From the Guidelines
The recommended dose of intravenous (IV) iron in pregnancy is typically 1,000 mg of iron sucrose or ferric carboxymaltose, administered in divided doses. For iron sucrose, this is usually given as 200 mg per session (up to 300 mg maximum) with sessions spaced 2-3 days apart until the total dose is reached. Ferric carboxymaltose can be administered in larger doses of 500-1,000 mg per session, requiring fewer infusions. Treatment should be initiated when oral iron is not tolerated or when anemia is severe (hemoglobin <8-9 g/dL) or diagnosed late in pregnancy (after 34 weeks). Before administration, patients should have confirmed iron deficiency anemia with hemoglobin <10.5 g/dL and ferritin <30 ng/mL. IV iron should be administered in a monitored setting due to the small risk of hypersensitivity reactions. The benefit of IV iron is its ability to rapidly replenish iron stores and increase hemoglobin levels within 2-3 weeks, which is particularly important when time to delivery is limited. This approach helps prevent peripartum blood transfusions and postpartum anemia, as supported by recent expert consensus guidelines 1.
Some key points to consider:
- IV iron is used in the management of iron deficiency and iron deficiency anemia in pregnancy, especially when oral iron is insufficient or not tolerated.
- The administration of IV iron should be based on the patient's individual needs and medical history.
- Monitoring for potential infusion reactions and treatment-emergent hypophosphatemia is essential when administering IV iron.
- Recent guidelines emphasize the safety and efficacy of IV iron, and its use should not be limited by concerns about rare infusion reactions 1.
Overall, the use of IV iron in pregnancy can be an effective and safe way to manage iron deficiency and iron deficiency anemia, and its benefits can help improve maternal and fetal outcomes.
From the Research
Recommended Dose of IV Iron in Pregnancy
The recommended dose of intravenous (IV) iron in pregnancy varies depending on the specific iron formulation and the patient's individual needs.
- Ferric carboxymaltose: a dose of 1500 mg is often used 2
- Iron sucrose: a dose of 1000 mg is sometimes used, but may be insufficient for iron repletion in some patients 2
- Iron dextran: a dose of 1000 mg can be administered over 1 hour 3
Factors Influencing Dose
The dose of IV iron may be influenced by factors such as:
- Severity of iron deficiency anemia
- Gestational age
- Patient's weight and body mass index (BMI)
- Presence of other medical conditions
Safety and Efficacy
IV iron therapy has been shown to be safe and effective in improving hematological parameters in pregnant women with iron deficiency anemia 4, 3, 5, 6
- Ferric carboxymaltose, iron sucrose, and iron polymaltose have all been used successfully in pregnancy
- The choice of IV iron formulation may depend on factors such as cost, convenience, and patient tolerance
Specific Patient Populations
In certain patient populations, such as those with twin pregnancies, IV iron therapy may be particularly beneficial in improving maternal hemoglobin and reducing the risk of postpartum hemorrhage 6