From the Guidelines
For a pregnant patient with a hemoglobin of 107 g/L and hematocrit of 0.32, oral iron supplementation is recommended. The preferred treatment is ferrous sulfate 325 mg taken orally once or twice daily between meals with vitamin C to enhance absorption, as supported by the U.S. Preventive Services Task Force recommendation statement 1. Alternative options include ferrous gluconate 300 mg or ferrous fumarate 200 mg if ferrous sulfate is not tolerated.
Key Considerations
- Treatment should continue throughout pregnancy and for at least 3 months postpartum to replenish iron stores.
- These values indicate mild anemia in pregnancy, which is common due to physiologic hemodilution and increased iron demands for fetal development and maternal blood volume expansion.
- Iron supplementation helps prevent complications such as preterm birth, low birth weight, and maternal fatigue.
- If oral iron is not tolerated or hemoglobin levels don't improve after 4-6 weeks, intravenous iron formulations may be considered, as noted in the Annals of Internal Medicine 1.
- Regular monitoring of hemoglobin levels every 4-8 weeks is important to assess treatment response.
Additional Recommendations
- Prenatal vitamins often include a low dose of iron; the usual dose prescribed in early pregnancy is 30 mg of elemental iron per day.
- Higher doses (60 to 100 mg of elemental iron per day) are sometimes prescribed in populations at increased risk for iron deficiency anemia.
- Dietary iron is also crucial, with the Recommended Dietary Allowance for iron in pregnant women being 27 mg per day, as stated by the Institute of Medicine.
From the FDA Drug Label
WARNINGS: ... If you are pregnant or nursing a baby, seek advice of a health professional before using this product. The FDA drug label does not answer the question.
From the Research
Treatment for Pregnant Patients with Low Hemoglobin/Hct
- The patient's hemoglobin level of 107 g/L and hematocrit (Hct) of 0.32 is considered anemic in pregnancy, as a hemoglobin concentration of less than 11.0 g/dL in the first trimester and less than 10.5 or 11.0 g/dL in the second or third trimester is considered anemic 2.
- The American College of Obstetricians and Gynecologists recommends screening for anemia with a complete blood count in the first trimester and again at 24 0/7 to 28 6/7 weeks of gestation 2.
- For patients with iron deficiency anemia, first-line treatment is oral iron, and a trial of oral iron can be both diagnostic and therapeutic 2.
- New evidence suggests that intermittent dosing of oral iron is as effective as daily or twice-daily dosing with fewer side effects 2.
- For patients who cannot tolerate, cannot absorb, or do not respond to oral iron, intravenous iron is preferred 2, 3, 4.
- A study comparing single-dose intravenous iron to oral iron for treatment of maternal iron deficiency anemia found that single-dose intravenous iron resulted in a reduced incidence of low birthweight infants and a higher incidence of attaining maternal non-anemic state without use of additional iron or blood transfusion 3.
Iron Supplementation and Anemia Prevention
- Iron supplementation has been shown to increase hemoglobin levels and reduce the risk of anemia and iron deficiency anemia in pregnant women 5.
- Daily or intermittent iron supplementation may increase hemoglobin levels and reduce the risk of anemia and iron deficiency anemia in infants, preschool and school-aged children, and pregnant and non-pregnant women 5.
- Iron fortification of foods, such as milk or cereals, and use of iron pots may have prophylactic benefits for malaria endemicity low-risk populations 5.
Intravenous Iron Therapy
- Intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used 4.
- Modern intravenous iron preparations can facilitate rapid iron repletion in one or two doses, both for absolute iron deficiency and functional iron deficiency 4.
- Adverse events occurring with intravenous iron can be anticipated according to when they typically occur, which provides a basis for educating and preparing staff and patients on how iron infusions can be administered safely and efficiently 4.