The Use of Iron Sucrose Complex for Anemia in Pregnancy and the Postpartum Period

Iron-deficiency anemia resulting in reduced blood reserves is one the most common problems in pregnancy. It is estimated that 20% to 50% of the world population is suffering from iron deficiency and iron-deficient states, pregnancy being one of the most important “risk factors” for iron deficiency and iron-deficiency anemia. The traditional treatments, ie, oral iron therapy and blood transfusion, involve significant drawbacks. High doses of oral iron frequently cause side effects, and noncompliance is common. Therefore, intravenous iron, alone or in association with recombinant human erythropoietin (rHuEPO) therapy, has been considered as an alternative in the management of iron deficiency in this setting. There is increasing evidence that iron sucrose is safe for the mother and the fetus using the recommended dosages and therapy regimens. Iron sucrose is effective in pregnant and postpartum patients who do not respond to oral iron, who are noncompliant to oral iron, or who are treated with rHuEPO. In both cases, according to the present data, the expected hemoglobin increase and time for therapy are predictable in responding patients. Whether it is reasonable to wait for a response to oral iron in moderate to severe anemia is therefore questionable. Indications for the use of iron sucrose complex are: preexisting (moderate-severe) anemia; no effect of oral iron; side effects of oral iron; refusal of blood transfusion (eg, Jehovah's Witness patients); limited time until delivery; coexisting risks (eg, bowel disease, renal disease); pre- and postoperative period and postpartum anemia. Future fields of research are the evaluation of patient satisfaction and quality of life, impact on costs and hospital stay, impact on blood transfusion frequency and mortality rate, and finally impact on other factors such as breast feeding behavior and neonatal outcome such as birth weight, prematurity and neonatal iron stores.