Contemporary uses of erythropoietin in pregnancy: a literature review.
OBJECTIVE
The objectives of this study were to survey the current research and provide an update on the uses and benefits of erythropoietin (EPO) in pregnancy and the postpartum period.


METHODS
A review of MEDLINE (1947 to present) was performed. Search terms included "erythropoietin," "pregnan*," with subheadings of "administration & dosage," "pharmacokinetics," "therapeutic use," "fetus," "fertility."


METHODS
We reviewed relevant articles published from 2002 to 2012. Case reports, observational studies, case-control studies, randomized controlled trials, retrospective analyses, animal studies, and review articles were included. Articles were selected if they discussed a use of EPO in pregnancy or the immediate postpartum period, as well as use of EPO in the neonate.


RESULTS
Authors independently reviewed and extracted data. Of the 65 articles reviewed, 45 were included. Erythropoietin was used in the treatment of maternal anemia. Because of the molecule's large size, recombinant EPO does not appear to cross the placenta. No fetal morbidity or mortality was noted. Therefore, this is a safe therapy that can be used in pregnancy. Use of EPO may be especially important for women who decline blood products. Neonatal uses of EPO show benefit in the treatment of anemia due to blood type incompatibility.


CONCLUSIONS
Erythropoietin is gaining popularity as a therapeutic option during pregnancy and the postpartum period. Further investigation is needed to establish a standard dosage and dosing interval. New studies reviewing its use in the neonate for perinatal-hypoxic injury and anemia due to blood type incompatibility provide exciting opportunities for further therapeutic use.


BACKGROUND
Obstetricians and gynecologists, family physicians.


OBJECTIVE
After completing this CME activity, physicians should be better able to treat anemia in pregnancy, including causes and interventions; assess renal disease in pregnancy, targets of hemoglobin, precautions, and treatment considerations; and evaluate erythropoietin use in neonates and fetuses, including benefits, complications, and areas for upcoming research/uses.
First Year Resident, UC Davis Medical Center, Sacramento CA, USA.
Laura
L
Sienas
Tienne
T
Wong
Rebecca
R
Collins
James
J
Smith
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D006473:Postpartum Hemorrhage / Q000188:drug therapy; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy* / Q000209:etiology; D011644:Puerperal Disorders / Q000188:drug therapy* / Q000209:etiology; D012720:Severity of Illness Index; D014592:Uterine Hemorrhage / Q000188:drug therapy
D006397:Hematinics; D004921:Erythropoietin