A single-center practice was able to safely and effectively administer iron infusions to pregnant women with iron deficiency anemia (IDA) or iron deficiency without anemia (IDWA) by using trained nurses to monitor for infusion reactions, according to a poster presentation at the 65th ASH Annual Meeting and Exposition.
Additionally, the majority of patients who received iron infusions reported improvements in their symptoms and iron saturation.
Steven Fein, MD, MPH, of Heme On Call in South Miami, Florida, and colleagues presented retrospective data from a single-center case series that looked at 1,383 pregnant women with either IDA (n=1,314) or IDWA (n=69). Between June 2021 and June 2023, 2,971 iron infusions were administered.
“Oral iron has been preferred because most obstetrics doctors learned that it is adequate for pregnant women,” Dr. Fein said. However, “oral iron provides an inadequate amount [of iron] for pregnant women because the gastrointestinal tract absorbs a maximum of 5 mg iron daily, while the needs of a pregnancy are about 800 mg.”
Although iron infusions have been shown to be more effective than oral iron in many clinical trials, there has historically been a fear of reactions with older formulations of iron infusions, Dr. Fein said.
In this analysis, each woman was administered an iron formulation determined by her health plan coverage and, in some cases, by experience with prior infusions. The iron infusions included ferric derisomaltose 1,000 mg single dose (n=417), two ferumoxytol 510 mg doses (n=510), four iron sucrose 200 mg doses (n=1,661), or two iron sucrose 400 mg doses (n=383).
Ninety-four percent of pregnant women who received iron infusions reported improvement of one or more symptoms, which included shortness of breath, fatigue, or ice craving/ice chewing. Two weeks after the last infusion, 87% had iron saturation greater than 15%; 83% had ferritin above 30 ng/mL; and 88% had increased hemoglobin compared with pre-infusion hemoglobin.
Additionally, the iron infusions had acceptable side effect profiles. About 5% of patients experienced infusion reactions. Five pregnant women (0.17%) discontinued iron treatments because of these reactions.
About one-quarter (22.5%) of pregnant women experienced post-infusion discomfort symptoms, such as headache, tiredness, low back pain, leg swelling, or shortness of breath. None of the adverse events affected the woman’s pregnancy.
To implement this type of program, practices would need to increase capacity to see women who have iron deficiency via telemedicine, possibly with the use of advanced practice providers. This would enable the practices to see more women in a convenient way, Dr. Fein said.
“The practices need to have a health insurance authorization team that understands the iron infusion coverage, [as well as] have the capacity and expertise to do the iron infusions efficiently and safely,” Dr. Fein said. “After all these elements are in place, I recommend that practices plan outreach and education of obstetrics doctors so they increase iron deficiency referrals.”
Any conflicts of interest declared by the authors can be found in the original abstract.
Reference
Fein S, Alonso D, Campos G, et al. Efficacy, safety, and tolerability of iron infusions in pregnant women: a retrospective chart review. Abstract 2381. Presented at the 65th American Society of Hematology Annual Meeting and Exposition; December 9, 2023; San Diego, California.