Iron infusions are safe and more effective than tablets at treating significant anaemia in expectant mothers in late pregnancy.
Infusions are better than tablets at boosting the iron levels of pregnant women in their third trimester, according to an African study co-led by Australian researchers.
According to the randomised controlled trial of almost 600 pregnant women who were moderately to severely anaemic in the third trimester, an iron infusion more than halved the incidence of anaemia at delivery, whereas oral iron only reduced the incidence by just over a third.
“This is the first concrete evidence that proves infusions in late pregnancy are the superior treatment for combating anaemia in expectant mothers, boosting iron levels at a critical time that can ensure both mother and baby are better protected during birth,” author Professor Sant-Rayn Pasricha, head of the anaemia research laboratory at WEHI, said in a statement.
The researchers randomly assigned 590 women in Malawi antenatal clinics who were moderately or severely anaemic at 27-35 weeks to receive either an iron infusion or standard care which included oral iron supplementation.
Anaemia rates at 36 weeks or delivery were 46.7% for those who had the infusion (20mg/kg up to 1000mg), compared with 62.7% of those who took 60mg elemental iron twice daily for 90 days.
Treating six women with an infusion would mitigate one case of anaemia, they found.
Around half of pregnant women in Malawi are anaemic, and women who are anaemic at childbirth are more likely to die, have postpartum haemorrhage or go on to have anaemia afterwards. Babies are also at a greater risk of low birthweight and early birth, the researchers said.
No differences were found between groups for serious infusion-related reactions or adverse events at the four-week postpartum follow-up. Infusions were not linked to differences in birthweight or the child’s haemoglobin concentration.
Intravenous iron infusions reduced the prevalence of moderate and severe anaemia, iron deficiency and iron deficiency anaemia and increased mean haemoglobin and ferritin compared with baseline levels at both the time of childbirth and at follow-up, the study authors said.
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“This sustained impact on anaemia is an unprecedented finding that really crystallises the case for using infusions in late pregnancy to rapidly boost red blood cell production and iron levels,” said Professor Pasricha.
“We hope our findings will soon be translated in health settings across the world to form a uniform set of guidelines that can ensure more women get the right iron treatment when they need it most.
“If intravenous iron can be safely delivered in basic health centres in remote Malawi as our trial has shown, there’s really no health setting where IV iron couldn’t be effectively and safely given.”
A recent study of anaemia in regional Australia found that 97% of women giving birth at hospital were iron deficient and 17% were anaemic. This 2024 study of a Bathurst hospital found iron infusions were given to 14% of women, which was 1.75 times higher than the recommended rate.
According to guidelines in the Australian Red Cross 2020 Antenatal Audit tool, all women should be screened in the first and second trimester, but only in the third trimester if they were previously iron deficient and had been prescribed an oral supplement. Iron infusions are only indicated for women in the third trimester who haven’t sufficiently responded to the supplements, or if they failed to regularly take them.
The Bathurst study found less than a third of women were screened for full blood counts in trimester one and only half by trimester three. Ferritin was often ignored too, despite it being a better predictor than haemoglobin for iron stores and future red blood cell production. This is important for pregnant women, who are facing blood loss during labour.
One in 10 women were given an infusion without justification in the guidelines, which were based on blood values and did not factor in clinical judgement.
Oral supplements were recommended for 97% of women, but only 42% reported taking them. Side effects and compliance weren’t well documented, but constipation was noted as an issue.
