New methods for the treatment and prevention of anemia during pregnancy
DOI: 10.32364/2618-8430-2024-7-1-4
Yu.E. Dobrokhotova, V.V. Romanovskaya, M.R. Narimanova
Pirogov Russian National Research Medical University, Moscow, Russian Federation
Iron deficiency anemia is the most common extragenital pathology in pregnancy. Its relevance is determined by its impact on obstetric and perinatal outcomes, since iron deficiency negatively affects the course of pregnancy and fetal development. Timely detection, treatment, and prevention of iron deficiency conditions during pregnancy are necessary to reduce the risk of complications. The article discusses the main issues and criteria of rational diagnosis and modern approaches to the anemia treatment. It notes the importance of timely and full correction of iron deficiency to avoid the development of fetal neurocognitive disorders. Special attention is paid to the choice of iron products, the benefits and drawbacks of various forms of iron that limit their use in pregnant women. Separately, an innovative dosage form sucrosomal® iron is viewed, which can be considered as an effective means of treating this pathology. The article also presents the clinical studies and pharmacokinetic characteristics of oral sucrosomal iron, using which the necessary effect is achieved with lower doses in the absence of adverse events, which is of paramount importance during gestation.
Keywords: anemia of pregnancy, iron deficiency anemia, iron deficiency, iron preparations, sucrosomal iron, sucrosome.
For citation: Dobrokhotova Yu.E., Romanovskaya V.V., Narimanova M.R. New methods for the treatment and prevention of anemia during pregnancy. Russian Journal of Woman and Child Health. 2024;7(1):26–34 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-4.
About the authors:
Yulia E. Dobrokhotova — Dr. Sc. (Med.), Professor, Head of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117997, Russian Federation; ORCID iD 0000-0002-7830-2290.
Valentiva V. Romanovskaya — C. Sc. (Med.), assistant of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0003-0413-5431.
Metanat R. Narimanova — C. Sc. (Med.), associate professor of the Department of Obstetrics & Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0003-0677-2952.
Contact information: Valentiva V. Romanovskaya, e-mail: valentinaromano2005@yandex.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 30.11.2023.
Revised 20.12.2023.
Accepted 15.01.2024.
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3. Bothwell T.H. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72(1 Suppl):257S–264S. DOI: 10.1093/ajcn/72.1.257S.
4. Доброхотова Ю.Э., Бахарева И.В. Железодефицитная анемия беременных: профилактика и лечение. РМЖ. Мать и дитя. 2018;26(2(I)):59–64. [Dobrokhotova Yu.E., Bakhareva I.V. Iron deficiency anemia of pregnant women: prevention and treatment. RMJ. 2018;2(I):59–64 (in Russ.)].
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6. Shi H., Chen L., Wang Y. et al. Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes. JAMA Netw Open. 2022;5(2):e2147046. DOI: 10.1001/jamanetworkopen.2021.47046.
7. Daru J., Zamora J., Fernández-Félix B.M. et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health. 2018;6(5):e548–e554. DOI: 10.1016/S2214-109X(18)30078-0.
8. Wiegersma A.M., Dalman C., Lee B.K. et al. Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders. JAMA Psychiatry. 2019;76(12):1294–1304. DOI: 10.1001/jamapsychiatry.2019.2309.
9. Auerbach M., Abernathy J., Juul S. et al. Prevalence of iron deficiency in first trimester, nonanemic pregnant women. J Matern Fetal Neonatal Med. 2021;34(6):1002–1005. DOI: 10.1080/14767058.2019.1619690.
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11. Cantor A.G., Bougatsos C., Dana T. et al. Routine iron supplementation and screening for iron deficiency anemia in pregnancy: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(8):566–576. DOI: 10.7326/M14-2932.
12. Achebe M.M., Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood. 2017;129(8):940–949. DOI: 10.1182/blood-2016-08-672246.
13. Peña-Rosas J.P., De-Regil L.M., Garcia-Casal M.N., Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;2015(7):CD004736. DOI: 10.1002/14651858.CD004736.pub5.
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15. Tolkien Z., Stecher L., Mander A.P. et al. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015;10(2):e0117383. DOI: 10.1371/journal.pone.0117383.
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17. Мартынов А.И., Малявин А.Г., Лукина Е.А. и др. Резолюция Совета экспертов «Железодефицитная анемия». Терапия. 2023;5:142–147. DOI: 10.18565/therapy.2023.5.142-147. [Martynov A.I., Malyavin A.G., Lukina E.A. et al. Resolution of the Expert council "Iron-deficiency anemia". Therapy. 2023;5:142–147 (in Russ.)]. DOI: 10.18565/therapy.2023.5.142-147.
18. Pavord S., Daru J., Prasannan N. et al.; BSH Committee. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020;188(6):819–830. DOI: 10.1111/bjh.16221.
19. Tariq N., Ayub R., Khan W.U. et al. Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial. J Coll Physicians Surg Pak. 2015;25(3):193–197.
20. Sultan P., Bampoe S., Shah R. et al. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(1):19–29.e3. DOI: 10.1016/j.ajog.2018.12.016.
21. Wesström J. Safety of intravenous iron isomaltoside for iron deficiency and iron deficiency anemia in pregnancy. Arch Gynecol Obstet. 2020;301(5):1127–1131. DOI: 10.1007/s00404-020-05509-2.
22. Гоззард Д. Когда требуется насыщение высокими дозами внутривенного железа? Оценка новых методов лечения. Акушерство и гинекология: новости, мнения, обучение. 2014;4:105–115. [Gozzard D. When is high-dose intravenous iron repletion needed? Assessing new treatment options. Obstetrics and gynecology. News, Opinions, Training. 2014;4:105–115 (in Russ.)].
23. Тютюнник В.Л. Современные принципы лекарственной терапии железодефицитной анемии у беременных. Мать и дитя. 2016;1(4). (Электронный ресурс.) URL: https://ru.aig-journal.ru/articles/Sovremennye-principy-lekarstvennoi-terapii-jelezodeficitnoi-anemii-u-beremennyh.html?ysclid=lsdkxfa7o0875543071. (дата обращения: 21.01.2024). [Tyutyunnik V.L. Modern principles of drug therapy for iron deficiency anemia in pregnant women. Mat' i ditya. 2016;1(4). (Electronic resource.) URL: https://ru.aig-journal.ru/articles/Sovremennye-principy-lekarstvennoi-terapii-jelezodeficitnoi-anemii-u-beremennyh.html?ysclid=lsdkxfa7o0875543071 (in Russ.) (access date: 21.01.2024)].
24. Моисеев С.В. Внутривенные препараты железа в лечении железодефицитной анемии. Фарматека. 2015;20:78–82. [Moiseev S.V. Intravenous iron supplements in the treatment of iron deficiency anemia. Pharmateca. 2015;20:78–82 (in Russ.)].
25. Liles A.M. Intravenous Versus Oral Iron for Treatment of Iron Deficiency in Non-hemodialysis-dependent Patients With Chronic Kidney Disease. Am J Health Syst Pharm. 2012;69(14):1206–1211.
26. Тютюнник В.Л., Кан Н.Е., Михайлова О.И., Дубровина Н.В. Оценка эффективности терапии железодефицитной анемии у беременных препаратом Мальтофер. Эффективная фармакотерапия. Акушерство и гинекология. 2017;26:4–10. [Tyutyunnik V.L., Kan N.E., Mikhailova O.I., Dubrovina N.V. Evaluation of Effectiveness of Iron-Deficiency Anemia Therapy during Pregnancy by Maltofer. Effektivnaya farmakoterapiya. Akusherstvo i ginekologiya. 2017;26:4–10 (in Russ.)].
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