A single third-trimester iron infusion significantly reduces anemia in pregnant women, outperforming oral iron tablets and offering potential to improve maternal care globally.
A groundbreaking study has demonstrated that a single iron infusion during the third trimester significantly reduces anemia in pregnant women, surpassing the effectiveness of standard iron tablets. This discovery could reshape the standard of care for managing iron deficiency in pregnancy.
Iron is essential during pregnancy to ensure the health of both mother and baby. Insufficient iron levels are associated with increased risks of preterm birth, low birth weight, and postpartum depression.
The research, led jointly by WEHI (Australia) and the Training Research Unit of Excellence (Malawi), is the first to confirm that iron infusions in late pregnancy can substantially increase iron levels in women as they prepare for childbirth. These findings hold the potential to enhance maternal care and improve birth outcomes worldwide.
The Global Burden of Anaemia in Pregnancy
Iron deficiency is one of the leading causes of anemia in pregnancy worldwide. Globally, around 37% of pregnant women are anemic – almost 32 million women at any given time. In Australia, anemia reportedly occurs in 25% of all pregnancies.
Pregnant women with anemia are at elevated risk of complications, including chronic fatigue, post-partum hemorrhage, and stillbirth deliveries. Anemic pregnancies can also be risky for the baby, with potential impacts on 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 anemia is one of the most avoidable causes of illness and death in resource-poor nations, any woman across the world can become anemic 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 anemia in expectant mothers, boosting iron levels at a critical time that can ensure both mother and baby are better protected during birth.”
Large-Scale Trial Results
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 anemia is an unprecedented finding that really crystallizes 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 centers 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 anemia. Researchers hope to soon share this data with the WHO to help inform future global antenatal care guidelines.
Reference: “Ferric carboxymaltose for anemia in late pregnancy: a randomized controlled trial” by Sant-Rayn Pasricha, Ernest Moya, Ricardo Ataíde, Glory Mzembe, Rebecca Harding, Martin N. Mwangi, Truwah Zinenani, Khic-Houy Prang, Justina Kaunda, Owen P. L. Mtambo, Maclean Vokhiwa, Gomezgani Mhango, Elisabeth Mamani-Mategula, Katherine Fielding, Ayşe Demir, Naomi Von Dinklage, Hans Verhoef, Alistair RD McLean, Lucinda Manda-Taylor, Sabine Braat and Kamija S. Phiri, 6 January 2025, Nature Medicine.
DOI: 10.1038/s41591-024-03385-w
