From the Guidelines
The American College of Obstetricians and Gynecologists (ACOG) guidelines for intravenous (IV) iron infusion postpartum are not explicitly stated in the provided evidence, but based on the expert consensus guidelines, IV iron can be safely administered postpartum.
Key Points
- Administration of IV iron: There is no difference in the administration of IV iron compared with the non-pregnant person, and all IV iron formulations have been shown to be safe and effective in pregnancy 1.
- Formulations: Formulations administered as a single total dose infusion (TDI) are recommended over formulations requiring multiple dose infusions, with optimal formulations including ferumoxytol, low molecular weight iron dextran (LMWID), and ferric derisomaltose (FDI) 1.
- Monitoring: Monitoring for 30 min post-IV iron administration is not indicated, and premedication should be reserved for those persons at high risk of hypersensitivity reactions (HSRs) 1.
- Ferritin goal: A ferritin goal of 50 ng/mL regardless of sex at birth is recommended 1.
Important Considerations
- Pregnancy: Administration of IV iron is generally avoided prior to the 13th week of gestation due to a lack of safety data 1.
- Infusion reactions: Infusion reactions should be managed as outlined in the consensus recommendations, and rechallenge with the same IV iron formulation may be attempted following an infusion reaction 1.
- Phosphorus monitoring: Phosphorus monitoring following IV iron administration should be guided by clinical symptoms for all formulations except ferric carboxymaltose (FCM) 1.
From the Research
American College of Obstetricians and Gynecologists (ACOG) Guidelines for IV Iron Infusion Postpartum
The American College of Obstetricians and Gynecologists (ACOG) guidelines for intravenous (IV) iron infusion postpartum are not explicitly stated in the provided studies. However, the studies provide information on the efficacy and safety of IV iron infusion in treating postpartum iron deficiency anemia.
Efficacy of IV Iron Infusion
- IV iron infusion has been shown to be effective in increasing hemoglobin levels and replenishing iron stores in women with postpartum iron deficiency anemia 2, 3, 4, 5.
- A study found that IV iron sucrose was as effective as blood transfusion in replenishing hemoglobin and iron storage status in hemodynamically stable women with moderate postpartum anemia 4.
- Another study found that IV iron infusion resulted in a faster improvement in hemoglobin and iron biochemical markers compared to oral iron supplementation 5.
Safety of IV Iron Infusion
- The safety of IV iron infusion has been evaluated in several studies, with most reporting no significant adverse events 2, 3, 4, 5.
- A study found that IV iron infusion was associated with a lower risk of constipation compared to oral iron supplementation 6.
- However, another study reported that IV iron infusion was associated with a higher risk of anaphylaxis or hypersensitivity reactions compared to oral iron supplementation, although the evidence was very uncertain 6.
Comparison with Other Treatments
- IV iron infusion has been compared to oral iron supplementation, with most studies finding that IV iron infusion is more effective in increasing hemoglobin levels and replenishing iron stores 2, 3, 5, 6.
- IV iron infusion has also been compared to blood transfusion, with one study finding that IV iron sucrose was as effective as blood transfusion in replenishing hemoglobin and iron storage status in hemodynamically stable women with moderate postpartum anemia 4.
- A Cochrane review found that IV iron infusion probably reduces fatigue slightly in the early postpartum weeks compared to oral iron tablets, but probably results in little to no difference after four weeks 6.