TOPLINE:

Intravenous (IV) ferumoxytol showed superior efficacy than oral ferrous sulfate for treating iron deficiency anemia (IDA) in pregnancy, with a median hemoglobin increase of 1.10 g/dL compared with 0.40 g/dL at 4 weeks. Anemia resolution at delivery occurred in more than 90% of IV ferumoxytol recipients compared with 65% of oral iron recipients.

METHODOLOGY:

• Researchers conducted an open-label randomized controlled trial at a single university-based prenatal clinic in the US, enrolling 80 pregnant women with IDA at 24-34 weeks of gestation between January 2021 and July 2024.
• Participants were randomized to receive either IV ferumoxytol (510 mg for hemoglobin 9.0-10.9 g/dL or 1020 mg for hemoglobin 7.0-8.9 g/dL) or oral ferrous sulfate every other day (325 mg for hemoglobin 9.0-10.9 g/dL or 650 mg for hemoglobin 7.0-8.9 g/dL).
• IDA was defined as hemoglobin 7.0-10.9 g/dL with serum ferritin less than 30 ng/dL or transferrin saturation less than 20%; patients with hereditary anemias or malabsorptive disorders were excluded.
• The primary outcome measured was change in hemoglobin from treatment initiation to 4 weeks post-initiation, with secondary outcomes including hemoglobin change at 8 weeks, anemia resolution at delivery, and postpartum day 1 hemoglobin.
• The analysis was conducted using an intention-to-treat approach with Wilcoxon rank sum tests for continuous variables and Fisher exact tests for categorical variables, with statistical significance set at P < .05.

TAKEAWAY:

• Treatment with IV ferumoxytol resulted in a greater median change in hemoglobin at 4 weeks than treatment with oral ferrous sulfate (1.10 g/dL; interquartile range [IQR], 0.70-1.70 vs 0.40 g/dL; IQR, -0.10 to 0.80; P < .001).
• At 8 weeks post-initiation IV ferumoxytol showed a larger median hemoglobin increase than oral ferrous sulfate (1.80 g/dL; IQR, 1.20-2.10 vs 0.70 g/dL; IQR, 0.20-1.20; P < .001).
• Resolution of anemia at delivery admission was achieved in 92.5% of IV ferumoxytol recipients compared with 65.0% of oral ferrous sulfate recipients (P = .005).
• Median postpartum day 1 hemoglobin was higher among IV ferumoxytol recipients compared with oral ferrous sulfate recipients (10.25 g/dL; IQR, 9.28-10.90 vs 9.65 g/dL; IQR, 8.85-10.05; P = .013).

IN PRACTICE:

“Treatment of IDA during pregnancy with IV ferumoxytol improved hemoglobin at delivery and reduced the prevalence of anemia to a greater extent than oral ferrous sulfate,” wrote the authors of the study.

SOURCE:

The study was led by Irogue Igbinosa, MD, MS, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

According to the authors, some clinicians initially screened for IDA using hemoglobin measures alone without confirmatory tests such as serum ferritin, which limited the number of eligible patients until screening methods were changed. Adherence to the oral ferrous sulfate regimen was measured by patient report rather than pill count, which may affect accuracy. The study was inadequately powered to assess rates of blood transfusion, postpartum hemorrhage, and severe maternal morbidity. The researchers used stratified dosing of ferumoxytol based on anemia severity, whereas recent studies have used a universal single infusion of 1020 mg for convenience.

DISCLOSURES:

Funding for this work was provided in part by the Stanford Maternal and Child Health Research Institute and the National Institutes of Health (K12HD103084 to Igbinosa). Deirdre J. Lyell disclosed serving as a consultant for Bloomlife and holding stock in Zenflow, both unrelated to this work. The other authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.