Gebelikte demir eksikliği anemisinin tedavisinde oral demire karşı intravenöz ferrik karboksimaltoz: Retrospektif çalışma

Oral iron versus intravenous ferric carboxymaltose in the treatment of iron deficiency anemia in pregnancy: a retrospective study

Özet

Amaç: Demir eksikli¤i ve fliddetli anemisi olan gebeler, preterm do- ¤um, prematürite ve gebelik haftas›na göre küçük olma yönünden artm›fl risk alt›ndad›r. Artm›fl demir gereksinimi, gebelikte demir replasman›n› gerekli k›lmaktad›r. Oral demir takviyeleri yayg›n ilk tercihken, kad›nlar›n üçte ikisine kadar olan k›sm› doz s›n›rlay›c› gas- trointestinal yan etkiler yaflamaktad›r. Bu nedenle, demir replasma- n› için intravenöz demir alternatif bir yöntem olabilir. Çal›flmam›z- da, hemoglobin (Hb) ve hematokrit (Hct) seviyelerinde de¤iflim, or- talama eritrosit hacmi (MCV), gebelikte kilo alma, do¤umda gestas- yonel yafl, do¤um yöntemi ve do¤um a¤›rl›¤› yönünden gebelik sü- resince oral demir alan kad›nlarla ferrik karboksimaltoz alan kad›n- lar› karfl›laflt›rmay› amaçlad›k. Yöntem: Bu retrospektif çal›flmaya, altm›fl› oral demir grubu ve alt- m›fl› ferrik karboksimaltoz grubunda olmak üzere toplam 120 gebe dahil edildi. Tüm gebelere, birinci trimesterdeki ilk antepartum ba- k›m ziyaretlerinde Hb, MCV ve Hct seviyeleri için referans ölçü- mü yap›ld›. Oral demir grubundaki kad›nlara 16. ve 20. gebelik haf- talar› aras›nda takviye baflland›. Ferrik karboksimaltoz grubundaki kad›nlara 20. ve 28. gebelik haftalar› aras›nda 100 mg demir infüz- yonu uyguland›. Bulgular: Oral demir grubundaki kad›nlarda Hb seviyelerinde an- laml› bir azalma görüldü; referans ölçümünde 12.2 (aral›k: 11.5–13) g/dL ve do¤umdan önce 12.1 (aral›k: 11.2–12.5) g/dL idi. Ancak ferrik karboksimaltoz grubunda referans Hb seviyeleri ile do¤um- dan önceki Hb seviyeleri aras›nda herhangi bir fark görülmedi (p=0.60). Benzer flekilde Hct seviyelerinde de oral demir grubunda anlaml› azalma görüldü; referans ölçümünde ve do¤umdan önce s›- ras›yla 36.7 (aral›k: 34–39) ve 35.8 (aral›k: 34–38) idi (p=0.006). Ferrik karboksimaltoz grubunda Hct seviyeleri aras›nda anlaml› fark yoktu. Sonuç: ‹ntravenöz ferrik karboksimaltoz uygulamas›n›n, gebelik süresince demir takviyesi olarak verimli ve kullan›m› kolay bir se- çenek oldu¤u görülmektedir.

Abstract

Objective: Pregnant women with iron deficiency and severe anemia are at increased risk of preterm delivery, prematurity, and small for gestational age. Increased iron requirement necessitates iron replacement during pregnancy. While oral iron supplements are the common first choice, up to two-thirds of women experience dose- limiting gastrointestinal side effects. Hence, intravenous iron can be an alternative method for iron replacement. We aimed to compare women who were given oral iron with women who received ferric carboxymaltose during pregnancy with regard to change in hemo- globin (Hb) and hematocrit (Hct) levels, mean corpuscular volume (MCV), weight gain during pregnancy, gestational age at birth, delivery method and birthweight. Methods: A total of 120 pregnant women, 60 in the oral iron group and 60 in the ferric carboxymaltose group were included in this ret- rospective study. All pregnant women underwent a baseline measure- ment for Hb, MCV, and Hct levels at their first antepartum care visit in the first trimester. Women in the oral iron group were started sup- plementation between the 16 and 20 weeks of gestation. Women in the ferric carboxymaltose group underwent 1000 mg of iron infusion between 20 and 28 weeks of gestation. Results: Women in the oral iron group have shown a significant decrease in Hb levels which was 12.2 (range: 11.5–13) g/dL at base- line and 12.1 (range: 11.2–12.5) g/dL before delivery (p=0.034). However, ferric carboxymaltose group did not show any difference between baseline Hb levels and Hb levels before delivery (p=0.60). Likewise, Hct levels have shown a significant decrease in the oral iron group which were 36.7 (range: 34–39) and 35.8 (range: 34–38) at baseline and before delivery, respectively (p=0.006). There was no significant difference between Hct levels in the ferric carboxymal- tose group. Conclusion: Intravenous ferric carboxymaltose administration seems an effective, easy-to-use option for iron supplementation during pregnancy.