Intravenous iron treatment for iron deficiency anemia in pregnancy

Iron deficiency anemia in pregnancy can have serious deleterious effects for both mother and fetus. Estimates of prevalence vary widely, but those based on hemoglobin determinations are always considerably higher than those based on ferritin, emphasizing the need for a full hematological work-up in diagnosis. Intravenous therapy usually results in a more rapid increase in hemoglobin and iron stores, but unresolved concerns of possible teratogenicity mean that it should not be used in the first trimester, while cost considerations make it a second choice to oral treatment in the second trimester where this is feasible and effective, except in severe anemia where a more rapid response is desirable. On the other hand, intravenous administration is the first choice treatment in the third trimester and postpartum. All the available intravenous iron preparations are similar in molecular composition, but the exact nature of the complex determines the molecular weight and particle size, which to a large extent determine the properties of the preparation. All are effective and relatively safe, but the higher molecular weight iron dextrans are associated with a greater number of adverse events, and there are concerns about iron toxicity with ferric gluconate. It seems that a degree of expertise and experience and rigorous adherence to protocols and precautions may be required for their safe and effective use.