The course of pregnancy and childbirth in women with iron deficiency anemia treated with iron (II) sulfate and not treated

Introduction. Due to the plasma volume expansion prevailing over the increase in red blood cell production, as well as inadequate dietary intake with underlying physiologically increased iron requirements, pregnant women tend to suffer from iron deficiency and anaemia.

Aim. To evaluate the efficacy of Tardyferon (depot iron (II) sulphate 80 mg) in pregnant women with anaemia in reducing adverse perinatal outcomes. 

Materials and methods. To conduct the retrospective chart review of pregnant women of Stavropol Krai, the patients were divided into 2 groups: Group 1 (n = 70) – the treatment group, which included pregnant women who were diagnosed with IDA in the 1st, 2nd or 3rd trimesters and who received antianemic therapy, and Group 2 (n = 30) – pregnant women with IDA (diagnosed in the 3rd trimester) who did not use any iron supplements.

Results. In Group I, haemoglobin levels identified at the time of detection of anaemia ranged from 91 to 109 g/l (103.1 ± 4.5), red blood cell counts from 2.7 to 4.1 × 109/l (3.5 ± 0.3), and hematocrit levels from 26 to 37 (32.9 ± 1.8). Once the diagnosis of anaemia had been established, pregnant women were prescribed with Tardiferon 80 mg twice a day, which they administered on a regular basis until delivery and continued using during the postpartum period. In Group 2, patients did not receive any iron supplements and showed a gradual decrease in haemoglobin levels by an average of 5.6 g/l. Pregnant women receiving Tardyferon prolonged-release tablets from the date when anaemia was diagnosed showed an increase in clinical blood test values.

Conclusions. In pregnant women with anaemia, iron therapy normalizes haematological parameters, which leads to improved tissue oxygen supply and a favourable clinical effect.

1. O’Toole F, Sheane R, Reynaud N, McAuliffe FM, Walsh JM. Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines. Int J Gynaecol Obstet. 2024;166(1):214–227. https://doi.org/10.1002/ijgo.15270.

2. Harrison RK, Lauhon SR, Colvin ZA, McIntosh JJ. Maternal anemia and severe maternal morbidity in a US cohort. Am J Obstet Gynecol MFM. 2021;3(5):100395. https://doi.org/10.1016/j.ajogmf.2021.100395.

3. Соловьева АВ, Стуров ВГ, Апресян СВ, Стуклов НИ, Иванов АВ, Симоновская ХЮ. Анемии и репродуктивное здоровье. М.: Редакция журнала StatusPraesens; 2019. 200 с. Режим доступа: https://elibrary.ru/ekwams.

4. Bitzer J, Serrani M, Lahav A. Women’s attitudes towards heavy menstrual bleeding, and their impact on quality of life. Open Access J Contracept. 2013;2013(4):21–28. https://doi.org/10.2147/OAJC.S38993.

5. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol. 2021;138(2):e55–e64. https://doi.org/10.1097/AOG.0000000000004477.

6. Zimmermann MB, Burgi H, Hurrell RF. Iron deficiency predicts poor maternal thyroid status during pregnancy. J Clin Endocrinol Metab. 2007;92(9):3436–3440. https://doi.org/10.1210/jc.2007-1082.

7. Benson AE, Shatzel JJ. Ryan KS, Hedges MA, Martens K, Aslan JA, Lo JO. The Incidence, Complications and Treatment of Iron Deficiency in Pregnancy. Eur J Haematol. 2022;109(6):633–642. https://doi.org/10.1111/ejh.13870.

8. Omotayo MO, Abioye AI, Kuyebi M, Eke AC. Prenatal anemia and postpartum hemorrhage risk: A systematic review and meta-analysis. J Obstet Gynaecol Res. 2021;47(8):2565–2576. https://doi.org/10.1111/jog.14834.

9. Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N 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. https://doi.org/10.1016/S2214-109X(18)30078-0.

10. Rahmati S, Azami M, Badfar G, Parizad N, Sayehmiri K. The relationship between maternal anemia during pregnancy with preterm birth: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020;33(15):2679–2689. https://doi.org/10.1080/14767058.2018.1555811.

11. Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015;55(12):2799–2806. https://doi.org/10.1111/trf.13252.

12. Wiegersma AM, Dalman C, Lee BK, Karlsson B, Gardner RM. Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders. JAMA Psychiatry. 2019;76(12):1294–1304. https://doi.org/10.1001/jamapsychiatry.2019.2309.

13. Tamura T, Goldenberg RL, Hou J, Johnston KE, Cliver SP, Ramey SL, Nelson KG. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr. 2002;140(2):165–170. https://doi.org/10.1067/mpd.2002.120688.

14. Долгушина НВ, Шмаков РГ, Баранов ИИ, Баев ОР, Павлович СВ, Прялухин ИА и др. Нормальная беременность: клинические рекомендации. М.; 2023. 90 с. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/288_2.

15. Verstraelen H, Delanghe J, Roelens K, Blot S, Claeys G, Temmerman M. Subclinical iron deficiency is a strong predictor of bacterial vaginosis in early pregnancy. BMC Infect Dis. 2005;5:55. https://doi.org/10.1186/1471-2334-5-55.

16. Bendich A. Micronutrients in women’s health and immune function. Nutrition. 2001;17(10):858–867. https://doi.org/10.1016/s0899-9007(01)00649-9.

17. Радзинский ВЕ, Князев СА, Костин ИН, Апресян СВ, Артымук НВ, Белокриницкая ТЕ и др. Предиктивное акушерство. М.: Редакция журнала StatusPraesens; 2021. 520 c. Режим доступа: https://www.elibrary.ru/phhuef.

18. Tiongco RE, Arceo E, Clemente B, Pineda-Cortel MR. Association of maternal iron deficiency anemia with the risk of gestational diabetes mellitus: a meta-analysis. Arch Gynecol Obstet. 2019;299(1):89–95. https://doi.org/10.1007/s00404-018-4932-0.

19. Solovyeva AV, Aleynikova EY, Gulenkova KA, Kuznetsova OA, Ermolenko KS. Pregnancy complicated by iron deficiency anemia: does the problem have a solution? Meditsinskiy Sovet. 2023;17(5):106–113. (In Russ.) https://doi.org/10.21518/ms2023-068.