The efficacy of treatment of manifest iron deficiency in pregnant women with varied levels of endogenous erythropoietin
The objective. A comparative analysis of the effectiveness of treating pregnant women with MID with iron preparations in adequate and inadequate levels of endogenous erythropoietin (EPO). Patients and methods. The examination included 59 pregnant women with mild MID. Group 1 comprised 30 women with adequate basal levels of s-EPO (O/P ratio > 0.8); group 2 - 29 with inadequate s-EPO levels (O/P ratio < 0.8). All the patients received the drug Ferro-Folgamma («Woerwag Pharma», Germany) 1 capsule 2 times daily for 2 months. No significant differences between the groups with respect to basal levels of hemoglobin (Hb), hematokrit (Ht), erythrocytes (RBC), transferrin (TRF), serum iron (SI), transferrin saturation (TSAT), serum ferritin (SF), cyanocobalamin and folic acid (FA) were found. Pregnant women in group 2 initially differed from those in group 1 in significantly lower levels of s-EPO and the adequacy of EPO production (O/P ratio). Results. As a result of treatment, in both groups the levels of Hb, Ht, SI, TSAT, SF and cyanocobalamin increased significantly with respect to basal values, however, a reliable dynamic of FA, TRF, s-EPO and O/P ratio was absent. The increment of mean values of Hb, RBC and Ht with respect to their basal levels was significantly higher (p < 0.05) in pregnant women in group 1 as compared with such in group 2 by 1.45; 2.25 and 1.77 times, respectively. Basal parameters of oxygen transport capacity (OTC) in pregnant women of group 2 are significantly higher that those in pregnant women of group 1 (p < 0.05 and p < 0.02, respectively, for OF (oxygen flow) and OFI - OF index). The level of OTC parameters against the background of therapy did not change in group 2, while in group 1 the values of OF and OFI significantly increased with respect to the basal ones (p < 0.01 and p < 0.05, respectively). Conclusion. Defective EPO production in pregnant women with MID might be associated with one or several levels of molecular regulation, formation and reception of EPO. These regulatory mechanisms require further study to enhance the effectiveness of treating MID.