• Correction of iron deficiency in pregnant women with congenital heart defects, heart failure and anaemia

Correction of iron deficiency in pregnant women with congenital heart defects, heart failure and anaemia

PERINATOLOGY AND PEDIATRIC. UKRAINE. 2018.3(75):31-34; doi 10.15574/PP.2018.75.31

Ogorodnyk A. O., Limanskaya А. Yu., Butenko L. P., Davydova Iu. V.
SI Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine, Kyiv

Objective: to improve treatment of iron deficiency anaemia in pregnant women of high cardiac risk.

Materials and methods. The study included 73 pregnant women with congenital heart defects (CHD) associated with heart failure (HF) and anaemia. When the haemoglobin level was above 95 g/L and the estimated delivery date more than 40 days from the treatment onset, the oral iron (II) preparations were administered to pregnant women. When the haemoglobin level was below 95 g/L, in order to correct anaemia, the iron sucrose was administered in parenteral solution in the event of abdominal delivery suggested with the succeeding transition to the oral iron (II) preparations before and after delivery.

Results. The use of a stepwise treatment regimen with intravenous and oral iron preparations contributed to the iron depot normalization, in contrast to the exclusively oral iron preparations administration, and stabilizing the condition of women as well as. All pregnants who received treatment according to the developed algorithm did not have the perinatal losses, childbirth in term less than 28 gestation weeks or Apgar score lower than 5 points at birth.

Conclusions. Stabilization of pregnant women's condition with CHD, HF and anaemia due to the lack of HF progression, normalization of iron metabolism and avoidance of obstetric complications and perinatal losses prove the efficacy of stepwise antianaemic therapy using the intravenous iron and oral iron (Fe II) in pregnant women of high cardiac risk.

Key words: pregnancy, congenital heart defects, anaemia, heart failure.

References

1. Davydova IuV, Apresova KT, Ogorodnyk АА et al. (2013). Crucial approaches to diagnostics and anaemia treatment in pregnant women with heart failure at the extragenital pathology clinic. Reproduktivnaya endokrinologiya. 6(14): 32–35.

2. Davydova Iu., Zadorozhna T., Butenko L., Limanskaya A., Ogorodnyk A., Mokrik A. (2016). Prevention of hypoxic fetal complications in pregnant women with congenital heart disease and anemia. Perinatologiya i pediatriya. 2: 43–48. doi 10.15574/PP.2016.66.43

3. Davydova IuV, Limanskaya AYu, Ogorodnyk АO. (2013). Zhelezodefitsitnaya anemiya v XXI veke: ionnyie i neionnyie preparatyi zheleza, prakticheskie rekomendatsii dlya beremennyih. Health of woman. 3(79): 25–29.

4. Cohen-Solal A, Damy T, Terbah M et al. (2014). High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur J Heart Fail. 16(9): 984–91. https://doi.org/10.1002/ejhf.139.

5. Drozd М, Jankowska EA, Banasiak W, Ponikowski Р. (2017). Iron therapy in patients with heart failure and iron deficiency:review of iron preparations for practitioners.Am J Cardiovasc. Drugs. 17(3): 183–201. doi 10.1007/s40256-016-0211-2.

6. Jankowska EA, Kasztura M, Sokolski M et al. (2014). Iron deficiency defined as depleted iron stores accompanied by unmet cellular iron requirements identifies patients at the highest risk of death after an episode of acute heartfailure. Eur Heart J. 35(36): 2468–76. https://doi.org/10.1093/eurheartj/ehu235.

7. Jankowska EA, Rozentryt P, Witkowska A et al. (2010). Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J. 31(15): 1872–80. https://doi.org/10.1093/eurheartj/ehq158.

8. Kaldara-Papatheodorou EE, Terrovitis JV, Nanas JN. (2010). Anemia in heart failure: should we supplement iron in patients with chronic heart failure? Pol Arch Med Wewn. 120(9): 354–60. PMid:20864909

9. Nunez J, Comin-Colet J, Minana G et al. (2016). Iron deficiency and risk of early readmission following a hospitalization for acute heart failure. Eur J Heart Fail. 18(7): 798–802. https://doi.org/10.1002/ejhf.513.

10. Nunez J, Dominguez E, Ramon JM et al. (2016). Iron deficiency and functional capacity in patients with advanced heart failure with preserved ejection fraction. Int J Cardiol. 207: 365–7.

https://doi.org/10.1016/j.ijcard.2016.01.187.

11. Yeo TJ, Yeo PSD, Ching-Chiew Wong R et al. (2014). Iron deficiency in a multi-ethnic Asian population with and without heart failure: prevalence, clinical correlates, functional significance and prognosis. Eur J Heart Fail. 16(10): 1125–1132. https://doi.org/10.1002/ejhf.161.

Article received: Jul 18, 2018. Accepted for publication: Sep 12, 2018.