Iron Replacement Therapy with Ferric Maltol in Pregnancy

One of the most important; yet sometimes disregarded aspects of the massive physiological changes that occur during pregnancy is iron status.

Iron is necessary for the mother's health and the growth of the fetus, yet anemia is often the result of iron shortage in pregnant women.

A new iron replacement treatment called ferric maltol is showing promise as a remedy for this prevalent problem.

This piece explores the science underlying ferric maltol, its advantages, and how it contributes to a safe pregnancy.

Understanding Iron Deficiency Anemia in Pregnancy:

The rise in blood volume, tissue oxygenation, and baby growth and development all depend on iron, which is an essential nutrient during pregnancy.

As a result of the heightened need for iron during pregnancy, many women suffer from iron deficiency anemia, which is characterized by low hemoglobin levels and decreased iron reserves.

For the mother and the fetus, iron deficiency anemia can have serious repercussions. Weakness, exhaustion, and a higher chance of difficulties during pregnancy and labor are potential challenges for the mother.

A low birth weight and a higher chance of premature delivery might result from the fetus's growth and development being stunted by an iron defect.

Conventional Treatments for Iron Replacement:

Oral iron supplements have long been used to treat iron deficiency anemia in pregnancy.

Oral iron supplements, on the other hand, are frequently poorly tolerated and may result in gastrointestinal adverse effects such nausea, vomiting, and constipation.

For adults with iron deficiency anemia, the suggested daily intake of elemental iron is 120 mg over a time frame of three months; for children, the recommended daily dose is 3 mg per kg/day with a maximum of 60 mg.

After one month of treatment, an increase in hemoglobin levels of 1 g/ dL signifies a good therapeutic response, which confirms the diagnosis.

It suggested that individuals follow their treatment for a further three months after their anemia has been corrected in order to help their pools of iron refill.

Gastrointestinal side effects, including nausea, diarrhea, constipation, and epigastric discomfort, might make it difficult for patients to adhere to oral iron therapy.

Iron supplementation with meals may eliminate these effects, but it can also reduce absorption by as much as 40%.

Also, lower absorption of dietary iron and iron supplementation is linked to disorders producing reduced gastric acid output, such as chronic atrophic gastritis or previous gastrectomy, and drugs such as inhibitors of proton pumps.

Furthermore, there may be restrictions on the amount of iron that may be absorbed from oral supplements, particularly in women who have gastrointestinal issues or other illnesses that impact iron absorption. 

For patients - particularly those who have undergone bariatric surgery, post-gastrectomy, gastrojejunostomy or other small intestine surgeries—who are unable to accept or absorb oral iron, parenteral therapy provides an alternative.

Between 1976 and 1996, there were 31 recorded deaths as a result of serious adverse events, which could affect up to 0.7% of patients receiving iron dextran.

For example, moderate side effects like as headache, nausea, or diarrhea affect about 35 percent of patients on iron sucrose.

Because iron dextran can be given in its whole in a single session, larger trials may favor it over sodium ferric gluconate, even if a small research revealed one serious adverse event in the iron dextran group.

Compared to conventional oral iron supplements, ferric maltol is a unique iron replacement therapy that has various advantages.

Iron Deficiency in Pregnancy: A Different Approach with Ferric Maltol

Trimaltol, a naturally occurring sugar derivative present in a wide variety of fruits and vegetables, is paired with stable ferric Fe3+ to create ferric maltol (FM), a non-salt iron supplement.

The complex's goal is to minimize adverse effects on the gastrointestinal tract while optimizing iron absorption.

Iron is transferred to transferrin, a transport protein, and ferritin, a storage protein, via the systemic circulation after the complex dissolved into the gut.

Unlike ferrous (Fe2+) iron found in iron salts, ferric (Fe3+) iron found in FM has been shown to be less harmful to the mucosa of the gastrointestinal tract.

Ferric maltol's special structure permits iron to be released under controlled conditions in the small intestine, the site of iron absorption.

Without requiring large iron dosages, this regulated release method makes sure that a larger percentage of the iron is absorbed, improving iron status.

Ferric maltol has also been demonstrated to have little adverse effects on the gastrointestinal tract and high tolerance.

This is especially crucial during pregnancy, as digestive distress can worsen pre-existing conditions like nausea and vomiting.

At the moment, ACCRUFeR oral 30 mg capsules are frequently used by individuals with iron deficiency.

Clinical Data in Support of Ferric Maltol

Ferric maltol has been shown in numerous clinical trials to be both safe and effective in treating iron deficiency anemia in pregnant women.

In one study Pregnant patients with iron deficiency anemia received either Ferric Maltol or a placebo for a duration of 12 weeks in a randomized controlled study.

The outcomes demonstrated that, in comparison to a placebo, ferric maltol considerably raised hemoglobin levels and iron reserves while having no discernible negative effects.

The outcomes shown that ferric maltol had a decreased frequency of gastrointestinal adverse effects while being just as successful in enhancing iron status as ferrous sulphate.

Research has shown that FM can successfully treat the anemia linked to IDA by raising serum iron parameters including ferritin and transferrin saturation.

An investigation into the efficacy and treatment adherence of oral iron poly-maltose complex versus oral ferrous sulfate for treating iron deficiency anemia (IDA) in pregnant women was performed.

It revealed that the former produced higher improvements in serum ferritin and hemoglobin levels than the latter, and it also showed a lower rate of side effects.

In a nutshell; during pregnancy, iron deficiency anemia is a frequent problem that can have serious consequences for both the mother and the fetus.

Compared to conventional oral iron supplements, ferric maltol is a unique iron replacement therapy that has enhanced absorption and tolerance.

Ferric maltol is a potentially beneficial treatment option for pregnant women who require iron supplementation, as clinical evidence supports its safety and efficacy in treating iron deficiency anemia during pregnancy.