Letters
Volume 48, Issue 10, October 2019

October correspondence


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The opinions expressed by correspondents in this column are not endorsed by the editors or The Royal Australian College of General Practitioners.

Lactoferrin and iron deficiency anaemia in pregnancy

I thank Dr Frayne and Clinical Nurse Consultant Pinchon for their review of anaemia in pregnancy (AJGP March 2019).1 A significant barrier to treatment of iron deficiency anaemia (IDA) in pregnancy is that up to 70% of women have significant gastrointestinal intolerance to oral iron preparations, resulting in non-adherence with therapy in up to 50% of women.2–5 Iron infusions are currently not recommended in the first trimester of pregnancy because of uncertainty regarding teratogenicity.

Lactoferrin is an iron-binding multifunctional cationic glycoprotein secreted by exocrine glands and neutrophils. It is present in large quantities in colostrum and breast milk. In addition to its iron-binding properties, lactoferrin also has antimicrobial, immunomodulatory, anti-inflammatory and anticancer activity. A systematic review and meta-analysis of four studies (600 women in total) found that four weeks’ treatment with daily oral lactoferrin was as effective as daily oral ferrous sulphate in improving haematological parameters in pregnant women with IDA.6 A randomised controlled trial comparing treatment of IDA with intravenous iron dextran, and treatment with twice daily oral lactoferrin together with health education from a nurse regarding IDA, found no statistical difference in improvement in haemoglobin concentration after four weeks, though there was a significantly greater improvement in iron indices with lactoferrin.7

In conclusion, oral lactoferrin may be a useful alternative in the management of IDA in pregnant women who are intolerant of oral iron supplements and who do not wish to receive parenteral iron therapy.

 

Adam Morton
Senior Staff Specialist,
Obstetric Medicine,
The University of Queensland
and Mater Health, Qld

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References
  1. Frayne J, Pinchon D. Anaemia in pregnancy. Aust J Gen Pract 2019;48(3):125–29. Search PubMed
  2. Auerbach M, James SE, Nicoletti M, et al. Results of the first American prospective study of intravenous iron in oral iron-intolerant iron-deficient gravidas. Am J Med 2017;130(12):1402–07. doi: 10.1016/j.amjmed.2017.06.025. Search PubMed
  3. Souza AI, Batista Filho M, Bresani CC, Ferreira LO, Figueiroa JN. Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials. Cad Saude Publica 2009;25(6):1225–33. doi: 10.1590/S0102-311X2009000600005. Search PubMed
  4. Triharini M, Nursalam N, Sulistyono A, Adriani M, Armini NKA, Nastiti AA. Adherence to iron supplementation amongst pregnant mothers in Surabaya, Indonesia: Perceived benefits, barriers and family support. Int J Nurs Sci 2018;5(3):243–48. doi: 10.1016/j.ijnss.2018.07.002. Search PubMed
  5. Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: A systematic review and meta-analysis. PLoS One 2015;10(2):e0117383. doi: 10.1371/journal.pone.0117383. Search PubMed
  6. Abu Hashim H, Foda O, Ghayaty E. Lactoferrin or ferrous salts for iron deficiency anemia in pregnancy: A meta-analysis of randomized trials. Eur J Obstet Gynecol Reprod Biol 2017;219:45–52. doi: 10.1016/j.ejogrb.2017.10.003. Search PubMed
  7. Darwish AM, Fouly HA, Saied WH, Farah E. Lactoferrin plus health education versus total dose infusion (TDI) of low-molecular weight (LMW) iron dextran for treating iron deficiency anemia (IDA) in pregnancy: A randomized controlled trial. J Matern Fetal Neonatal Med 2018:32(13):2214–20. doi: 10.1080/14767058.2018.1429396. Search PubMed

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