Efficacy and safety of intravenous iron sucrose for treatment of iron deficiency anemia in pregnancy

Sadaf Raja, Erum Saleem, Sobia Sohail, Humaira Shams


Background: Leading cause of anemia is due to thedeficiency of iron in pregnant women. The aim of the study was to evaluate the efficacy of intravenous iron sucrose for the treatment of iron deficiency anemia in pregnancy particularly for those who had unsatisfactory response to oral iron therapy.

Methods: This is an open label, observational study that was carried out in Jamal Noor Hospital, Karachi for 6 months by using non-probability consecutive sampling technique, after taking ethical approval. Seventy two pregnant women with level of Hb equivalent to or <10 g/dl, Serum ferritin level equivalent to or <10 μg/l with the age ranging from 18-40 years, Gestational age 16 weeks or above were included in the study. A two times-weekly dose of 200 mg of iron sucrose (Axifer) intravenously were infused to pregnant women. However, the dose was calculated for every patient through total iron deficit. SPSS version 22 was used to analyze the data.

Results: The study results showed that the mean age of the pregnant womenwas 25.83±5.03 years, their mean weight was 59.50±10.28 kg, and their mean gestational week was 28.88±4.09. It showed that both the haemoglobin (9.01±0.74 mg/dl versus 11.92±11.07 mg/dl), (p<0.001) and ferritin levels (9.85±12.38 ng/ml versus 50.74±59.42 ng/ml), (p<0.001)were significantly increased at term after receiving intravenous iron sucrose as compared to the baseline.

Conclusions: This study concluded that the administration of iron sucrose (Axifer) intravenously is a secure and effective choice in the management of iron deficiency anemia in pregnant women particularly for those who had inadequate response to oral iron supplementation.


Iron deficiency anemia, intravenous iron sucrose, Efficacy, Safety

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WHO. Maternal Health and Safe Motherhood Programme & World Health Organization. Nutrition Programme. The prevalence of anaemia in women : a tabulation of available information, 2021. Available at: https://apps.who.int/iris/handle/10665/5. Accessed on 20 November 2021.

Ansari NB, Badruddin SH, Goldenberg RL. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. FoodNutr Bull. 2008;29(2):132-9.

van den Broek N. Anaemia in pregnancy in developing countries. Br J ObstetGynaecol. 1998;105(4):385-90.

Gopalan C. Current food and nutrition situation in south Asian and south-east Asian countries. Biomed Environ Sci. 1996;9(2-3):102-16.

Seshadri S. Prevalence of micronutrient deficiency particularly of iron, zinc and folic acid in pregnant women in South East Asia. Br J Nutr. 2001;85(suppl 2):S87-92.

Cao C, O'Brien KO. Pregnancy and iron homeostasis: an update. Nutr Rev. 2013;71(1):35-51.

Burke RM, Leon JS, Suchdev PS. Identification, prevention and treatment of iron deficiency during the first 1000 days. Nutrients. 2014;6(10):4093-114.

Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am. J. Clin. Nutr. 2005;81(5):S1218-22.

Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet. 2007;370(9586):511-20.

Congdon EL, Westerlund A, Algarin CR. Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years. J. Pediatr. 2012;160(6):1027-33.

Peña-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2012;12:CD004736.

Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Nutrition Impact Model Study Group (anaemia). Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2013;346.

Silverstein SB, Rodgers GM. Parenteral iron therapy options. Am J Hematol. 2004;76(1):74-8.

Van Wyck DB, Cavallo G, Spinowitz BS, Adhikarla R, Gagnon S, Charytan C et al. Safety and efficacy of iron sucrose in patients sensitive to iron dextran: North American clinical trial. Am J Kidney Dis. 2000;36(1):88-97.

Kriplani A, Mahey R, Dash BB, Kulshreshta V, Agarwal N, Bhatla N. Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy. Indian J Med Res. 2013;138(1):78-82.

Auerbach M, Ballard H. Clinical use of intravenous iron: administration, efficacy, and safety. Hematology Am SocHematolEduc Program. 2010;2010:338-47.

Cançado RD, Lobo C, Friedrich JR. Tratamento da anemia ferropriva com ferro via parenteral. Rev Bras HematolHemoter. 2010;32(2):121-8.

Muñoz M, Breymann C, García-Erce JA, Gómez-Ramírez S, Comin J, Bisbe E. Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion. Vox Sang. 2008;94(3):172-83.

Lindgren S, Wikman O, Befrits R, Blom H, Eriksson A, Granno C et al. Intravenous iron sucrose is superior to oral iron sulphate for correcting anaemia and restoring iron stores in IBD patients: A randomized, controlled, evaluator-blind, multicentre study. Scand J Gastroenterol. 2009;44(7):838-45.

Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh RP et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull. 2006;27(4):311-5.

Al RA, Unlubilgin E, Kandemir O, Yalvac S, Cakir L, Haberal A. Intravenous versus oral iron for treatment of anemia in pregnancy. Obstet Gynecol. 2005;106(6):1135-40.

Cançado RD, Novis de Figueiredo PO, AlbeOlivatoMS,Chiattone CS. Efficacy and safety of intravenous iron sucrose in treating adults with iron deficiency anemia. Rev Bras HematolHemoter. 2011;33(6):439-43.

Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anaemia. BJOG. 2006;113(11)1248-52.

Neeru S, Nair NS, Rai L. Iron sucrose versus oral iron therapy in pregnancy anemia. Indian J Comm Med. 2012;37(4):214-8.

Haldar P, Kant S, Yadav V, Majhi J, Malhotra S, Kaur R et al. Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural Northern India. J Family Med Prim Care. 2018;7(4):762.

Dubey S, Suri V, Aggarawal N, Das R. Is it safe to use intravenous iron sucrose during pregnancy? a randomized controlled trial. Int J ReprodContraceptObstet Gynecol. 2013;2(4):544-9.

Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex. Br J Nutr. 2002;88(1):3-10.

Chandler G, Harchowal J, Macdougall IC. Intravenous iron sucrose: establishing a safe dose. Am J Kidney Dis. 2001;38(5):988-91.

National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006;47(3):S1-146.

Ray S, Neogi SB, Singh R, Devasenapathy N, Zodpey S. Is IV iron sucrose a cost-effective option for treatment of severe anemia in pregnancy as compared with oral iron? Health Policy and Planning. 2020;35(10):23-34.