Management of Mild Postpartum Anemia: Is Iron Administration Effective?

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Aug 26

PMID 39184625

Authors

Akihito Morita

Daisuke Higeta

Yoshikazu Kitahara

Maki Inoue

Akira Iwase

Affiliations

Soon will be listed here.

Abstract

Background This study aimed to investigate the efficacy of iron therapy in the treatment of mild postpartum anemia. Methods We conducted a case-control study involving women who underwent cesarean section at our hospital between 2015 and 2020. Following propensity score matching, participants were categorized into two groups based on whether or not they received iron therapy. These patients were evaluated for mean hemoglobin (Hb) levels on the seventh postoperative day (POD 7), the percentage of subjects achieving Hb greater than 10 g/dL on POD 7, and the incidence of adverse events. The efficacy of iron administration was evaluated using a superiority test, and receiver operating characteristic analyses were employed to generate area under the receiver operating characteristic curves (AUROC). Results The mean Hb level on POD 7 was 10.12 g/dL in the iron group and 9.89 g/dL in the iron-free group (P = 0.206). The superiority test revealed that the percentage of subjects achieving Hb levels greater than 10 g/dL on POD 7 was 56.1% in the iron group and 48.8% in the iron-free group (P = 0.880), indicating that the iron group did not demonstrate superiority over the iron-free group. The incidence of adverse events was significantly higher in the iron group (P = 0.027). The highest AUROC was observed with preoperative mean corpuscular Hb, measuring 0.632 (95% CI: 0.509-0.755), with a cutoff point of 28.5 pg. Conclusion Consideration should be given to the uniform administration of iron for the management of mild postpartum anemia.

References

Milman N, Agger A, Nielsen O . Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Dan Med Bull. 1991; 38(6):471-6. View

Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C . Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol. 2018; 221(1):19-29.e3. PMC: 7060493. DOI: 10.1016/j.ajog.2018.12.016. View

Komatsu N, Arita K, Mitsui H, Nemoto T, Hanaki K . Efficacy and safety of ferric citrate hydrate compared with sodium ferrous citrate in Japanese patients with iron deficiency anemia: a randomized, double-blind, phase 3 non-inferiority study. Int J Hematol. 2021; 114(1):8-17. PMC: 10917848. DOI: 10.1007/s12185-021-03123-9. View

Seid M, Derman R, Baker J, Banach W, Goldberg C, Rogers R . Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008; 199(4):435.e1-7. DOI: 10.1016/j.ajog.2008.07.046. View

Chandrasekaran N, De Souza L, Urquia M, Young B, McLeod A, Windrim R . Is anemia an independent risk factor for postpartum depression in women who have a cesarean section? - A prospective observational study. BMC Pregnancy Childbirth. 2018; 18(1):400. PMC: 6186102. DOI: 10.1186/s12884-018-2032-6. View

Wiegersma A, Dalman C, Lee B, Karlsson H, Gardner R . Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders. JAMA Psychiatry. 2019; 76(12):1294-1304. PMC: 6751782. DOI: 10.1001/jamapsychiatry.2019.2309. View

Maeda Y, Ogawa K, Morisaki N, Tachibana Y, Horikawa R, Sago H . Association between perinatal anemia and postpartum depression: A prospective cohort study of Japanese women. Int J Gynaecol Obstet. 2019; 148(1):48-52. DOI: 10.1002/ijgo.12982. View

VanderMeulen H, Strauss R, Lin Y, McLeod A, Barrett J, Sholzberg M . The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study. BMC Pregnancy Childbirth. 2020; 20(1):196. PMC: 7132873. DOI: 10.1186/s12884-020-02886-z. View

Rahman M, Abe S, Rahman M, Kanda M, Narita S, Bilano V . Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr. 2016; 103(2):495-504. DOI: 10.3945/ajcn.115.107896. View

10.

Azami M, Badfar G, Khalighi Z, Qasemi P, Shohani M, Soleymani A . The association between anemia and postpartum depression: A systematic review and meta-analysis. Caspian J Intern Med. 2019; 10(2):115-124. PMC: 6619471. DOI: 10.22088/cjim.10.2.115. View

11.

Butwick A, McDonnell N . Antepartum and postpartum anemia: a narrative review. Int J Obstet Anesth. 2021; 47:102985. DOI: 10.1016/j.ijoa.2021.102985. View

12.

Osol G, Ko N, Mandala M . Plasticity of the Maternal Vasculature During Pregnancy. Annu Rev Physiol. 2019; 81:89-111. PMC: 6571171. DOI: 10.1146/annurev-physiol-020518-114435. View

13.

Breymann C, Honegger C, Hosli I, Surbek D . Diagnosis and treatment of iron-deficiency anaemia in pregnancy and postpartum. Arch Gynecol Obstet. 2017; 296(6):1229-1234. DOI: 10.1007/s00404-017-4526-2. View

14.

Bose P, Regan F, Paterson-Brown S . Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG. 2006; 113(8):919-24. DOI: 10.1111/j.1471-0528.2006.01018.x. View

15.

Mintsopoulos V, Tannenbaum E, Malinowski A, Shehata N, Walker M . Identification and treatment of iron-deficiency anemia in pregnancy and postpartum: A systematic review and quality appraisal of guidelines using AGREE II. Int J Gynaecol Obstet. 2023; 164(2):460-475. DOI: 10.1002/ijgo.14978. View

16.

Beard J, Hendricks M, Perez E, Murray-Kolb L, Berg A, Vernon-Feagans L . Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005; 135(2):267-72. DOI: 10.1093/jn/135.2.267. View