A shot of iron

Can a single dose of iron, administered intravenously during pregnancy, help break the intergenerational effect of anaemia in India? A recent study, conducted on 3,368 mildly anaemic (with haemoglobin levels of 7.0-9.9g/DL) pregnant women in their second trimester, demonstrated it had a better outcome than treatment with daily iron tablets twice a day.

The study (bit.ly/iron-shot), funded by the U.K.-based Children's Investment Fund Foundation, was conducted in Rajasthan and Karnataka. Investigators divided them into three groups. One group was administered iron pills twice a day till delivery; the other two were given a single shot of an intravenous (IV) dose of either of the two iron formulations approved in India: ferric carboxymaltose and ferric derisomaltose.

The study concluded that "first-line treatment of moderate maternal iron deficiency anaemia" with a single-dose infusion of IV iron results in a reduced incidence of low-weight infants and a higher incidence of attaining "maternal non-anaemic status", around the time of delivery, without the use of additional iron or blood transfusion. "Clinical guidelines should address the potential benefit of single-dose IV iron as the primary treatment of moderate iron deficiency anaemia in pregnancy," it states.

Mrutyunjaya Bellad, Professor and Senior Consultant, Obstetrics and Gynaecology, KLES Hospital, Belagavi, and Principal Investigator of the study, notes that anaemia incidence remains high in India despite longstanding government programmes for treating it with iron tablets. The National Family Health Survey-5 shows that around 50% of women across all groups are anaemic and that the incidence of male anaemia has also risen. The incidence of anaemia in children under five has increased from 59% to 67% since Survey-4. "An anaemic woman delivers an anaemic child, whose growth gets affected, and the anaemic child grows up to produce another anaemic child. We have to break this intergeneration chain," he says.

The results with oral iron tablets are poor for various reasons. Not all women can tolerate them well, so the compliance rate varies. The regular use of tablets increases hepcidin levels in the liver, inhibiting iron absorption in the body. Chronic urinary tract infections also inhibit iron absorption, Bellad explains.

Sunita Tandulwadkar, President of the Federation of Obstetric and Gynaecological Societies of India, notes that in India, a majority of couples do not get a health check-up before planning a family, with the result that many are anaemic from the beginning. "The need for iron is very high during pregnancy," she notes, adding that studies have demonstrated the advantages of injectable iron. "We endorse the findings. Injectable iron goes directly into the bloodstream, bypassing the digestive tract. Building up iron stores in the body is also better," she says.