 g/dL.
Effective Dosage
500 mg intravenous iron sucrose (single dose) and 60 mg oral iron bisglycinate daily for 45 days (for the combined group).
Duration
6 weeks post-delivery.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
500 mg intravenous iron sucrose | neutral | postpartum moderate to severe anemia | women with postpartum anemia | - | has not been evaluated | #1 |
intravenous iron sucrose in combination with oral iron bisglycinate supplementation | increase | hemoglobin level | women with postpartum hemoglobin level of ≤9.5 g/dL | 0.4 g/dL | postpartum hemoglobin levels were only 0.4 g/dL higher | #2 |
intravenous iron sucrose in combination with oral iron bisglycinate supplementation | increase | hemoglobin level | women with postpartum hemoglobin level of ≤9.5 g/dL | 4.2 g/dL | increase from baseline of 4.2 g/dL | #3 |
intravenous iron sucrose alone | increase | hemoglobin level | women with postpartum hemoglobin level of ≤9.5 g/dL | 3.7 g/dL | increase from baseline of 3.7 g/dL | #4 |
oral iron bisglycinate supplementation | no change | rate of women with hemoglobin level of <12.0 or 11.0 g/dL | women with postpartum hemoglobin level of ≤9.5 g/dL | no difference | was no difference in the rate of women with hemoglobin level of <12.0 or 11.0 g/dL | #5 |
oral iron bisglycinate supplementation | no change | iron storage parameters and quality of life | women with postpartum hemoglobin level of ≤9.5 g/dL | not different | Iron storage and health quality were not different | #6 |
oral iron bisglycinate supplementation | increase | adverse effects | women with postpartum hemoglobin level of ≤9.5 g/dL | 29% rate | was associated with 29% rate of adverse effects | #7 |
intravenous 500 mg iron sucrose treatment alone | neutral | postpartum anemia | women with postpartum anemia | - | is sufficient to treat postpartum anemia without the necessity of adding oral iron treatment | #8 |
BACKGROUND: 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. OBJECTIVE: 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. STUDY DESIGN: 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. RESULTS: 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 <12.0 or 11.0 g/dL. Iron storage and health quality were not different between the cohorts. Oral iron treatment was associated with 29% rate of adverse effects. Compliance and satisfaction from treatment protocol were high in both cohorts. CONCLUSION: Intravenous 500 mg iron sucrose treatment alone is sufficient to treat postpartum anemia without the necessity of adding oral iron treatment.