Iron Deficiency Anaemia in Pregnancy – Which Iron is Best?

Iron Deficiency Anaemia in Pregnancy – Which Iron is Best?

InterClinical eNews August 2018, Issue 83

Iron deficiency anaemia (IDA) represents a major health concern during pregnancy. IDA is associated with increased risk of preterm pregnancy, low birth weight and restricted intrauterine growth rates.(1)  A number of types of iron supplementation exist such as ferrous fumarate, ferrous sulphate, ferrous gluconate and amino-chelated forms such as ferrous bis-glycinate. Amino chelated forms are considered superior due to their ability to transit the intestines still bound to their amino acid carrier for delivery to target tissues, whereas mineral salt forms which disassociate in the intestinal tract can result in side effects such as nausea, constipation, vomiting or colic. This randomised controlled trial investigated whether ferrous glycine sulphate (a salt) or ferrous bis-glycinate (a chelate), performed better for efficacy and tolerability in resolving IDA during pregnancy. 

Study Population
Eligible participants were women in their 14th to18th week of pregnancy, carrying a single foetus, with a diagnosis of IDA (indicated by a haemoglobin between 7 – 10.9 g/dL and serum ferritin < 15 mcg/L). The participants were otherwise free of disease and untreated. Baseline clinical and anthropometric tests were conducted. Computer-generated randomisation assigned the participants to receive either 27 mg of elemental iron as a ferrous bis-glycinate fully reacted amino acid chelate tablet or 567.6 mg ferrous glycine sulphate (providing 100 mg elemental iron), once daily for eight weeks.

Study Results
At the study close all haematological indices i.e. haemoglobin, hematocrit, MCV, MCHC, TIBC and ferritin were statistically higher in the ferrous bis-glycinate group compared to the ferrous iron sulphate group (P < 0.05). The cure rate was defined as an increase in haemoglobin higher than 11 g/dL. The cure rate for the bis-glycinate group was 89.2% versus 72.3% for the ferrous glycine sulphate group (P < 0.01). With regard to adverse events, these occurred at a significantly higher rate in the ferrous glycine sulphate group compared to the bis-glycinate group (P < 0.05).

Study Conclusions 
The authors conclude that ferrous bis-glycinate shows superior efficacy in increasing haemoglobin and serum ferritin than ferrous glycine sulphate in pregnant women with IDA. They recommend that bis-glycinate be considered for routine supplementation in pregnant women from the second trimester to prevent IDA developing in prone individuals.

InterClinical Comment:
This finding is consistent with other studies which show bis-glycinates perform with equal parity and at much lower doses than the standard treatment, ferrous sulphate. (3,4,5, ) 

References

1. Pasricha SR, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, Roger SD, Savoia HF, Tampi R, Thomson AR, Wood EM. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust. 2010 Nov 1;193(9):525-32.
2. Abbas A, A. Abdelbadee S, Alanwar A, Mostafa S. Efficacy of ferrous bis-glycinate versus ferrous glycine sulphate in the treatment of iron deficiency anemia with pregnancy: a randomized double-blind clinical trial. The Journal of Maternal-Fetal & Neonatal Medicine. 2018:1-61.
3. Milman N, Jønsson L, Dyre P, Pedersen PL, Larsen LG. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. Journal of perinatal medicine. 2014;42(2):197-206.
4. Ferrari P, Nicolini A, Manca ML, Rossi G, Anselmi L, Conte M, Carpi A, Bonino F. Treatment of mild non-chemotherapy-induced iron deficiency anemia in cancer patients: comparison between oral ferrous bisglycinate chelate and ferrous sulfate. Biomedicine & Pharmacotherapy. 2012;66(6):414-8.
5. Bagna R, Spada E, Mazzone R, Saracco P, Boetti T, Cester EA, Bertino E, Coscial A. Efficacy of Supplementation with Iron Sulfate Compared to Iron Bisglycinate Chelate in Preterm Infants. Current pediatric reviews. 2018 Jan 23.

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