Ferric carboxymaltose for iron deficiency in twin pregnancies: A single center 10-year retrospective longitudinal pre-post study

Abstract

Background

Iron demand is almost double and anemia prevalence four times higher in twin pregnancy. There is limited information on the impact of antenatal intravenous iron (IVI) on maternal hemoglobin in women pregnant with twins.

Objective

The main objective was to assess the safety and efficacy of IVI in twin pregnancy. The secondary objective was to analyze the impact of intraoperative cell salvage as an additional Patient Blood Management (PBM) tool.

Study Design

Single center retrospective longitudinal pre-post study of all women, pregnant with twins, receiving intravenous Ferric Carboxymaltose (FCM) between 2013 and 2023.

Results

One hundred nineteen women were included in the analysis. Mean ferritin values prior infusion was 10.9, 12.9, 15.3, and 15.4 µg/L in the severe, moderate, mild and no anemia group respectively. Post infusion mean hemoglobin increased by 21.6 g/L, 13.4 g/L, 11.0 g/L, and 6.8 g/L in the respective groups. No serious adverse events were reported. Forty-four (36.9 %) suffered a postpartum hemorrhage (mean blood loss 1278 ml). Seventeen women received red blood cells. Five had an allogeneic transfusion whereas twelve had cell salvaged autologous re-infusion. Post IVI hemoglobin was negatively correlated with length of stay.

Conclusions

We observed a significant increase in antenatal hemoglobin and restored iron status in twin pregnancies in response to IVI. Low allogeneic red blood cell transfusion rates were achieved by combining iron infusion with the utilization of cell salvage technology and autologous reinfusion as part of our Obstetric PBM approach.