From the FDA Drug Label
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
The threshold for iron infusions in pregnancy is not explicitly stated in the drug label. However, it is mentioned that untreated IDA in pregnancy is associated with adverse maternal and fetal outcomes, suggesting that iron infusions may be considered when IDA is present.
- Key points:
- Untreated IDA in pregnancy is associated with adverse outcomes
- Iron infusions may be considered in cases of IDA
- No specific threshold is mentioned in the label 1
From the Research
Iron infusions in pregnancy are typically recommended when hemoglobin levels fall below 10.5 g/dL (105 g/L) with confirmed iron deficiency, especially in the second or third trimester when oral iron supplementation has failed or isn't tolerated. This approach is supported by the most recent and highest quality study, which found that intravenous iron is superior to oral iron for treating iron-deficiency anemia in pregnancy, with benefits including achieving target hemoglobin levels more often, increasing hemoglobin levels faster, and decreasing adverse reactions 2.
Key Considerations
- The threshold for iron infusions in pregnancy is generally considered to be a hemoglobin level below 10.5 g/dL (105 g/L) with confirmed iron deficiency.
- Ferric carboxymaltose (Ferinject/Injectafer) or iron sucrose (Venofer) are recommended as first-line options for iron infusions in pregnancy, with dosing based on pre-pregnancy weight and hemoglobin levels.
- A typical regimen might include 1000-1500 mg of iron administered in 1-2 infusions for ferric carboxymaltose, or multiple smaller doses of 200-300 mg for iron sucrose.
- Iron infusions are generally considered safe after the first trimester, with the second trimester being optimal for treatment.
Benefits of Iron Infusions
- Rapidly replenish iron stores and support increased maternal blood volume.
- Prevent anemia complications and ensure adequate iron transfer to the developing fetus.
- Reduce adverse reactions compared to oral iron supplementation.
- Achieve target hemoglobin levels more often and increase hemoglobin levels faster compared to oral iron supplementation 2.
Important Notes
- Oral iron supplementation should be tried first, but iron infusions may be necessary if oral iron is not effective or tolerated.
- The choice of iron infusion product and dosing regimen should be individualized based on patient factors, such as pre-pregnancy weight and hemoglobin levels.
- Close surveillance during administration is recommended for all intravenous iron products, as anaphylactic reactions can occur, although they are extremely rare with non-dextran products 3.