The document discusses the high prevalence of iron deficiency anemia (IDA) among pregnant women in India and explores intravenous iron sucrose as a potential solution. It finds that 69.4% of rural and 61.4% of urban pregnant women in India are anemic. The traditional oral iron-folic acid supplementation program has failed, with only 10% of women consuming it correctly. A pilot study found that 92.7% of women receiving two doses of intravenous iron sucrose saw increased hemoglobin levels, compared to only 35% of those taking oral supplements. Intravenous iron sucrose may help reduce IDA, but more research is still needed.

1. Stemming the rising tide of Iron Deficiency Anemia in Pregnancy Is Intravenous Iron Sucrose a viable alternative to the failed Iron-Folate supplementation program in India? Hema Divakar, MD, Consultant Obstetrician, Nandakumar BS, MD, Public Health Consultant Isaac Manyonda, PhD, MRCOG, Consultant Obstetrician

2. Study Objectives To determine the current prevalence and severity of IDA in pregnancy in rural and urban populations in India To prospectively document the response to an IFA supplementation program To pilot the response to intravenous iron-sucrose

3. Anemia scenario in India Prevalence in pregnant women: 87% Contribution to maternal deaths: 16%

4. Anemia scenario in India A vast majority of women in rural India embark upon pregnancy with frank iron deficiency anemia and/or depleted iron stores

5. Objective 1 - Prevalence To determine the current prevalence and severity of IDA in pregnancy in rural and urban populations in India Among 10,000 rural ante-natal women 6,948 (69.4%) were found to be anemic, while among 1985 urban ante-natal women 1,247 (61.4%) were anemic. The difference in prevalence of anemia between rural and urban pregnant women was statistically significant (p<0.001)

6. Objective 1 - Severity The majority of anemic women in the rural population pregnant women had a moderate degree of anemia (43.5%) while the majority in the urban women had a mild degree of anemia (35.7%)

7. Objective 1 - Severity

8. Conclusion 1 In India, prevalence of IDA is rising

9. We are still talking about it …. In India, the iron-folic acid (IFA) supplementation program was launched more than 30 years ago (1970) yet IDA remains a major challenge. Only 10% of women consume correctly! (Indian J Med Res 2006:124:173-184)

10. Objective 2 – Document Response to IFA Supplementation program Traditional Treatment – Oral Iron Folic Acid Supplements Oral iron-folate was administered at 200mg once daily for 10 weeks after deworming with mebendazole Hb estimations were performed before and after the 10 week course of therapy Women with unchanged Hb, or those whose Hb fell compared to pre-treatment values, were considered non-responders

11. Response to Oral Iron Folic Acid Supplements

12. Conclusion 2 The IFA program has failed to eradicate IDA in pregnancy

13. Irrefutable evidence IV iron sucrose results in a much more rapid resolution of IDA and because it is administered intravenously, it circumvents the problems of compliance. Am J Obstet Gynecol 2002;88:3-10. Eur J Obstet Gynecol Reprod Biol 1996;69:121-124. If oral iron does not work, switch quickly to intravenous iron, don’t waste your & your patient’s time Scott, Govan, Lancet -1949 Jan, 253(6540) 14-7 Holds good even after 50 yrs!

14. Objective 3 – Pilot the response to intravenous iron-sucrose Two doses of IV iron sucrose (200mg each) were administered on alternate days. Hb was assessed prior to treatment, and again at 4 weeks after therapy.

15. Objective 3 – Response to IV Iron Sucrose Fall in the percentage of women with moderate anemia at 4 weeks following treatment with 400mg intravenous iron On a study of 152 pts – group A - IV push group B - IV infusion Both equally effective - IV bolus push is less costly, more compliance

16. Objective 3 – Response to IV Iron Sucrose 92.7% registered a rise in Hb across all ranges of anemia when given IV sucrose as against 35% responders in the oral group

17. Conclusion 3 Intravenous Iron Sucrose may be the solution, but rigorous research and evaluation will be required to establish its full place and potential.

18. Anemia is a neglected tragedy that continues to exact a heavy toll of suffering and death on women, while there are also the not-so-obvious but potentially just as devastating sequelae on the newborn child’s motor and intellectual development, and future risk of cardiovascular disease.

19. Thank you for viewing this presentation Dr Hema Divakar, Consultant Obstetrician at Divakar’s Global Hospital carries out field research to solve some of the basic problems in the OBGYN space in India. Visit http://www.abcofobg.com for more details.