Written by Mary Marschner
Spoon Feed
IV ferric carboxymaltose reduced anemia in late pregnancy of Malawian women more effectively than oral iron supplements and was found to be as safe as oral iron.
IV ferric carboxymaltose for anemia in late pregnancy
It is estimated that over 30% of reproductive age women are anemic, and the prevalence is even higher in pregnant women. Anemia in pregnancy is associated with worse outcomes for the mother and the baby. In Malawi, HIV and malaria are prevalent, resources scarce, and this paper shows that giving IV iron is as safe and more effective in reducing anemia – specifically in late pregnancy – in this population. This randomized controlled trial evaluated the efficacy of a single dose of intravenous ferric carboxymaltose (FCM) versus standard-of-care oral iron in treating third-trimester anemia among pregnant women in rural Malawi. The FCM group demonstrated a higher hemoglobin increase at four weeks postpartum (mean difference 0.5 g/dL; 95%CI 0.3–0.7) and a lower incidence of anemia (RR 0.6; 95%CI: 0.5–0.8). These findings suggest that FCM is more effective than oral iron in managing late-pregnancy anemia in low-resource settings. I appreciate this study was designed for resource constrained environments.Patients with unknown infection status and unspecified anemia were either given IV iron or oral iron and compared. The study is limited because the secondary outcomes were not convincing- although they were able to correct some anemia, did it really affect maternal or neonatal outcomes?
How does this change my practice?
This paper doesn’t change my current practice, but with healthcare disparities on the rise in the US we need to start reviewing research on how to treat our patients when “best practice” isn’t a realistic option. Before transfusing all of our anemic pregnant patients, a one time ferritin does not accurately diagnose or work up anemia. Additionally, IV iron is associated with an increase of worsening infections. Bacteria like Pseudomonas spp., E. coli, and Klebsiella spp. depend on iron to grow, and a transfusion of IV iron would increase the risk of sepsis in a patient with an active infection.
Source
Ferric carboxymaltose for anemia in late pregnancy: a randomized controlled trial. Nat Med. 2025 Jan;31(1):197-206. doi: 10.1038/s41591-024-03385-w. Epub 2025 Jan 6. Erratum in: Nat Med. 2025 Jan;31(1):351. doi: 10.1038/s41591-025-03492-2. PMID: 39762420
