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Table 4 Free text responses

From: The use of intravenous iron in pregnancy: for whom and when? A survey of Australian and New Zealand obstetricians

Common themes Representative responses
Advantages of IV iron
 Specific difficulties with oral iron (n = 6) Low ferritin, not responding to oral iron
Avoid side effects of oral iron
Noncompliance with oral iron
Avoids the daily hassle of taking oral tabs
 Avoidance of blood transfusion (n = 4) Reduction in need for transfusion peri-partum
Well timed, it can be a step to consider before packed RBCs transfusion, although this consideration has more merit in the immediate postpartum period
Useful after a mild postpartum haemorrhage
Postpartum haemorrhage when Hb is between 7 and 9
 Reduced PPH risk (n = 1) Women bleed less at delivery
 Maternal QOL outcomes (n = 1) Health related QOL outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488743/
 Others (n = 8) Although NOT in favour of infusion, hospital dictates one to implement infusion
Symptomatic women
You know the iron status will improve
Severe iron deficiency
Disadvantages of IV iron
 Anaphylaxis (n = 18) Risk of anaphylaxis (although low)
Anaphylaxis 1/1000 = risk to mother and baby
 Other adverse effects (n = 12) Potential side effects
Adverse reactions in up to 20%
 Risk of allergic reactions (n = 10) Possibility of allergic reactions
Risk of allergic and anaphylactoid events not inconsiderable and overall adverse reactions - a few/100
 Administrative difficulties (n = 4) Tedious process to prescribe. Too much admin for clinic
 Cost and resource factors (n = 4) Cost of (hospital) admission to administer the drug
Cost to health services and personal needed
 Over-prescription (n = 3) Over prescribed, e.g. women with low serum iron but normal Hb
It’s often not necessary
 Lack of evidence regarding improved pregnancy outcomes (n = 2) Lack of evidence on its efficacy
No evidence of improved outcome of pregnancy; possible increased adverse outcome
 Others (n = 7) Minimal disadvantages - a few have reactions, mainly fever but not seen major adverse effects
Most women prefer it compared to side effects of oral iron
Risks of toxicity, huge doses used are above physiological, risks of free radical generation
Indications for IV iron in the treatment of iron deficiency without anaemia
 Symptomatic iron deficiency (n = 9) Extreme tiredness after other options tried
Very rarely if restless legs or severe fatigue if not tolerating oral supplementation
 Special circumstances (n = 4) Hyperemesis with PICC (peripherally inserted central) line, influenza or bronchitis, bowel disease
I would only do this where a woman was unable to access regular antenatal care … and where oral iron was not well tolerated.
Intolerance to oral iron in a Jehovah’s witness with a high bleeding risk
 Not used (n = 4) I have recently modified my practice so that the target is Hb not ferritin. I therefore … modify oral iron supplements … and actively try to avoid IV infusions of iron
In my institution I do not prescribe, but many others do
 Women’s preference (n = 3) Women prefer it. Most of the women I see dislike oral replacement and avoid secondary to sides effects, i.e. constipation, nausea
Patient request
 Response to oral iron (n = 3) Failure of oral iron supplements with falling Hb AND altered RBC indices
Lack of response to oral iron
 Precaution in case of PPH (n = 2) To increase iron store as a precaution against PPH
 Other (n = 4) Only on the advice of obstetric medicine colleagues
Iron deficiency (with or without anaemia) is a condition that requires treatment.
Aim for normal iron stores in fetus
Would consider on case by case. Wouldn’t routinely measure iron unless anaemic or if notable drop over successive trimesters.
  1. Abbreviations: IV intravenous; RBC red blood cell; PPH postpartum haemorrhage; Hb haemoglobin; QOL quality of life