Iron status and choice of iron therapy during pregnancy: advantages and disadvantages

Iron deficiency anaemia (IDA) still becomes major health problem all over the world and pregnant women at particular risk. IDA is associated with negative outcomes for both mother and infant. Therefore, many laboratory assessments can be used as estimation of iron status during pregnancy, with haemoglobin (Hb) and serum ferritin (SF) as the most widely used tools. However, the uses of these two indicators remain controversies, because of physiological hemodilution that appears during pregnancy. Other methods are used to provide more accurate results of iron status, all with their advantages and drawback. Therapeutic options of IDA ranging from oral to intravenous therapy. Oral iron replacement became first choice for many years due to its safety and low cost. However, in some conditions such as severe anaemia and intolerance to oral iron, intravenous iron is preferable. Nowadays there are several preparations of intravenous iron in the market: Iron sucrose (IS), ferric gluconate, ferric carboxymaltose, iron dextran (high and low molecular weight dextran), iron isomaltoside and ferumoxytol. These preparations provide rapid replenishment of iron stores with good safety profiles. The present review summarizes methods to assess iron status during pregnancy, and choices of iron therapy, with their advantages and disadvantages.