AIM
To assess the impact of iron deficiency conditions on pregnancy and its outcomes based on the analysis of real clinical practice data, and to determine the economic feasibility of timely correction of iron deficiency anaemia (IDA) in pregnant women with modern iron preparations.
MATERIAL AND METHODS
Within the framework of this study, we analyzed the primary documentation of 440 patients observed in three regions of the Russian Federation. The peculiarities of the course and management of pregnancy and its outcomes in patients depending on the presence and severity of iron deficiency (ID) were analyzed. We evaluated the cost-effectiveness of diagnostics and correction of IDA ferric carboxymaltose in the presence of indications, taking into account its effect on the cost of in-hospital therapy for complicated pregnancy, blood transfusions, and the patient’s stay in the intensive care unit (ICU).
RESULTS
The mean age of the pregnant women was 29 years (95% CI 25 to 33 years), and 30.9% were diagnosed with anaemia in the first trimester of pregnancy. At the time of discharge after delivery, 55.5% of the patients had unadjusted IDA: the median haemoglobin at discharge was less than 100 g/l. An analysis of diagnostic approaches to the detection of IDA showed that diagnosis is based only on haemoglobin levels, and ferritin levels were determined in a limited number of patients. Of those admitted for delivery with a diagnosis of anaemia, in 22.5% of cases it was recorded throughout all three trimesters. Anaemia of moderate severity was diagnosed in 11% of pregnant women and severe anaemia in 3%, with Hb concentration below 100 g/l in 58.3% of women immediately before delivery. It has been shown that IDA is a risk factor for complicated pregnancy, threatened termination of pregnancy, complications of labour and postpartum haemorrhage, and is associated with a higher frequency of perinatal haemotransfusions. The duration of hospitalisation was statistically significantly longer in the presence of severe anaemia, and the length of stay in the ICU was longer in the presence of severe and moderate anaemia. Adequate correction of anaemia resulted in a 12.4% reduction in the risk of threatened termination of pregnancy, while the use of ferric carboxymaltose resulted in a statistically significant 11.1% (95% CI –0.016; –0.206) reduction in the risk of postpartum haemorrhage and a 13.8% (95% CI –0.044; –0.232) reduction in the volume of blood loss. Adequate prenatal correction of severe IDA in 100 patients will reduce the need for postpartum transfusions, the duration of stay in hospital and ICU, as well as the frequency of hospitalisations due to complicated pregnancy, thus eliminating additional healthcare costs by RUB 2.74 million. These savings fully cover the cost of adequate diagnosis and treatment of IDA.
CONCLUSION
The actual practice of management of patients with iron deficiency anaemia differs significantly from clinical recommendations. The problem of iron deficiency anaemia in pregnant and postpartum women, its adverse impact on the course and outcomes of pregnancy, clinical inertness, use of irrational drugs for correction, such as iron preparations for intramuscular administration, and deficiencies in diagnostic approaches to detecting this condition are still acutely relevant. Adequate and timely correction of iron deficiency anaemia not only leads to improved clinical outcomes of pregnancy but is also a cost-effective technology that helps to reduce the costs of the health care system.
