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BMJ Open. 2012; 2(5): e000998.
Published online Oct 18, 2012. doi:  10.1136/bmjopen-2012-000998
PMCID: PMC3488743
Three-year follow-up of a randomised clinical trial of intravenous versus oral iron for anaemia in pregnancy
Alhossain A Khalafallah,1,2,3 Amanda E Dennis,2,3,4 Kath Ogden,2 Iain Robertson,3 Ruth H Charlton,1,2,4 Jackie M Bellette,1,2,4 Jessica L Shady,1,2,4 Nep Blesingk,1,2 and Madeleine Ball3
1Department of Medicine and Clinical Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
2Clinical School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
3School of Human Life Sciences, University of Tasmania, Launceston, Tasmania, Australia
4Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston,Tasmania, Australia
Correspondence to Dr Alhossain A Khalafallah; khalafallah/at/dhhs.tas.gov.au
Received February 11, 2012; Accepted September 4, 2012.
Abstract
Background
To date, there are no data available concerning the impact of iron therapy on the long-term well-being and health-related quality of life (HRQoL) in pregnancy.
Objective
To assess the long-term effect of iron therapy on HRQoL in pregnancy.
Design
This is a follow-up study conducted between January 2010 and January 2011 of an earlier randomised open-label clinical trial of intravenous and oral iron versus oral iron for pregnancy-related iron deficiency anaemia. We used a modified version of the SF-36 questionnaire together with the original prospective HRQoL data collected during and after pregnancy.
Participants and interventions
Of the original evaluable 183 pregnant Caucasian women randomised to receive oral iron or a single intravenous iron polymaltose infusion followed by oral iron maintenance, 126 women completed the follow-up HRQoL study.
Methods
The participants were followed up 4 weeks after treatment, predelivery and postdelivery for a median period of 32 months (range, 26–42) with a well-being and HRQoL questionnaire using a modified SF-36 QoL-survey and child growth charts as set by the Australasian Paediatric Endocrine Group (APEG).
Results
Patients who received intravenous iron demonstrated significantly higher haemoglobin and serum ferritin levels (p<0.001). There were strong associations between iron status and a number of the HRQoL parameters, with improved general health (p<0.001), improved vitality (physical energy) (p<0.001), less psychological downheartedness (p=0.005), less clinical depression (p=0.003) and overall improved mental health (p<0.001). The duration of breastfeeding was longer (p=0.046) in the intravenous iron group. The babies born in both groups recorded similarly on APEG growth chart assessments.
Conclusions
Our data suggest that HRQoL is improved until after pregnancy in anaemic pregnant women by repletion of their iron stores during pregnancy. About 80% of the intravenous iron group showed a maintained normal ferritin until delivery with long-term benefits. Further studies to confirm these findings are warranted.
Keywords: Qualitative Research
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