Ferric maltol suitable and convenient treatment option for Iron deficiency anemia during pregnancy: Study

During pregnancy, IDA is defined as hemoglobin levels below 11 g/dL in the first and third trimesters, and below 10.5 g/dL in the second trimester. Increased iron requirements during pregnancy, necessary for maternal blood volume expansion and fetal growth, make diagnosing IDA challenging. Complications of IDA during pregnancy include premature birth, intrauterine developmental retardation, and diminished newborn iron storage. Managing IDA during pregnancy is crucial due to associations with conditions like autism, abnormal brain structure, and schizophrenia in offspring.

During pregnancy, the demand for iron triples to support fetoplacental development and maternal adaptation. Dietary modifications focusing on increased intake of iron-rich foods and interventions improving iron absorption are crucial. Daily iron requirements rise from 4 to 6 mg/day in the second trimester to 10 mg/day in the last half of the third trimester. Thus, daily or intermittent oral supplementation is necessary to prevent IDA.

Recognizing the unmet need for effective and well tolerated treatments for iron deficiency anemia during pregnancy, there is a push for alternative oral iron therapies that match the efficacy of IV iron therapy while offering the convenience of oral administration. New formulations, including ferric maltol, ferric citrate, polysaccharide–ferric iron complexes, sodium feredate, and sucrosomial iron, aim to address this need by potentially improving bioavailability and reducing the risk of gastrointestinal side effects. One such alternative is ferric maltol (FM), a novel oral iron formulation designed to enhance the gastrointestinal absorption and tolerability of oral iron. FM, composed of iron in the stable ferric (Fe3+) state complexed with trimaltol, a naturally occurring sugar derivative, is a promising option for effective and convenient treatment of iron deficiency and iron-deficiency anemia. The ferric and trimaltol complex remains strongly chelated in the intestinal lumen until absorption, minimizing the risk of gastrointestinal toxicity. FM is available for treating iron deficiency in adults, with or without anemia, across diverse populations, including those with conditions like inflammatory bowel disease (IBD), chronic kidney disease (CKD), and pulmonary hypertension.

In cases of mild-to-moderate anemia, ferric maltol may serve as a viable oral treatment option when individuals either cannot tolerate ferrous preparations or experience suboptimal efficacy after four weeks of treatment. For moderate anemia, especially in patients with gastrointestinal intolerance to oral ferrous iron, intravenous iron stands out as the preferred treatment. In the maintenance therapy of iron deficiency anemia (IDA), ferric maltol could play a significant role in sustaining the benefits achieved through intravenous therapy. This form of treatment ensures an adequate supply of iron to meet the body’s erythropoietic needs, thereby reducing the reliance on blood transfusions or erythropoiesis-stimulating agents. Additionally, ferric maltol helps minimize the amount of free iron in the intestinal tract, reducing the risk of damage to the gut microbiome and preventing the exacerbation of underlying gastrointestinal diseases.

Ferric maltol (FM) has demonstrated the ability to elevate serum iron parameters, including ferritin and transferrin saturation (TSAT), effectively addressing anemia associated with iron deficiency, especially during pregnancy. Its potential advantages encompass improved iron absorption, minimized gastrointestinal side effects, and a decreased dosage necessity. Furthermore, FM facilitates the absorption of iron through the intestinal wall and its subsequent transfer to transferrin and ferritin. This makes it a relatively safe and efficient oral iron therapy, potentially more tolerable than alternative oral iron formulations

Clinical studies have consistently demonstrated the effectiveness and efficacy of ferric maltol as an oral treatment for iron deficiency and anemia in patients with various conditions, including IBD, CKD, and pulmonary hypertension. Ferric maltol has shown significant and sustained improvements in hemoglobin levels and iron status, with good tolerance throughout the treatment duration. These studies suggest that ferric maltol is an effective and convenient treatment option for individuals who seek long-term, well-tolerated management of iron deficiency anemia, irrespective of the underlying condition.

The research highlights the importance of a healthy diet and iron supplementation before or at the beginning of pregnancy. Ferric maltol offers a convenient alternative to oral treatment, potentially reducing the need for intravenous iron therapy for iron deficiency anemia during pregnancy. Clinical trials have consistently demonstrated the effectiveness of ferric maltol in diverse settings, including IBD, CKD, and pulmonary hypertension, making it a suitable option for long-term, well-tolerated management of iron deficiency anemia, especially for patient’s intolerant to other oral treatments or noncompliant with intravenous therapy

Source: Zinzuwadiya, Modi and Dhande / Indian Journal of Obstetrics and Gynecology Research 2024;11(2):147–151; https://doi.org/10.18231/j.ijogr.2024.031