A major trial has found a single iron infusion in the third trimester can significantly reduce anaemia in pregnant women and outperform the efficacy of iron tablets – the current recommended standard of care.
Adequate iron is critical during pregnancy to support the health of the mother and developing baby, with poor iron levels linked to a higher risk of preterm delivery, low birth weight and postpartum depression.
The study, co-led by WEHI, is the first to show infusions in late pregnancy can significantly boost iron stores in pregnant women as they approach delivery and give birth – findings that could improve maternal care and birth outcomes across the globe.
At a glance
-Landmark study reveals giving iron infusions in the third trimester of pregnancy is safe and significantly boosts pregnant women's iron levels, more effectively than iron tablets. -Severe iron deficiency during pregnancy can impact the development of the baby and is linked with a higher risk of complications. -The findings could transform maternal care guidelines and improve birth outcomes in countries worldwide, including Australia.
Iron deficiency is one of the leading causes of anaemia in pregnancy worldwide. Globally, around 37% of pregnant women are anaemic – almost 32 million women at any given time. In Australia, anaemia reportedly occurs in 25% of all pregnancies. Pregnant women with anaemia are at elevated risk of complications, including chronic fatigue, post-partum haemorrhage and stillbirth deliveries. Anaemic pregnancies can also be risky for the baby, with potential impacts to the development of the placenta, the baby's brain development and red blood cell formation. In efforts to reduce iron-deficiency in pregnancy, WEHI researchers worked with scientists at the Training Research Unit of Excellence and Kamuzu University of Health Sciences (Malawi) on an innovative trial comparing the effectiveness of iron infusions to oral iron tablets during late pregnancy.
"While anaemia is one of the most avoidable causes of illness and death in resource-poor nations, any woman across the world can become anaemic during pregnancy, highlighting how this remains a global priority," co-corresponding author Professor Sant-Rayn Pasricha said.
"We found that a single iron infusion in the third trimester can achieve what oral iron tablets taken every day during a pregnancy cannot.
"This is the first concrete evidence that proves infusions in late pregnancy are the superior treatment for combatting anaemia in expectant mothers, boosting iron levels at a critical time that can ensure both mother and baby are better protected during birth."
Working alongside Professor Kamija Phiri (Training Research Unit of Excellence), the research team conducted one of the largest iron trials, involving 590 pregnant women in Malawi.
The team found the women receiving infusions had a lower anaemia prevalence (46.7%) compared to those receiving iron tablets (62.7%) at the time of delivery.
A third-trimester infusion was also found to protect a mother's iron stores, even postpartum.
"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," Prof Pasricha, head of the Anaemia Research Laboratory at WEHI, said.
"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." The World Health Organization (WHO) currently recommends oral iron tablets taken twice daily for pregnant women as the primary prevention strategy for maternal anaemia. Researchers hope to soon share this data with the WHO to help inform future global antenatal care guidelines.
The study, "Ferric carboxymaltose for anaemia in late pregnancy: a randomised controlled trial" is published in Nature Medicine (DOI: 10.1038/s41591-024-03385-w).
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