Stemming the rising tide of Iron Deficiency Anemia in Pregnancy

Is Intravenous Iron Sucrose a viable alternative to the failed Iron-Folate supplementation program in India?

Hema Divakar, MD, Consultant Obstetrician,Nandakumar BS, MD, Public Health ConsultantIsaac Manyonda, PhD, MRCOG, Consultant Obstetrician

Study Objectives

1. To determine the current prevalence and

severity of IDA in pregnancy in rural and

urban populations in India

2. To prospectively document the response to

an IFA supplementation program

3. To pilot the response to intravenous iron-

sucrose

Anemia scenario in India

•Prevalence in pregnant women: 87%

•Contribution to maternal deaths: 16%

Anemia scenario in India

A vast majority of women in rural India embark upon pregnancy with frank iron deficiency anemia and/or depleted iron stores

Objective 1 - PrevalenceTo determine the current prevalence

and severity of IDA in pregnancy in rural and urban populations in India

Among 10,000 rural ante-natal women 6,948 (69.4%) were found to be anemic, while among 1985 urban ante-natal women 1,247 (61.4%) were anemic. The difference in prevalence of anemia between rural and urban pregnant women was statistically significant (p<0.001)

Objective 1 - Severity

The majority of anemic women in the rural population pregnant women had a moderate degree of anemia (43.5%)

while the majority in the urban women had a mild degree of anemia (35.7%)

Objective 1 - Severity

Conclusion 1

In India, prevalence of IDA is rising

We are still talking about it ….

In India, the iron-folic acid (IFA)

supplementation program was launched more than 30 years

ago (1970)

yet IDA remains a major challenge.

Only 10% of women consumecorrectly!

(Indian J Med Res 2006:124:173-184)

Objective 2 – Document Response to IFA Supplementation programTraditional Treatment – Oral

Iron Folic Acid Supplements• Oral iron-folate was administered

at 200mg once daily for 10 weeks after deworming with mebendazole

• Hb estimations were performed before and after the 10 week course of therapy

• Women with unchanged Hb, or those whose Hb fell compared to pre-treatment values, were considered non-responders

Response to Oral Iron Folic Acid Supplements

Conclusion 2

The IFA program has failed to

eradicate IDA in pregnancy

Irrefutable evidence•IV iron sucrose results in a much

more rapid resolution of IDA and because it is administered intravenously, it circumvents the problems of compliance.

Am J Obstet Gynecol 2002;88:3-10.Eur J Obstet Gynecol Reprod Biol 1996;69:121-124.

•If oral iron does not work, switch quickly to intravenous iron, don’t waste your & your patient’s time

Scott, Govan, Lancet -1949 Jan, 253(6540) 14-7

•Holds good even after 50 yrs!

Objective 3 – Pilot the response to intravenous iron-sucrose•Two doses of IV iron sucrose (200mg each) were administered on alternate days.

•Hb was assessed prior to treatment, and again at 4 weeks after therapy.

Objective 3 – Response to IV Iron SucroseFall in the percentage of women with moderate anemia

at 4 weeks following treatment with 400mg intravenous iron

On a study of 152 pts – group A - IV push group B - IV infusion

Both equally effective - IV bolus push is less costly, more compliance

Objective 3 – Response to IV Iron Sucrose

92.7% registered a rise in Hb across all ranges of anemia when given IV sucrose as against 35% responders in the oral group

Conclusion 3

Intravenous Iron Sucrose may be the solution, but rigorous research and

evaluation will be required to establish its full place and potential.

Anemia is a neglected tragedy that continues to exact a heavy toll of suffering and death on women, while there are also the not-so-obvious but potentially just as devastating sequelae on the newborn child’s motor and intellectual development, and future risk of cardiovascular disease.

Thank you for viewing this presentationDr Hema Divakar, Consultant Obstetrician

at Divakar’s Global Hospital carries out field research to solve some of the basic problems in the OBGYN space in India.

Visit http://www.abcofobg.com for more details.