Ferric Carboxymaltose Boosts Hemoglobin and Cuts Transfusion Needs in Twin Pregnancies: Study Finds
Australia: A decade-long study conducted at a single center in Australia has demonstrated that intravenous ferric carboxymaltose (FCM) is a safe and effective option for treating iron deficiency in twin pregnancies. Published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, the research led by Dr. Anna A. Wawer from the Northern Adelaide Local Health Network highlights the promising role of FCM in improving maternal outcomes and reducing the need for donor blood transfusions.
The study, conducted between 2013 and 2023, retrospectively examined 119 women carrying twins who received intravenous FCM during their pregnancies. The researchers observed that iron demand in twin pregnancies is nearly double that of singleton pregnancies, and the prevalence of anemia is four times higher. Given this significant need, the researchers aimed to evaluate the efficacy and safety of intravenous iron therapy in this unique population.
The key findings include the following:
- Ferric carboxymaltose (FCM) administration led to significant increases in hemoglobin (Hb) levels across all anemia severity groups in twin pregnancies.
- Women with severe anemia showed the highest mean Hb increase of 21.6 g/L after infusion.
- Moderate and mild anemia groups recorded mean Hb increases of 13.4 g/L and 11.0 g/L, respectively.
- Even women without anemia experienced a mild but beneficial rise in Hb levels.
- The treatment was well-tolerated, with no serious adverse events reported.
- Higher post-infusion Hb levels were associated with shorter hospital stays, indicating improved maternal recovery.
- Intraoperative cell salvage and autologous transfusion techniques were utilized, especially during cesarean sections, to support blood management.
- These strategies significantly reduced the need for allogeneic red blood cell transfusions.
- Of the 119 participants, only 17 required red blood cell transfusions.
- Among them, just five received allogeneic transfusions, while twelve underwent autologous reinfusion using their own salvaged blood.
The study supports the integration of intravenous FCM with advanced obstetric patient blood management (PBM) strategies to optimize care in twin pregnancies. According to the authors, this combination effectively prevented postpartum anemia and reduced dependency on donor blood, addressing both safety and resource utilization.
While the retrospective nature of the study poses some limitations, such as the absence of a formal power calculation, the findings still offer compelling real-world evidence. The research stands as one of the largest reports of its kind and emphasizes the importance of proactive iron management in high-risk twin pregnancies.
"Intravenous ferric carboxymaltose has emerged as a vital tool in antenatal care for women expecting twins, improving hemoglobin levels, minimizing transfusion needs, and enhancing overall maternal outcomes," the authors concluded.
Reference:
Wawer, A. A., Lambrakis, A., White, K., Sinha, R., Dekker, G., & Froessler, B. (2025). Ferric carboxymaltose for iron deficiency in twin pregnancies: A single center 10-year retrospective longitudinal pre-post study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 114084. https://doi.org/10.1016/j.ejogrb.2025.114084
