Iron Infusion in pregnancy

An Intra Venous (IV) iron infusion is used to treat low levels of iron in the body (sometimes called iron deficiency anaemia).

What is an Iron Infusion and what is it used for?

Your doctor will offer an iron infusion if iron tablets have not worked or you struggle with side effects from iron tablets. Your doctor may offer an iron infusion if you need to build up your iron stores quickly.

Haemoglobin (Hb) is the part of your blood that carries oxygen around your body. In pregnancy Hb levels often naturally decrease.  Some women naturally have a lower or higher ‘normal’ level. Your body needs iron to form Hb.

Your Hb level is considered to be low if a blood test shows it is between 85 g/L and 110 g/L.  This is called iron deficiency anaemia.  Women with iron deficiency anaemia may be more likely to experience premature birth or have a baby who doesn’t grow as well as they should. Women with anaemia also have a higher chance of having heavier bleeding after birth and may be more likely to need a blood transfusion to replace the blood and iron stores that they lost. Research has found that being anaemic in the months after birth can be linked to an increased chance that women may struggle with their mental health, memory, concentration and decision making.

In some circumstances, an IV iron infusion is an option for people who do not consent to being treated with blood products for personal reasons.

When would an IV iron infusion not be advised?

  • During the first trimester of pregnancy, but it is proven to be safe after this time
  • If you have anaemia that is not caused by iron deficiency
  • If you have a history of an allergic reaction to intravenous iron preparations
  • A history of liver problems such as Cirrhosis

How is an IV iron infusion given?

If you decided to have this treatment the doctor will organise a date and time for you to come to the maternity unit.  An IV iron infusion will usually be administered on the maternity ward. You will need to allow approximately 1 to 2 hours for the appointment, although you could be with us for longer.  Please bear this in mind and bring some things to do.

The midwife will administer iron by an infusion (drip) into your vein. This means you will need to have a cannula in a vein, usually in the back of your hand.

The midwife will record your temperature, pulse, breathing rate and blood pressure before starting the infusion. These observations will be repeated every 15 minutes during the infusion and then 30 minutes after it is finished.  Keeping a close eye on your observations means the midwife can check to see all is well.

You will be asked to stay for 30 minutes after the infusion finishes so that the midwife can make sure you are feeling well.

Are there any side effects?

Side effects are uncommon. If they do occur they are usually mild and get better without the need for treatment. This includes allergic reactions.

Possible side effects include:

Common – may affect up to 1 in 10 people/9 in 10 people unaffected

Nausea, rash, or skin reactions at or near canula site e.g. redness, swelling, pain, bruising, or discolouration from leakage of the medication.

Uncommon – may affect up to 1 in 100 people/99 in 100 people unaffected

Flushing, itching and rashes, feeling sick, dizziness, increased heart rate, infection, headache, stomach upset, chest/back pain with shortness of breath. Muscle or joint aches can occur in the first few days but symptoms usually settle.

Rare – may affect up to 1 in 1000 people/999 in 1000 people unaffected

Irregular heartbeat, hoarseness, seizure, tremor, altered mental state.

If you experience any side effects or feel unwell or have any concerns at all during the treatment, please inform a midwife straightaway.  The staff are happy to help and support you – we encourage you to use your call bell if you would like to speak to a member of the team.

What follow up will I have?

Most women just need one iron infusion. The blood count usually takes about 2 to 3 weeks to improve so you will be asked to have your blood count checked by your community midwife after 3 and 4 weeks. If the iron infusion has occurred very close to your delivery date, or in the postnatal period, the GP will be asked to check your iron levels when he/she sees you for your postnatal check.

Although the infusion will take 2 to 3 weeks to reach its peak effect, women will respond differently.  The infusion is likely to have some effect on your iron levels quite soon after the infusion.

If your Hb levels are very low or birth is expected to happen soon you may be offered a blood transfusion rather than an iron infusion.  This is because a blood transfusion works more quickly, so if your Hb levels are so low that this might significantly impact on your health, a blood transfusion may be more appropriate.

What would happen if I decide I do not want an IV iron infusion?

You always have the choice to decline any aspect of care or treatments that you are offered.  If you decide not to have an IV iron infusion, the alternative choices your doctor would discuss with you would depend on how low your Hb level is, your individual circumstances and your preferences.

You can choose to do nothing

Your Hb may drop further, or may not. You may experience some effects of a low Hb, or not.  You may agree to have repeat blood tests at agreed intervals to check your Hb and identify if it does get lower, at which point you may choose to have an iron infusion, or not.

You can choose to decline an iron infusion but prefer another treatment option

You could discuss either increasing or changing oral iron medication, or if your Hb is quite low you might prefer a blood transfusion to an iron infusion.  We do try to avoid giving blood products if possible, however, if you prefer this you can discuss with your doctor.

You can choose to accept an IV iron infusion

You can choose to wait for a short time

You can choose to repeat your blood test and decide what you want to do when you have these results.

You can choose to think about your options at home and let us know what you decide over the following days.

What might happen if I choose to wait or delay treatment?

An IV iron infusion can take up to 3 weeks to have full effect.  Delaying treatment might mean that a longer period of time passes before your iron stores reach a higher level.

We would prefer your Hb to reach >100g/L before birth.  If it is lower you might be more likely to experience heavy bleeding after birth.  If this were to happen with an already low Hb your body may find it more difficult to cope with heavy blood loss and you may become more unwell.

What else can I do to help improve my Hb?

Regardless of whether you choose to have an iron infusion now or not, it is really important that you focus on increasing the iron in your diet by eating foods from the list below.  You should also try to increase your Vitamin C intake as Vitamin C improves iron absorption in your body.  Ensuring you eat enough protein can also help.

Everyone individually has a ‘maximum’ level of iron they can take into their body in any one day.

You should take iron tablets if you have been prescribed these.  If you have an IV iron infusion or blood transfusion the midwife will explain how and when to take your tablets.

Usually you are advised to take two or three tablets each day.  Take one with orange juice for Vitamin C and drink plenty of water every day.  Taking three tablets a day sometimes can make side effects more likely – the most common side effect is constipation so it is important to drink plenty of water.  If the side effects are difficult for you to manage please contact your midwife or doctor for advice.

We recommend you eat foods that have high iron levels to help as well.  Some foods contain more iron than others.  Some foods containing phytates (bran cereals) or tannins (tea and coffee) can make it difficult for your body to absorb iron.