Intravenous iron sucrose and ferric carboxymaltose in pregnant patients: an observational study of maternal efficacy and tolerance

Aim: To compare the tolerability and effectiveness of ferric carboxymaltose (FCM) and iron sucrose (FeS) in pregnant women with iron deficiency (ID).

Methods: Retrospective audit of pregnant women in their second or third trimesters receiving intravenous (IV) FCM or FeS at an Australian tertiary maternity hospital from January 2007 to July 2013. Demographics, haematological and infusion details, including adverse events and pregnancy outcomes, were compared using Student's t-test, Chi-square and Fisher's exact tests.

Results: Eighty-three women had 94 infusions (56 FCM requiring 2 h in Day Stay; 38 FeS requiring 6 h in Acute Care) administered. There were no significant demographic differences between groups. Neither group had anaphylactic reaction or unplanned admission after infusion. Non-anaphylactic adverse reactions at first infusion were lower in the FCM group (16 vs 34%, p = 0.049). Pre-infusion mean Hb and ferritin were 98.1 g/L ± 10.8 g/L and 9.7 μg/L ± 6.2 μg/L in the FCM group and 98.3 g/L ± 11.7 g/L and 8.0 μg/L ± 3.9 μg/L in the FeS group. Post-infusion, both groups had significantly higher Hb and ferritin: rises of 12.7 g/L and 296 μg/L, respectively for FCM (p < 0.001 vs all pre-infusion values) and rises of 8.9 g/L and 105 μg/L in FeS (p < 0.05 vs all pre-infusion values). Pregnancy outcomes, including post partum haemorrhage rates, were similar between groups.

Conclusion: Although haematological parameters improved following infusion in both groups, FCM had a lower incidence of infusion-related adverse events compared to FeS. Although sample size is small, given decreased monitoring and infusion time required for FCM, it may become the preferred formulation for ID treatment in pregnancy.