This is a lengthy review of studies involving treatment of mild anemia during pregnancies with iron. This review can be found at the following link and is also attached to this post as a pfd file. I will quote the author's conclusions. Some of the findings are troublesome, none more than IV iron can lead to deep vein thrombosis, which may already be a concern in thal minor pregnancies.
http://212.150.243.194/~karlosc/files/wordocs/Treatments%20for%20iron-deficiency%20anaemia%20in%20pregnancy.pdfA U T H O R S ’ C O N C L U S I O N S
Implications for practice
Avoidable limitations in the included randomised controlled trials (RCTs) resulted in these failing to provide sound evidence that
currently available treatments for iron-deficiency anaemia in pregnant women are beneficial for women or their children. We found
no scientific basis to suggest that in otherwise healthy women, the benefits of treatments for mild anaemia in pregnancy will outweigh the adverse effects associated with them. We found no evidence that in women with iron-deficiency anaemia in pregnancy, improvement in women’s haematological indices translate into clinical improvements for them or their children. However, treatments are associated with frequent adverse effects such as gastrointestinal disturbances and poor compliance. Compared with oral iron, intramuscular (IM) iron improves haematological indices. But again, the support from clinical research seems to be missing and adverse effects remain poorly evaluated despite indications that treatments can result in important adverse outcomes. Intravenous iron sorbitol improves haematological values compared to IM or oral iron, but serious adverse effects are possible and remain poorly studied; knowledge of their magnitude and mitigation strategies is missing. Potential adverse effects may include venous thrombosis and severe allergic reactions. Treatment of mild anaemia in pregnancy remains controversial and unsupported by scientific proof. It is also unclear what treatments work better for severe anaemia in pregnancy. Iron-deficiency anaemia in pregnancy is frequently diagnosed and treated, but the effects of these treatments remain largely unknown. Severe iron-deficiency anaemia affects many pregnant women in developing countries and may have considerable impact on maternal and neonatal health.
Implications for research Considerable resources are being used globally to diagnose and treat anaemia in pregnant women, but it remains unclear if these efforts are worthy and beneficial to individuals or populations. Also, it is unclear if there is a positive return for this investment, and if it improves people’s lives. This review is an invitation for researchers, especially those working towards the improvement of health of communities in under-resourced settings, to implement high quality RCTs addressing knowledge gaps (such as those flagged up by this review), for this common condition. In particular, determining when treatments are worthwhile, and providing sufficient information to allow better balancing of the benefits and harms of treatments. The authors of this systematic review consider that a solution to this would be to conduct a large multicenter RCT assessing the clinical effects of a selection of commonly used treatments in different regions of the world. The sample and duration of the follow up in such an RCT should be estimated to allow the identification of important, frequent, and long-term effects in women and babies. Large RCTs such as the MAGPIE trial or the CRASH trial illustrate how gaps in knowledge can be effectively addressed through research, and how this can reduce harmful practices and inappropriate use of resources. We found a compelling case for a similar approach to be taken on iron-deficiency anaemia in pregnancy.
Some important considerations for future research are as follows.
(1) There is an urgent need to determine what treatments improvematernal and neonatal prognosis in women with severe and moderate anaemia in poorly-resourced settings.
(2) The effects of different doses, regimens and routes of administrations for commonly-used treatments remain to be determined.
The suitability of the route of administration may be influenced by the setting or cultural background.
(3) Stratification according to anaemia severity can help address questions of the effects in different populations, and balance differently the benefits and harms.
(4) Women with additional factors contributing to their anaemia, such as vitamin A deficiency, need to be studied as a different
population.
(5) Clinical outcomes, including adverse effects and quality of life, need to be better addressed and considered for study sample size
calculations.
(6) Offspring outcomes are particularly important given the possibility that iron has been associated with adverse effects in some
observational studies.
(7) RCTs need to have sample sizes big enough to allow assessing adverse effects such as venous thrombosis, allergic reactions, infections, and rare but serious adverse effects, as well as long-term outcomes.
(8) For women with mild iron-deficiency anaemia, it would be helpful to assess whether oral iron is overall beneficial compared
with placebo or no treatment. Researchers need to remain aware about the clinical effects of high iron on haemoglobin levels, and
possible overdosing.
(9) We found no studies on oral erythropoietin or transfusions; these need to be evaluated in populations where they remain likely
to be used. But providing scientific support for commonly used treatments seems to be the priority; we do not know if more harm
then good is being done and yet these interventions remain widely prescribed and used.
(10) Studies are needed to determine the effects in specific populations such as pregnant women who are anaemic and also infected with human immunodeficiency virus.
(11) To use the CONSORT statement to improve the quality of reports of randomised trials (http://www.consort-statement.org/).
P O T E N T I A L C O N F L I C T O F
I N T E R E S T
None known.
Luis Gabriel Cuervo has contributed to this systematic review in a
personal capacity and during his spare time. Most of his contributions were made before joining the Pan American Health Organization. The Pan American Health Organization does not assume
responsibility for the statements contained therein.