Oral versus Intravenous Iron for Treatment of Anaemia in Pregnancy

Anaemia is a condition in which either the number of circulating red blood cells or their haemoglobin concentration is decreased. As a result, there is decreased transport of oxygen from the lungs to peripheral tissues. In pregnancy, the total volume of plasma is dramatically increased (50 %) along with increase in red cell mass (18-25 %) depending on iron status, and the haemoglobin is consequently reduced to a varying extent, occasionally, as low as 80 % making anaemia the most common haematological abnormality diagnosed during pregnancy. Also contributing significantly to maternal morbidity and mortality, intrauterine growth retardation, preterm delivery and perinatal morbidity and mortality. The Centers for Disease Control and Prevention (1990) defined anaemia as haemoglobin (Hb) less than 11 gdl-1 in first and third trimester and less than 10.5 gdl-1 in second trimester. WHO defines anaemia as haemoglobin concentration less than 11 gdl-1 and a hematocrit less than 0.33. Diet alone can not supply such amounts of iron in non-industrialized countries making iron supplementation a necessity in all pregnant women. Iron can be supplemented by mouth, intramuscular or intravenous injection. Alternatively, blood transfusion and recombinant erythropoietin are used. The traditional treatments i. e. oral iron therapy and blood transfusion involve significant drawbacks. Oral iron is frequently restricted by limited absorption, low tolerability, non-compliance and side effects. Therefore, intravenous iron alone or in association with recombinant human erythropoietin (rHvEPO) therapy, has been considered as an alternative in the management of iron deficiency in this setting.