Can intravenous (IV) iron supplementation during pregnancy cause chest pain due to tachycardia?

From the Guidelines

Intravenous (IV) iron therapy during pregnancy can occasionally cause chest pain associated with tachycardia, though this is not among the most common side effects. IV iron infusions can trigger infusion reactions in some patients, which may include symptoms of rapid heart rate (tachycardia) and chest discomfort. These reactions typically occur during or shortly after administration and are more common with older iron formulations like iron dextran. Newer preparations such as iron sucrose, ferric carboxymaltose, and iron isomaltoside generally have better safety profiles with lower rates of these reactions. The mechanism behind these symptoms involves the release of free iron, which can trigger an immune response or directly affect the cardiovascular system. If a pregnant woman experiences chest pain or tachycardia during IV iron administration, the infusion should be stopped immediately, and medical attention sought. Healthcare providers typically administer IV iron at a slow rate initially and monitor patients closely during infusion to minimize these risks. For pregnant women requiring iron supplementation, oral iron is usually tried first, with IV iron reserved for cases of severe anemia, intolerance to oral preparations, or when rapid correction of iron deficiency is needed 1.

Some key points to consider:

• The usual dose of elemental iron per day is 60 to 120 mg for pregnant women 1.
• Prenatal vitamins often include a low dose of iron, with the usual dose prescribed in early pregnancy being 30 mg of elemental iron per day 1.
• Higher doses of iron (60 to 100 mg of elemental iron per day) are sometimes prescribed in populations at increased risk for iron deficiency anemia 1.
• Natural food sources of iron include certain fruits, vegetables, meat, and poultry, and the Institute of Medicine recommends a daily intake of 27 mg of iron for pregnant women 1.
• Fortified breads and grain products are also important potential sources of iron, with more than 50% of the iron in the U.S. food supply coming from iron-fortified cereal grain products 1.

Overall, while IV iron therapy can cause chest pain associated with tachycardia, the benefits of iron supplementation for pregnant women with iron deficiency anemia often outweigh the risks, and healthcare providers can take steps to minimize these risks.

From the FDA Drug Label

The following adverse reactions have been identified during post approval use of Injectafer. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure The following adverse reactions have been reported from the post-marketing spontaneous reports with Injectafer: Cardiac disorders: Tachycardia General disorders and administration site conditions: Chest discomfort, chills, pyrexia

Intravenous iron supplementation during pregnancy may cause chest pain due to tachycardia.

• The FDA drug label reports tachycardia and chest discomfort as potential adverse reactions to Injectafer, an intravenous iron supplement, in the post-marketing experience section 2.
• However, the label does not provide direct evidence of a causal relationship between intravenous iron supplementation and chest pain due to tachycardia during pregnancy.
• Given the potential risks, caution should be exercised when administering intravenous iron supplements during pregnancy.

From the Research

Intravenous Iron Supplementation and Chest Pain due to Tachycardia

• There is no direct evidence in the provided studies that links intravenous (IV) iron supplementation during pregnancy to chest pain due to tachycardia 3, 4, 5, 6, 7.
• The studies focus on the efficacy and safety of IV iron supplementation in treating iron deficiency anemia during pregnancy, comparing it to oral iron supplementation 3, 5, 6, 7.
• Adverse events reported in the studies include mild reactions such as abdominal pain, weakness, shivering, and phlebitis at the injection site, but do not mention chest pain or tachycardia as a common side effect 3, 4, 5, 6, 7.
• One study notes that anaphylactic reactions are extremely rare with non-dextran products, and close surveillance during administration is recommended for all intravenous iron products 6.
• Another study mentions that individual adverse events were inconsistently reported across trials, making it challenging to synthesize adverse outcomes 5.