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Is it safe to take iron injections during pregnancy?

Q: I am a 25 years old female. I am 23 weeks pregnant, with haemoglobin of 11 g/dl. My placenta is anterior low lying (3 cm from os) and am on bed rest. My doctor has asked to take an iron injection. Can you tell me the benefits and side effects of such injections? Does a low lying placenta entail a delivery by c-section. Please advise.

A:Treatment of most patients with iron deficiency is with oral iron therapy. The cheapest and most effective form is ferrous iron. The side effects experienced on taking iron tablet are proportional to the amount of iron available for absorption. The iron preparation you take should contain between 30-100 mg elemental iron. Avoid enteric-coated or prolonged-release preparations. The dose you take should be sufficient to provide between 150-200 mg elemental iron per day and the tablet may be taken 2 to 3 times a day about 1 hour before meals, preferably with a glass of juice (as vitamin C enhances iron absorption). Though ferrous sulphate is recommended to treat iron deficiency, often patients complain of gastrointestinal discomfort, bloating and other distress. Ferrous gluconate, which is roughly equivalent in cost, produces fewer problems, and is preferable as the initial treatment of iron deficiency. Polysaccharide-iron complex is another option. The polar oxygen groups in the polysaccharide form complexes with the iron atoms and the well-hydrated microspheres of polysaccharide iron remain in solution over a wide pH range. Most patients tolerate this form of iron better than the iron salts, even though the 150 mg of elemental iron per tablet is substantially greater than that provided by iron salts (50 to 70 mg per tablet). The treatment should be continued for 3 months after the haemoglobin has returned to normal so that the body iron stores are replenished. Response to treatment is confirmed by doing a reticulocyte count after 10-12 days of treatment and the rate of rise of haemoglobin (with adequate dose of iron) is about 1 g/dl per week. Take a normal nutritious diet and folic acid supplement twice a week. The use of injectable iron is restricted to only those patients in whom oral supplementation of iron is not possible or fails i.e. patients who are either unable to absorb oral iron or who have increasing anaemia despite adequate doses of oral iron. This form of therapy is more expensive and has greater morbidity than oral iron treatment. It has to be given carefully as it may leave stain marks on the skin akin to tattooing. Hypersensitivity reaction (anaphylaxis) can occur with it. Its other side effects include fever, nausea & vomiting, dizziness, disorientation, joint pains, chest pain, wheezing, breathlessness, pain in abdomen, delayed serum sickness and even respiratory arrest. Animal studies show that in high doses, injectable iron is teratogenic. The term used for a placenta close to the internal os of the cervix is placenta previa. It can be of several types - total (if it blocks the cervical opening), partial (partially covering the os) or marginal (placenta which approaches the border of the os). A placenta which is 2-3 cm from the os is referred to as a low-lying placenta. Migration of placenta is seen between 28-36 weeks of pregnancy. In case it does not migrate, then cesarean section is done. Please go by the advice of your treating doctor.

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