Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis.
Administration, Intravenous
Administration, Oral
Anemia, Iron-Deficiency
/ drug therapy
Female
Ferric Compounds
/ administration & dosage
Ferrous Compounds
/ administration & dosage
Hematinics
/ administration & dosage
Hemoglobins
/ metabolism
Humans
Iron
/ administration & dosage
Pregnancy
Puerperal Disorders
/ drug therapy
Treatment Outcome
anemia
iron
postpartum period
Journal
American journal of obstetrics and gynecology
ISSN: 1097-6868
Titre abrégé: Am J Obstet Gynecol
Pays: United States
ID NLM: 0370476
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
17
08
2018
revised:
15
11
2018
accepted:
08
12
2018
pubmed:
24
12
2018
medline:
16
1
2020
entrez:
23
12
2018
Statut:
ppublish
Résumé
To perform a systematic review of randomized trials comparing oral vs intravenous (IV) iron therapy to treat postpartum anemia. Data sources were as follows: PubMed (1972-2017); Cochrane Central Register of Controlled Trials, CENTRAL (1972-2017); CINAHL (1972-2017); Web of Science; Excerpta Medica Database, and EMBASE (1972-2017). We included randomized trials comparing oral vs IV iron monotherapy to treat postpartum anemia (classified as a hemoglobin <12 g/dL). Study quality was assessed with the Cochrane risk of bias assessment tool. The primary outcome was hemoglobin concentration at 6 weeks postpartum. Secondary outcomes included hemoglobin concentration at 1-5 weeks postpartum, ferritin concentration at 1-6 weeks postpartum, and maternal adverse outcomes. For meta-analysis, mean differences and odds ratios using a random effects model were calculated. Risk of heterogeneity was reported as I A total of 15 randomized trials met our inclusion criteria (n = 1001 and 1 181 women receiving oral iron and IV iron, respectively); 4 studies reported data for our primary outcome. We observed higher postpartum week 6 hemoglobin concentrations in the IV iron group compared to the oral iron group (mean difference, 0.9 g/dL; 95% confidence interval (CI), 0.4-1.3; P = .0003). Compared to oral iron, women receiving IV iron had higher hemoglobin concentrations at postpartum weeks 1, 2, and 3; higher ferritin concentrations at postpartum weeks 1, 2, 4, and 6; an increased likelihood of skin flushing (odds ratio [OR], 6.95; 95% CI, 1.56-31.03; P = .01; I In this systematic review, among women with postpartum anemia, hemoglobin concentrations at 6 weeks postpartum were almost 1 g/dL higher in women who received IV iron compared to oral iron. The safety profile of IV iron was also reassuring. Given the weaker hemoglobin response and higher risk of gastrointestinal side effects with oral iron use, our findings suggest that IV iron be considered as a viable treatment option for postpartum iron deficiency anemia.
Identifiants
pubmed: 30578747
pii: S0002-9378(18)32226-9
doi: 10.1016/j.ajog.2018.12.016
pmc: PMC7060493
mid: NIHMS1526629
pii:
doi:
Substances chimiques
Ferric Compounds
0
Ferrous Compounds
0
Hematinics
0
Hemoglobins
0
Iron
E1UOL152H7
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
19-29.e3Subventions
Organisme : NICHD NIH HHS
ID : K23 HD070972
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
BMJ. 2016 Jul 20;354:i3507
pubmed: 27443385
Obstet Gynecol. 2008 Sep;112(3):703
pubmed: 18757678
Transfusion. 2017 Jan;57(1):36-44
pubmed: 27618767
J Clin Diagn Res. 2016 Nov;10(11):QC08-QC10
pubmed: 28050450
J Matern Fetal Neonatal Med. 2013 May;26(7):654-9
pubmed: 23130909
J Nutr. 2005 Feb;135(2):267-72
pubmed: 15671224
Transfusion. 2016 Mar;56 Suppl 1:S94-102
pubmed: 27001367
J Obstet Gynecol Neonatal Nurs. 1999 Mar-Apr;28(2):183-91
pubmed: 10102546
Br J Nutr. 2013 Mar 14;109(5):906-13
pubmed: 22676919
Am J Epidemiol. 2002 Nov 15;156(10):903-12
pubmed: 12419762
Ann Hematol. 2011 Nov;90(11):1247-53
pubmed: 21710167
Blood. 2015 Oct 22;126(17):1981-9
pubmed: 26289639
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
Obstet Gynecol. 2007 Aug;110(2 Pt 1):267-78
pubmed: 17666600
Lancet. 2016 Feb 27;387(10021):907-16
pubmed: 26314490
Clinicoecon Outcomes Res. 2017 Aug 10;9:475-483
pubmed: 28848355
Transfus Med. 2018 Feb;28(1):22-39
pubmed: 28722245
Lancet. 2013 May 25;381(9880):1845-54
pubmed: 23706801
Clin Exp Obstet Gynecol. 2011;38(2):159-61
pubmed: 21793279
Ann Hematol. 2012 Feb;91(2):143-54
pubmed: 22160256
MMWR Recomm Rep. 1998 Apr 3;47(RR-3):1-29
pubmed: 9563847
J Nutr. 2016 Jan;146(1):30-7
pubmed: 26661838
Blood. 2010 Dec 2;116(23):4754-61
pubmed: 20826717
Am J Clin Nutr. 2009 Mar;89(3):946S-950S
pubmed: 19158210
Mayo Clin Proc. 2015 Jan;90(1):12-23
pubmed: 25572192
MCN Am J Matern Child Nurs. 2003 Jul-Aug;28(4):252-7; quiz 258-9
pubmed: 12840692
Int J Gynaecol Obstet. 2008 Apr;101(1):67-73
pubmed: 18234203
Trop Med Int Health. 2012 Jan;17(1):9-22
pubmed: 21955293
Transfusion. 1989 Nov-Dec;29(9):821-2
pubmed: 2588319
Ann Intern Med. 1992 Mar 1;116(5):393-402
pubmed: 1736773
Vox Sang. 2017 Apr;112(3):219-228
pubmed: 28198084
Anesthesiology. 2012 Jun;116(6):1367-76
pubmed: 22487863
J Nutr. 2003 Dec;133(12):4139-42
pubmed: 14652362
Int J Appl Basic Med Res. 2015 Jan-Apr;5(1):25-30
pubmed: 25664264
Am J Obstet Gynecol. 2008 Oct;199(4):435.e1-7
pubmed: 18928998
Cochrane Database Syst Rev. 2015 Aug 13;(8):CD010861
pubmed: 26270434
Trials. 2015 Jan 14;16:5
pubmed: 25588587
BMJ Open. 2012 Oct 18;2(5):
pubmed: 23087011
Hippokratia. 2009 Jan;13(1):38-40
pubmed: 19240819
Blood Rev. 2017 Jul;31(4):225-233
pubmed: 28216263
J Matern Fetal Neonatal Med. 2017 Apr;30(8):967-971
pubmed: 27269410
Int J Gynaecol Obstet. 2005 Sep;90(3):238-9
pubmed: 16043181
Obstet Gynecol Surv. 2015 May;70(5):342-53
pubmed: 25974731
Evid Rep Technol Assess (Summ). 2005 Feb;(119):1-8
pubmed: 15760246
Ther Clin Risk Manag. 2017 May 17;13:647-653
pubmed: 28761350
Am J Clin Nutr. 2015 Dec;102(6):1585-94
pubmed: 26561626
Syst Rev. 2016 Dec 5;5(1):210
pubmed: 27919275
Am J Obstet Gynecol. 2001 Aug;185(2):438-43
pubmed: 11518906
BJOG. 2006 Nov;113(11):1248-52
pubmed: 17004982
PLoS One. 2015 Feb 20;10(2):e0117383
pubmed: 25700159
BJOG. 2007 May;114(5):655; author reply 655-6
pubmed: 17439582
J Obstet Gynaecol India. 2013 Mar;63(1):45-8
pubmed: 24431599
Acta Obstet Gynecol Scand. 2008;87(9):916-23
pubmed: 18720044
Am J Perinatol. 2019 Mar;36(4):366-376
pubmed: 30121943
Int J Surg. 2010;8(5):336-41
pubmed: 20171303