title: Treatments for iron-deficiency anaemia in pregnancy.
abstract: BACKGROUND
  Iron deficiency, the most common cause of anaemia in pregnancy worldwide, can be mild, moderate or severe. Severe anaemia can have very serious consequences for mothers and babies, but there is controversy about whether treating mild or moderate anaemia provides more benefit than harm.
  
  
  OBJECTIVE
  To assess the effects of different treatments for anaemia in pregnancy attributed to iron deficiency (defined as haemoglobin less than 11 g/dL or other equivalent parameters) on maternal and neonatal morbidity and mortality.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2011), CENTRAL (2011, Issue 5), PubMed (1966 to June 2011), the International Clinical Trials Registry Platform (ICTRP) (2 May 2011), Health Technology Assessment Program (HTA) (2 May 2011) and LATINREC (Colombia) (2 May 2011).
  
  
  METHODS
  Randomised controlled trials comparing treatments for anaemia in pregnancy attributed to iron deficiency.
  
  
  METHODS
  We identified 23 trials, involving 3.198 women. We assessed their risk of bias. Three further studies identified are awaiting classification.
  
  
  RESULTS
  Many of the trials were from low-income countries; they were generally small and frequently methodologically poor. They covered a very wide range of differing drugs, doses and routes of administration, making it difficult to pool data. Oral iron in pregnancy showed a reduction in the incidence of anaemia (risk ratio 0.38, 95% confidence interval 0.26 to 0.55, one trial, 125 women) and better haematological indices than placebo (two trials). It was not possible to assess the effects of treatment by severity of anaemia. A trend was found between dose and reported adverse effects. Most trials reported no clinically relevant outcomes nor adverse effects. Although the intramuscular and intravenous routes produced better haematological indices in women than the oral route, no clinical outcomes were assessed and there were insufficient data on adverse effects, for example, on venous thrombosis and severe allergic reactions. Daily low-dose iron supplements may be effective at treating anaemia in pregnancy with less gastrointestinal side effects compared with higher doses.
  
  
  CONCLUSIONS
  Despite the high incidence and burden of disease associated with this condition, there is a paucity of good quality trials assessing clinical maternal and neonatal effects of iron administration in women with anaemia. Daily oral iron treatment improves haematological indices but causes frequent gastrointestinal adverse effects. Parenteral (intramuscular and intravenous) iron enhances haematological response, compared with oral iron, but there are concerns about possible important adverse effects (for intravenous treatment venous thrombosis and allergic reactions and for intramuscular treatment important pain, discolouration and allergic reactions). Large, good quality trials, assessing clinical outcomes (including adverse effects) as well as the effects of treatment by severity of anaemia are required.
authors: Research Promotion and Development Team, Health Systems Based on Primary Health Care (HSS), Pan American Health Organization, 525, 23rd St, NW, Washington DC, USA, 20037-2895.
authors: Ludovic
authors: L
authors: Reveiz
authors: Gillian Ml
authors: GM
authors: Gyte
authors: Luis Gabriel
authors: LG
authors: Cuervo
authors: Alexandra
authors: A
authors: Casasbuenas
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000628:therapy*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D058085:Iron Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D058085:Iron Compounds