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IRON OVERDOSE IN PREGNANCY

Date of issue: January 2024, Version: 2.2

Please note, this document relates only to iron overdose in pregnancy and not therapeutic use of iron supplements.

SUMMARY: Iron is an essential mineral necessary for the formation of red blood cells. Iron toxicity can result in a range of symptoms, such as gastrointestinal disturbances, metabolic acidosis, hypovolaemic shock, and organ failure.

Published data and data collected by UKTIS on iron overdose in pregnancy are limited to case reports and small case series amounting to <100 exposed pregnancies, with the majority of exposures occurring after the first trimester. The very limited data, from around five cases of first trimester iron overdose, do not provide any signal of an increased risk of malformation but are too limited to perform an accurate assessment of risk.

Maternal toxicity is likely to be a major predictor of fetal outcome. There are currently no published guidelines on the treatment of iron overdose in pregnancy. Iron overdose can be fatal; therefore, treatment of the mother should be as for the non-pregnant patient. Data regarding the use of desferrioxamine during pregnancy, though limited, currently provide no signal that desferrioxamine is harmful to the fetus. Desferrioxamine, when indicated, should not be withheld on account of the pregnancy. For current UK guidelines regarding treatment of iron overdose please refer to TOXBASE.

There are no epidemiological studies reporting on rates of outcomes, such as miscarriage, stillbirth, neonatal problems, low birth weight, or preterm delivery following maternal iron overdose with or without desferrioxamine treatment in pregnancy but the limited data available suggest that timely and adequate treatment of maternal toxicity as for the non-pregnant patient mitigates the risk of these adverse outcomes. Effects on longer term infant neurodevelopment have not been studied and many reports relate to infant outcome shortly after birth.

When iron overdose is associated with maternal toxicity, enhanced fetal monitoring may be warranted. The absence of maternal toxicity, however, does not exclude the possibility of adverse events and obstetric follow up should be determined on a case-by-case basis.

All episodes of overdose, whether intentional or apparently accidental, should be fully documented in the maternity record. Referral to a perinatal psychiatrist should be considered in all cases of intentional iron overdose. Discussion with UKTIS is recommended for all cases.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from UKTIS.org to ensure you are using the most up-to-date version.