756 - Association between maternal hematologic parameters and risk of pregnancy loss in pregnancies treated for iron deficiency anemia

Publication Number: 756.3892

Rupsa Boelig, Thomas Jefferson University, Philadelphia, PA, United States; Simal Thind, Thomas Jefferson University, Philadelphia, PA, United States; Mrutyunjaya B. Bellad, KAHER’s JN Medical College Belgaum, Belgaum, Karnataka, India; Manjunath S. Somannavar, KLE Academy of Higher Education and Research JN Medical College, Belagavi, Karnataka, India; S Yogeshkumar, J.N.Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India; Benjamin E. Leiby, Thomas Jefferson University, Philadelphia, PA, United States; Rebecca Hartman, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Zubair H. Aghai, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Praveen Patil, Raichur Institute of Medical Sciences, Raichur, Raichur, Karnataka, India; Chander Shekhar, Thomos Jefferson University, New York, NY, United States; Umesh Y. Ramadurg, S Nijlingappa Medical College, Bagalkote, Karnataka,India, Bagalkote, Karnataka, India; Richard Derman, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Michael K. Georgieff, University of Minnesota, St. Paul, MN, United States

Background: Maternal anemia and iron deficiency have been associated with adverse pregnancy outcomes. It is unclear how treatment response mitigates those risks.

Objective: Evaluate the relationship between maternal ferritin and hemoglobin 4 weeks after treatment for iron deficiency anemia and pregnancy loss and low birth-weight (LBW) infants. This is secondary analysis of a multi-center randomized trial, on behalf of the RAPIDIRON Trial Group.

Design/Methods: This is a secondary analysis of a multi-center randomized controlled trial in India that compared single dose intravenous iron to oral iron for the management of moderate iron deficiency anemia (Hb 7.0-9.9g/dL) in the early second trimester (14-17 weeks gestation). The primary outcome for this secondary analysis was pregnancy loss/stillbirth, the primary predictor was maternal ferritin measured at 20-24 weeks (~4 weeks after treatment initiation). The secondary predictors evaluated were maternal hemoglobin and total iron saturation at 20-24 weeks; secondary outcome evaluated was LBW.

Results: In the primary trial, 4,368 participants were included in the intention to treat analysis. The incidence of pregnancy loss was 2.7% (113/4249) and of low birthweight was 27.9% (1153/4136). In unadjusted analyses, maternal Hb at 20-24 weeks following initiation of treatment for moderate IDA was significantly associated with reduced risk of pregnancy loss (Table 1, Figure 1). Similar trend was seen for ferritin (log corrected), although it did not reach statistical significance. Iron saturation did not appear to be associated with either outcome (Table 1). Relative risk estimates for both pregnancy loss and LBW were similar when adjusting for baseline ferritin and hemoglobin, as well as study site (Table 2).

Conclusion(s): Early improvement in maternal hematologic parameters for pregnant patients with moderate IDA may reduce the risk of pregnancy loss/stillbirth. These results have important implications for timing and potential benefits of treatment of maternal IDA.

Table 2: Adjusted Relative Risk of Adverse Pregnancy Outcome Based on Maternal Response to Treatment of Moderate Iron Deficiency Anemia
Log-adjusted ferritin, hemoglobin, and iron saturation (TSAT) as predictors of pregnancy loss/stillbirth and low birthweight infants. Hematologic parameters were assessed at 20-24 weeks following initiation of treatment for moderate iron deficiency anemia at 14-17 weeks. Model was adjusted for 1) baseline ferritin, hemoglobin, or TSAT respectively and 2) baseline ferritin, hemoglobin, or TSAT and study site

Maternal hemoglobin and ferritin through pregnancy in patients treated for moderate iron deficiency anemia with and without an outcome of pregnancy loss or stillbirth
Hemoglobin (A) and Ferritin (B) at baseline pre-treatment (12-16 weeks), and after treatment (>20 weeks) in those who ultimately did or did not suffer a pregnancy loss or stillbirth.