Malawi Trial Raises Iron Levels in Pregnant Women

Sub Levels

A world-first study exploring new ways to combat anemia in developing countries found that a single iron injection, compared to daily pills, could significantly reduce iron deficiency in pregnant women.

The World Health Organization (WHO) currently recommends twice-daily oral iron supplements as standard treatment in developing countries, but adherence to this treatment is poor.

The findings, driven by a collaboration of Australian and Malawian researchers, pave the way for more effective health policies to reduce the global health burden of anemia.

This research is published in The Lancet.

at a glance

  • First study of iron infusion of iron carboxymaltose (FCM) in pregnant women in developing countries. FCM is a common treatment for iron-deficient pregnant women in high-income countries like Australia.
  • This study showed that a single infusion of iron during the second trimester of pregnancy significantly reduced iron deficiency in pregnant women compared to the daily iron supplement currently recommended by the WHO.
  • The Malawi-based trial of 862 women may lead to urgently needed new treatment options for iron-deficient women in resource-poor communities.

Iron deficiency is a major public health burden in resource-poor countries and an important precursor to anemia, a condition that affects nearly half of all pregnancies in Africa. Occurs when there is a shortage.

The WHO recommends that pregnant women in sub-Saharan Africa take oral iron twice daily, but less than 30% of the population consumes this recommended dose. Iron carboxymaltose (FCM) is a 15-minute iron infusion treatment that is widely used for iron-deficient pregnant women in developed countries. To find more effective ways to treat iron-deficient patients, WEHI researchers are collaborating with Malawian scientists from the Training Research Unit of Excellence and the Kamuzu University of Health Sciences to develop FCM and standard-of-care oral iron supplements. compared. Half of the Malawian women (431) received her FCM in the second trimester and the other half received standard of care oral iron supplements. Professor Sant-Rayn Pasricha, a leading anemia expert and head of WEHI’s Department of Population Health and Immunity, said the trial was four times larger than the one conducted to bring FCM to market. said. “When we first embarked on this trial, people thought we were trying to achieve the impossible,” said Professor Pasricha, who is also a hematologist. “We have not only demonstrated that FCM can be administered safely in resource-limited and complex settings such as Malawi, but it can also reduce the iron deficiency component of anemia by approximately 60%. “The results are far superior to the oral iron supplements currently recommended in these populations.” “This opens up a whole new area of ​​research that was previously thought impossible and could help transform health policies in vulnerable communities.” “I am very excited that a drug widely used in high-income countries could be applied to help women in sub-Saharan Africa and other resource-poor settings. Our next task is to identify women who are most likely to benefit from IV treatment.”

A unique health challenge

Pregnant women with anemia are at increased risk of complications such as postpartum hemorrhage, stillbirth, and low birth weight. Despite significant improvements in iron levels, this trial found that FCM was not superior to oral iron in reducing the overall burden of anemia in pregnant women We found that it did not reduce the incidence of low birth weight or anemia. Researchers say that’s because anemia can be caused by factors other than iron deficiency in developing countries. The condition can promote inflammation in the body and impede access to stored iron,” said Professor Kamija Firi, principal epidemiologist and director of training and research. I said Unit of Excellence. “In addition, hemoglobinopathies – a group of inherited blood disorders that primarily affect red blood cells – are common in this region and cause anemia,” Professor Pasricha said. It emphasizes the urgent need for new mechanisms to meet the challenges of “More than half of the participants had inflammation in their bodies even though they tested negative for malaria,” he said. , current tests may not be sensitive enough to understand the full health status of the mother and the risks to the fetus. Testing can be done, but in these parts of the world there are no such tools to measure iron status. It shows an urgent need for laboratory capabilities and provides important insight into where and how drugs like FCM should be used.” FCM remains an expensive treatment option, so the researchers say hopes this promising result will encourage further research into this intervention and philanthropic efforts to make it more accessible to women in low-income settings. The research team is now following the mothers and their babies who participated in this study to assess whether the intervention affects the prevalence of anemia, postpartum depression and neurodevelopment in children. Iron carboxymaltose versus standard-of-care oral iron for treating anemia in the second trimester of pregnant women: A randomized controlled trial” published in The Lancet. (DOI: 10.1016/S0140-6736(23)00278-7). This research was funded by the Bill & Melinda Gates Foundation and a National Health and Medical Research Council (NHMRC) Investigator Grant awarded to Professor Pasricha. WEHI authors: Sant-Rayn Pasricha, Ricardo Ataide, Rebecca Harding, Danielle Clucas, Sabine Braat.

image caption

group photo

Professor Sant-Rayn Pasricha (left) and Professor Kamija Phiri (right) are exploring new ways to combat anemia in Malawi.


iron injection

Two nurses monitor the blood pressure of pregnant study participants receiving IV iron as part of a landmark trial.

Credits: Elisabeth Mamani-Mategula, Training and Research Unit of Excellence, Malawi.

hemoglobin screening

A research nurse will screen pregnant participants for anemia by collecting blood samples for hemoglobin.

Credits: Elisabeth Mamani-Mategula, Training and Research Unit of Excellence, Malawi.

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