What is the treatment for iron-deficiency anemia (IDA) in pregnancy?

From the Guidelines

Treatment of anemia in pregnancy should prioritize oral iron supplementation with a dose of 60 to 120 mg of elemental iron per day, as it is the most effective and safest approach to improve maternal health and birth outcomes. According to the American Family Physician recommendation statement 1, the treatment of iron deficiency anemia in pregnant women is similar to that in nonpregnant women and includes additional iron intake through oral iron pills, prenatal vitamins, and diet. The usual dose of 60 to 120 mg of elemental iron per day can be achieved through oral iron supplements, and intravenous iron treatment is also used during pregnancy for severe cases or when oral therapy is not tolerated.

Key considerations for treating anemia in pregnancy include:

• Oral iron supplements as the first line of treatment
• Dosage of 60 to 120 mg of elemental iron per day
• Use of intravenous iron for severe cases or intolerance to oral therapy
• Importance of folic acid supplementation to prevent neural tube defects and support red blood cell production
• Regular monitoring of hemoglobin levels to assess treatment response and adjust therapy as needed

In terms of specific treatment options, iron deficiency anemia can be treated with oral iron supplements such as ferrous sulfate, and folic acid supplementation is essential to prevent neural tube defects and support increased red blood cell production 1. For severe cases or those intolerant to oral therapy, intravenous iron formulations may be used. Blood transfusions are typically reserved for severe anemia with hemodynamic instability or when delivery is imminent. Treatment should continue throughout pregnancy and for at least 3 months postpartum to replenish iron stores, with the goal of achieving hemoglobin levels above 11 g/dL in the first trimester and above 10.5 g/dL in subsequent trimesters.

From the FDA Drug Label

Iron deficiency anemia during pregnancy should be treated. Untreated IDA in pregnancy is associated with adverse maternal outcomes such as post-partum anemia Adverse pregnancy outcomes associated with IDA include increased risk for preterm delivery and low birth weight Severe adverse reactions including circulatory failure (severe hypotension, shock including in the context of anaphylactic reaction) may occur in pregnant women with parenteral iron products Published data from randomized controlled studies and prospective observational studies on the use of Venofer in pregnant women have not reported an association of Venofer and adverse developmental outcomes.

Treatment of anemia in pregnancy should be done to prevent adverse maternal and fetal outcomes.

• Iron deficiency anemia should be treated to prevent post-partum anemia and preterm delivery.
• Parenteral iron products may cause severe adverse reactions, including circulatory failure and fetal bradycardia.
• Available data from studies on Venofer and Ferrlecit do not show an association with adverse developmental outcomes, but the data is limited 2 3. It is recommended to treat iron deficiency anemia in pregnancy with caution and careful monitoring.

From the Research

Diagnosis of Anemia in Pregnancy

• Anemia in pregnancy is defined 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 4
• 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 4
• Serum ferritin is a helpful adjunct for the diagnosis of iron deficiency anemia (IDA) 5, 6

Treatment of Iron Deficiency Anemia

• Oral iron therapy is given as the first-line treatment for IDA 4, 5, 6, 7
• Intermittent dosing of oral iron is as effective as daily or twice-daily dosing with fewer side effects 4
• Intravenous iron is preferred for patients who cannot tolerate, cannot absorb, or do not respond to oral iron 4, 5, 6
• Intravenous iron preparations can be safely used for the treatment of IDA during pregnancy and the postpartum period, and are more beneficial than oral iron preparations in specific indications 5, 6

Screening and Monitoring

• Screening for iron deficiency anemia is recommended upon initiation of prenatal care, at the start of the third trimester, and prior to birth 8
• Early screening for iron deficiency before the onset of anemia is beneficial 8
• Continued monitoring after treatment is necessary to assess the effectiveness of treatment and potential consequences of over-supplementation or iron deficiency without anemia 8