Stemming The Rising Tide Of Iron Deficiency Anemia In India


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A study on use of IV Iron Sucrose in treatment of Iron Deficiency Anemia in Pregnancy in India.

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Stemming The Rising Tide Of Iron Deficiency Anemia In India

  1. 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. 2. Study Objectives <ul><li>To determine the current prevalence and severity of IDA in pregnancy in rural and urban populations in India </li></ul><ul><li>To prospectively document the response to an IFA supplementation program </li></ul><ul><li>To pilot the response to intravenous iron-sucrose </li></ul>
  3. 3. Anemia scenario in India <ul><li>Prevalence in pregnant women: 87% </li></ul><ul><li>Contribution to maternal deaths: 16% </li></ul>
  4. 4. Anemia scenario in India <ul><li>A vast majority of women in rural India embark upon pregnancy with frank iron deficiency anemia and/or depleted iron stores </li></ul>
  5. 5. Objective 1 - Prevalence <ul><li>To determine the current prevalence and severity of IDA in pregnancy in rural and urban populations in India </li></ul>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. 6. Objective 1 - Severity <ul><li>The majority of anemic women in the rural population pregnant women had a moderate degree of anemia (43.5%) </li></ul><ul><li>while the majority in the urban women had a mild degree of anemia (35.7%) </li></ul>
  7. 7. Objective 1 - Severity
  8. 8. Conclusion 1 <ul><li>In India, prevalence of IDA is rising </li></ul>
  9. 9. We are still talking about it …. <ul><li>In India, the iron-folic acid (IFA) </li></ul><ul><li>supplementation program was launched more than 30 years ago (1970) </li></ul><ul><li>yet </li></ul><ul><li>IDA remains a major challenge. </li></ul><ul><li>Only 10% of women consume </li></ul><ul><li>correctly! </li></ul><ul><li>(Indian J Med Res 2006:124:173-184) </li></ul>
  10. 10. Objective 2 – Document Response to IFA Supplementation program <ul><li>Traditional Treatment – Oral Iron Folic Acid Supplements </li></ul><ul><li>Oral iron-folate was administered at 200mg once daily for 10 weeks after deworming with mebendazole </li></ul><ul><li>Hb estimations were performed before and after the 10 week course of therapy </li></ul><ul><li>Women with unchanged Hb, or those whose Hb fell compared to pre-treatment values, were considered non-responders </li></ul>
  11. 11. Response to Oral Iron Folic Acid Supplements
  12. 12. Conclusion 2 <ul><li>The IFA program has failed to eradicate IDA in pregnancy </li></ul>
  13. 13. Irrefutable evidence <ul><li>IV iron sucrose results in a much more rapid resolution of IDA and because it is administered intravenously, it circumvents the problems of compliance. </li></ul><ul><li>Am J Obstet Gynecol 2002;88:3-10. </li></ul><ul><li>Eur J Obstet Gynecol Reprod Biol 1996;69:121-124. </li></ul><ul><li>If oral iron does not work, switch quickly to intravenous iron, don’t waste your & your patient’s time </li></ul><ul><li>Scott, Govan, Lancet -1949 Jan, 253(6540) 14-7 </li></ul><ul><li>Holds good even after 50 yrs! </li></ul>
  14. 14. Objective 3 – Pilot the response to intravenous iron-sucrose <ul><li>Two doses of IV iron sucrose (200mg each) were administered on alternate days. </li></ul><ul><li>Hb was assessed prior to treatment, and again at 4 weeks after therapy. </li></ul>
  15. 15. Objective 3 – Response to IV Iron Sucrose <ul><li>Fall in the percentage of women with moderate anemia at 4 weeks following treatment with 400mg intravenous iron </li></ul>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. 16. Objective 3 – Response to IV Iron Sucrose <ul><li>92.7% registered a rise in Hb across all ranges of anemia when given IV sucrose as against 35% responders in the oral group </li></ul>
  17. 17. Conclusion 3 <ul><li>Intravenous Iron Sucrose may be the solution, but rigorous research and evaluation will be required to establish its full place and potential. </li></ul>
  18. 18. <ul><li>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. </li></ul>
  19. 19. <ul><li>Thank you for viewing this presentation </li></ul><ul><li>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. </li></ul><ul><li>Visit for more details. </li></ul>