Smith-Wade Sarah, Kidson-Gerber Giselle, Shand Antonia, Grzeskowiak Luke, Henry Amanda
School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia.
Haematology Department, Prince of Wales Hospital, Randwick, NSW, Australia.
BMC Pregnancy Childbirth. 2020 Nov 4;20(1):665. doi: 10.1186/s12884-020-03363-3.
Iron deficiency anaemia in pregnancy (IDAP) affects 11-18% of Australian pregnancies and is associated with adverse perinatal outcomes. National prescribing data suggests the use of intravenous iron in pregnancy is increasingly common. This study aimed to: 1) Establish the current patterns of intravenous iron use by Fellows of the Royal Australian and New Zealand College of Obstetricians (FRANZCOG) when treating iron deficiency and IDAP including immediately postpartum and; 2) Assess FRANZCOG opinions regarding potential trial of intravenous iron for first-line treatment of IDAP.
An online survey of RANZCOG Fellows practicing obstetrics was distributed in September 2018. Results were analysed descriptively and responses compared by clinician demographics using Chi-squared testing.
Of 484 respondents (21% of FRANZCOG), 457 were currently practicing obstetrics. Most prescribed intravenous iron in pregnancy (96%) and/or postpartum (85%). Most intravenous iron was prescribed for IDAP (98%) rather than iron deficiency without anaemia (53%), and for IDAP most commonly second-line to failed oral iron supplementation and first-line in special circumstances (59%). Intravenous iron prescribing was associated with shorter time since FRANZCOG completion (p = 0.01), public hospital practice (p = 0.008) and higher hospital birth numbers (p = 0.01). Most respondents (90%) would consider a randomised controlled trial of first-line intravenous iron for IDAP, although views on appropriate thresholds differed.
Almost all respondents prescribed intravenous iron for IDAP, and while mostly used for second-line treatment over half sometimes used it first-line. With accelerating intravenous iron use, further research is required into its optimal use in pregnancy, recognizing important clinical outcomes and cost effectiveness.
孕期缺铁性贫血（IDAP）影响着11% - 18%的澳大利亚孕妇，并与不良围产期结局相关。国家处方数据显示，孕期使用静脉铁剂的情况越来越普遍。本研究旨在：1）确定澳大利亚和新西兰皇家妇产科医师学院会员（FRANZCOG）在治疗缺铁和IDAP时，包括产后立即使用静脉铁剂的当前模式；2）评估FRANZCOG对于将静脉铁剂作为IDAP一线治疗的潜在试验的意见。
2018年9月对从事产科工作的RANZCOG会员进行了在线调查。对结果进行描述性分析，并使用卡方检验按临床医生人口统计学特征比较回答情况。
在484名受访者（占FRANZCOG的21%）中，457人目前从事产科工作。大多数人在孕期（96%）和/或产后（85%）开具静脉铁剂处方。大多数静脉铁剂是用于治疗IDAP（98%）而非无贫血的缺铁（53%），对于IDAP，最常见的是在口服铁剂补充失败后作为二线用药，在特殊情况下作为一线用药（59%）。静脉铁剂处方与完成FRANZCOG培训后的时间较短（p = 0.01）、公立医院工作（p = 0.008）以及较高的医院分娩数量（p = 0.01）相关。大多数受访者（90%）会考虑对IDAP进行一线静脉铁剂的随机对照试验，尽管对于合适的阈值观点不同。
几乎所有受访者都为IDAP开具静脉铁剂处方，虽然大多用于二线治疗，但超过一半的人有时会将其作为一线用药。随着静脉铁剂使用的加速，需要进一步研究其在孕期的最佳使用方法，同时要认识到重要的临床结局和成本效益。
