RHL Commentary by Gijs Walraven
EVIDENCE SUMMARY
This review examines the effectiveness on maternal and neonatal morbidity and mortality of different treatments for iron-deficiency anaemia in pregnancy. Fifty-four trials of treatment for this condition were identified. Five of these, involving 1254 women in total, met the reviewers' inclusion criteria. Most of the remaining trials were excluded because they were not truly randomized or had other methodological shortcomings.
The review was complicated by the lack of common definitions of iron-deficiency anaemia, lack of agreement on the tests to be used in diagnosing the condition and the cut-off points for diagnosing iron-deficiency in pregnancy, especially in the presence of other causes of anaemia and a coexisting infection. None of the five included trials had data on clinical outcomes.
In one trial (n=125) conducted in West Java, Indonesia, oral iron supplementation for anaemia in pregnancy was compared with a placebo (1). This trial showed a reduction in anaemia and higher mean haemoglobin and serum ferritin levels in the iron supplementation group. The addition of vitamin A to iron supplementation improved the results of the therapy. Unfortunately, the study evaluated the outcome at the end of treatment during the second trimester of pregnancy, and not at term (or at least the third trimester), which would have been more appropriate.
Comparison of different treatments showed that intravenous (IV) iron administration was associated with a higher risk of venous thrombosis than intramuscular (IM) administration, but the IM route resulted in pain at the injection site more frequently. Skin coloration was more frequently observed in people receiving IM iron-dextran compared with IM iron-sorbitol. As expected, women taking oral iron preparations complained of nausea and constipation more frequently than those receiving IV preparations. In one trial (n=100) in Singapore, higher haemoglobin values at the end of pregnancy were found with IV iron treatments compared with oral iron (2).
On the basis of this review, no recommendation can be made regarding how to treat iron-deficiency anaemia in pregnancy.
The search strategy was appropriate, except for the omission of "blood transfusion" as a search term. The strategy for extracting the data was appropriate.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
References
This document should be cited as: Gijs Walraven. Treatments for iron-deficiency anaemia in pregnancy: RHL commentary (last revised: 10 January 2002). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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