Is infusion the best way to treat iron deficiency?

Background:
In South Australia ~3000 (15.4%) pregnant woman experience iron deficieny (ID) annually (1). Complications due to ID include: fatigue(2), increased antenatal admissions, pre-eclampsia, placenta praevia and caesarean birth(3), risk of PPH(4) and puerperal sepsis(5). Maternal ID is associated with stillbirth, perinatal death, preterm birth, and SGA/LBW infants (6,7). First line management of antenatal ID includes nutritional advice and oral supplements. The rate of iron infusions in one metropolitan hospital exceeds 14%.

Method:
A prospective mixed methods cohort study assessed women’s knowledge and current practice regarding antenatal iron supplementation. Women attending antenatal services in early pregnancy were consented and invited to complete a questionnaire (online or paper) regarding iron requirements in pregnancy. Blood results and pregnancy outcomes, including iron supplementation, were collected.

Results:
206 women completed questionnaires. Women’s knowledge was variable, many identified knowledge gaps. Several reported difficulties with oral supplementation, including, cost, tolerance, and side-effects. Many felt iron infusion was simple, effective and safe, with minimal reservations about receiving one. Pregnancy outcome data are incomplete (babies due April 2023). Currently available data show mean booking Hb 126.06 g/L (range 95 to 155 g/L); mean ferritin 65.76 µg/L (range <6 to 321 µ/L). The timeframe for booking bloods was broad: 48/202 (23.7%) women had blood taken <6 weeks’ gestation and 19/202 (9.4%) had no booking bloods recorded on electronic patient records, of these 4 (1.9%) had documented “no booking bloods taken”. Currently available data show <50% of women had documented evidence of antenatal iron supplementation advice and 56/102 (54.9%) received an iron infusion.

Conclusion:
Midwives are not informing women about iron in pregnancy or supporting them to modify diet and consider oral supplementation. Blood sampling processes need improvement, to enable accurate knowledge of iron status and provide relevant care, advice and support. High numbers of infusions has considerable resource implications for health service providers.