Ferrous Succinate

Iron-deficiency anemia is the most common hematologic disorder in pregnancy. Slow iron repletion, poor gastrointestinal tolerance, and late presentation during gestation often limit the effectiveness of oral ferrous salts, which remain the traditional first-line treatment. Intravenous iron offers faster iron delivery, but its role in routine antenatal care remains uncertain, particularly regarding its long-term safety and cost-effectiveness compared to traditional oral iron treatments. This qualitative systematic review included 10 randomized controlled trials published within the last decade that enrolled pregnant women with iron-deficiency anemia or persistent iron deficiency (defined, where applicable, as ferritin <30 μg/L after approximately four weeks of oral iron therapy) and compared intravenous iron with oral iron or one intravenous formulation with another. Across the included trials, intravenous iron generally produced more rapid ferritin replenishment and, in many studies, a faster rise in hemoglobin than oral therapy. Oral ferrous preparations were associated with more gastrointestinal adverse effects; for example, in one study, gastrointestinal treatment-related events were reported in more women receiving oral ferrous sulfate versus those receiving ferric carboxymaltose. In another trial, nausea/vomiting occurred in greater number of oral-iron recipients versus intravenous ones, while constipation and epigastric discomfort were reported only in the oral group. By contrast, serious intravenous treatment-related events were uncommon in the larger trials.​ ​Smaller and medium-sized trials generally favored parenteral iron for hematologic recovery, but the largest pragmatic studies from India, Malawi, and Nigeria showed that biochemical superiority did not consistently translate into lower rates of late-pregnancy anemia or improved major maternal and neonatal outcomes. One head-to-head intravenous trial also suggested practical and hematologic advantages of ferric carboxymaltose over iron sucrose. From a hematology perspective, intravenous iron appears most useful when rapid restoration of iron stores is needed, when adherence to oral therapy is doubtful, or when little time remains before delivery. Future trials should standardize ferritin-based diagnostic criteria, clearly distinguish hematologic from obstetric endpoints, and better define which patients are most likely to derive clinically meaningful benefit from parenteral iron.

This study investigates the causal relationship between genetically proxied iron-supplement drugs and inflammatory bowel disease (IBD) risk. After identifying 8 commonly used iron supplementation drugs based on the guidelines, a search for each of these drugs yielded 18 key regulatory targets and the locus information of each drug-targeted gene was obtained. Hemoglobin was selected as a biomarker downstream of drug regulation and its single nucleotide polymorphism (SNP) data were extracted and screened from genome-wide association studies (GWAS). Strict screening conditions were set to obtain valid SNPs information for each drug-target gene from hemoglobin downstream marker information. We successively included European and Asian populations in our analyses. The SNP information of IBD, ulcerative colitis (UC) and Crohn disease (CD) were extracted from the GWAS database as the outcome variables. The bidirectional and multivariate Mendelian randomization was performed between each target gene and each outcome variable, and the robustness of these results was validated using heterogeneity tests, horizontal pleiotropy tests, and leave-one-out methods. Data from 34,652 patients with IBD, 417,932 patients with UC, 20,883 patients with CD, and 408,112 individuals with hemoglobin measurement were analyzed. Genetically proxied Egl nine homolog 1 (EGLN1) was associated with increased IBD, UC and CD risk. Genetically proxied Flap Endonuclease 1 (FEN1) was associated with an increased risk of IBD and CD. Genetically proxied Ferritin heavy chain 1 (FTH1) and Transferrin receptor 2 (TFR2) were associated with an increased risk of CD. Genetically proxied DNA polymerase beta (POLB) was associated with a reduced risk of CD. Sensitivity analyses of them did not provide statistical evidence of serious bias. The reverse Mendelian results showed a positive result between IBD and EGLN1, meaning that there is a bidirectional causal relationship between the 2. Upon inclusion of the Asian ethnic cohort, potential causal associations were found between EGLN1, FEN1, Integrin, beta 3 (ITGB3), Transferrin receptor gene (TFRC) and UC, inverse Mendelian analyses showed a causal relationship between POLB and CD. This study suggests that target genes such as EGLN1, FEN1, ITGB3, TFRC, FTH1, and POLB are potentially associated with the pathogenesis of inflammatory bowel disease.