(1122) Improved maternal outcomes with intravenous ferric carboxymaltose for severe third trimester anemia

To examine whether administration of intravenous ferric carboxymaltose (Injectafer) to patients with severe anemia in the third trimester improves maternal outcomes.

Study Design: This is a retrospective cohort study of patients delivering liveborn infants between 1/1/2019 and 7/7/2022 with severe iron-deficiency anemia diagnosed in the third trimester, defined as hemoglobin < 8 g/dL or hematocrit < 25% and either iron level < 40mcg/dL or ferritin < 15ng/mL.  On 10/28/2020, Injectafer was made available for pregnant patients at our institution and 2 infusions spaced 1 week apart were recommended for the treatment of severe anemia diagnosed in the third trimester to patients unresponsive to or unable to tolerate oral iron formulations. Patients were divided into 2 cohorts, those who delivered before (cohort 1) and after (cohort 2) the initiation of Injectafer therapy. Maternal characteristics, lab values, and transfusion rates were compared between cohorts.  Statistical analyses included chi-square, t-test, and Kruskal-Wallis tests. 

Results: There were 124 patients meeting inclusion criteria, 53 patients in cohort 1 and 71 patients in cohort 2.  Fourteen patients in cohort 2 did not receive Injectafer due to delivery prior to administration, 17 received one dose, and 40 completed two doses.  Laboratory indices were similar between groups except for a higher starting hemoglobin at the time of diagnosis in cohort 1 (Table). A dose-response was noted immediately prior to delivery with median hemoglobin rising to 10.8 g/dL in the group receiving two doses, compared to a median of 8.4 g/dL for patients in cohort 1, p< 0.0001 (Figure).  Additionally, patients who received Injectafer were less likely to require transfusion at delivery with transfusion rates of 26% in epoch 1 compared with 2.5% in patients who received 2 doses, p< 0.001.

Conclusion: Administration of Injectafer for the treatment of severe anemia in the third trimester improves pre-delivery hemoglobin and decreases the need for peripartum transfusion.