Prevention of Iron Deficiency Anemia Post-delivery

NCT ID: NCT05590260

Last Updated: 2023-12-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

4800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-30

Study Completion Date

2025-12-01

Brief Summary

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PRIORITY is designed as a 2-arm, randomized-controlled trial focused on postpartum women. The trial will recruit women who are diagnosed with moderate anemia based on a blood sample taken 6-48 hours after childbirth. A total of 4,800 eligible women, or 600 women per research site, will be consented and enrolled in the trial. The study hypothesizes that at 6 weeks post-delivery, prevalence of the non-anemic state in women in that received a single-dose IV iron infusion between 6 and 48 hours after delivery and prior to discharge from the facility will be greater than that of women given a supply of oral iron tablets taken twice daily for 6 weeks.

Detailed Description

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PRIORITY is a 2-arm, randomized-controlled trial (RCT) that will be implemented at 8 sites in 7 countries: Bangladesh, Democratic Republic of the Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia. The research team for each site will enroll approximately 600 women who deliver at a hospital or other facility such as a health center with delivery services. Participants will be randomized to receive a single-dose IV iron infusion between 6 and 48 hours after delivery prior to discharge from the facility or oral iron tablets taken twice daily for 6 weeks. They will then be assessed by research staff at an appropriate health facility at 6 weeks and 6 months post-delivery by providing a maternal blood sample that will be analyzed to determine Hb concentration. At each study visit, trained staff will also measure serum ferritin, serum transferrin receptor, C-reactive protein (CRP) and alpha 1 acid glycoprotein (AGP). Additionally, in the African research sites, a rapid diagnostic test (RDT) for malaria will be administered upon admission to the birthing facility, and at 6 weeks and 6 months postpartum. The Edinburgh Postnatal Depression Scale (EPDS), The World Health Organization Quality-of-Life (QOL) scale, The Maternal Fatigue Severity Scale (FSS-5R), and The Mother-to-infant Bonding Scale (MIBS) will also be used at the 6 weeks and 6 months postpartum follow up appointments to collect data for secondary study aims.The study hypothesizes that at 6 weeks post-delivery, the prevalence of the non-anemic state in women in that received a single-dose IV iron infusion between 6 and 48 hours after delivery and prior to discharge from the facility will be greater than that of women given a supply of oral iron tablets taken twice daily for 6 weeks. Secondary study aims will look at the effects of postpartum depression on maternal quality of life, fatigue, and breastfeeding initiation and retention rates. Depression is also a risk factor for reducing infant-mother bonding.

The PRIORITY RCT will include an implementation research (IR) sub-study to complement the findings of the RCT trial and provide evidence about facilitators, barriers, and costs of implementation to inform global guidelines on the use of IV iron in postpartum women in Low-Middle Income Countries (LMIC). This Implementation Research (IR) sub-study will build upon the PRIORITY trial as well as other research projects to assess IV iron that are being conducted by the Jawaharlal Nehru Medical College research team in Belagavi, India, Thomas Jefferson University (TJU) and by the Aga Khan University team in Pakistan. The IR will utilize a mixed methods approach, employing both quantitative and qualitative data collection to better understand the potential barriers and facilitators to IV iron use in India and Pakistan. The implementation research will be harmonized with the timeline of the main PRIORITY trial, enabling the investigators to collect the IR data in parallel with the trial. The mixed methods IR study for the PRIORITY trial in India and Pakistan will be guided by the Consolidated Framework for Implementation Research (CFIR) and by Proctor's implementation outcomes framework. CFIR and Proctor's framework are complementary and provide a structure for guiding the types of questions and target groups for the implementation research data collection during the trial.

Conditions

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Postpartum Anemia

Keywords

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Postpartum anemia Anemia Postpartum IV Iron Iron Tablets Iron Pregnancy Maternal Infant Hemaglobin

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Study participation will be individually randomized and allocated 1:1 to one of two arms stratified by site. A computer algorithm generated by the data coordinating center (DCC) will create the random assignment to one of the treatment arms based on randomly permuted block design with randomly varied block sizes. Randomization will be stratified based on delivery mode (Cesarean section vs. vaginal birth) and site. The block sizes will be known only by the Data Coordinating Center's personnel.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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IV iron arm

Which will result in receipt of a single-dose IV iron infusion between 6 and 48 hours after delivery and prior to discharge from the facility; folate tablets per local guidelines.

Group Type EXPERIMENTAL

IV iron infusion

Intervention Type DRUG

single-dose IV iron infusion

Oral iron comparator arm

Oral iron tablets (containing 60 mg of elemental iron (± folate as per local guidelines)) to be taken at a treatment dose of twice daily for 6 weeks.

Group Type ACTIVE_COMPARATOR

Oral iron tablets

Intervention Type DRUG

60 mg of elemental iron

Interventions

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IV iron infusion

single-dose IV iron infusion

Intervention Type DRUG

Oral iron tablets

60 mg of elemental iron

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Established pregnancy \>20 weeks gestation by LMP and/or clinical assessment and/ Or USG
* Age: 15 years (or lower limit age eligible\*) to 49 years
* Confirmed moderate anemia (Hb 7.0 to 9.9 g/dL, 6-48 hour after delivery based on a venous blood sample on Hemocue®)
* Deliver in participating study hospital or health facility
* Able to provide informed consent
* Plans to remain in study area for duration of the study

Exclusion Criteria

* IV Iron infusion received in past 3 weeks
* Contraindication to iron supplementation (some examples may include hemolytic anemia, allergy, severe infection)
* Blood transfusion already received or scheduled during the current hospital admission
* Known diagnosis of pre-existing depression or other psychiatric illness
* Stillbirth, major congenital anomaly, or neonatal loss prior to randomization
* Women testing positive and previously untreated for malaria
* Presenting with symptomatic anemia with dyspnea or fatigue and need for immediate correction
* Women with known hemoglobinopathy (sickle cell disease or thalassemia)
* Presence of severe allergic conditions such as severe asthma or known drug allergies
* Women presenting with any illness/condition requiring immediate medical care per physician's assessment
Minimum Eligible Age

15 Years

Maximum Eligible Age

49 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Thomas Jefferson University

OTHER

Sponsor Role collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role collaborator

Kinshasa School of Public Health

OTHER

Sponsor Role collaborator

University of Alabama at Birmingham

OTHER

Sponsor Role collaborator

University Teaching Hospital, Lusaka, Zambia

OTHER

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role collaborator

Institute of Nutrition of Central America and Panama

OTHER

Sponsor Role collaborator

University of Virginia

OTHER

Sponsor Role collaborator

International Centre for Diarrhoeal Disease Research, Bangladesh

OTHER

Sponsor Role collaborator

Columbia University

OTHER

Sponsor Role collaborator

Aga Khan University

OTHER

Sponsor Role collaborator

Boston University

OTHER

Sponsor Role collaborator

Lata Medical Research Foundation, Nagpur

OTHER

Sponsor Role collaborator

Indiana University

OTHER

Sponsor Role collaborator

Moi University

OTHER

Sponsor Role collaborator

RTI International

OTHER

Sponsor Role collaborator

Bill and Melinda Gates Foundation

OTHER

Sponsor Role collaborator

KLE University Jawaharlal Nehru Medical College

UNKNOWN

Sponsor Role collaborator

NICHD Global Network for Women's and Children's Health

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Richard J Derman, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Thomas Jefferson University, Philadelphia, PA

Locations

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ICDDRB

Dhaka, , Bangladesh

Site Status RECRUITING

Kinshasa School of Public Health

Kinshasa, , Democratic Republic of the Congo

Site Status RECRUITING

INCAP

Guatemala City, , Guatemala

Site Status NOT_YET_RECRUITING

KLE Society's Jawaharlal Nehru Medical College

Belagavi, Karnataka, India

Site Status RECRUITING

Lata Medical Research Foundation

Nagpur, , India

Site Status RECRUITING

Moi University School of Medicine

Eldoret, , Kenya

Site Status NOT_YET_RECRUITING

The Aga Khan University

Karachi, , Pakistan

Site Status NOT_YET_RECRUITING

University Teaching Hospital

Lusaka, , Zambia

Site Status NOT_YET_RECRUITING

Countries

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Bangladesh Democratic Republic of the Congo Guatemala India Kenya Pakistan Zambia

Central Contacts

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Elizabeth McClure, PhD

Role: CONTACT

Phone: 919 316 3773

Email: [email protected]

Facility Contacts

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Site Principal Investigator

Role: primary

Antoinette Tshefu, MD, MPH, PhD

Role: primary

Manolo Mazariegos, MD

Role: primary

Shivaprasad S Goudar, M.D.

Role: primary

Archana Patel, MD, DNB, MSCE

Role: primary

Fabian Esamai, MBChB, MMed, PhD

Role: primary

Sarah Saleem, MD

Role: primary

Elwyn Chomba, MD

Role: primary

References

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Related Links

Access external resources that provide additional context or updates about the study.

http://www.uptodate.com/contents/treatment-of-iron-deficiency-anemia-in-adults

Auerbach M. Treatment of iron deficiency anemia in adults. 2020

http://www.medicines.org.uk/emc/product/5676/smpc

Electronic Medicines Compendium (eMC). Monofer 100mg/ml solution for injection/infusion.

http://www.medicines.org.uk/emc/product/5910/smpc

Electronic Medicines Compendium (eMC). Ferinject (ferric carboxymaltose).

http://www.who.int/health-topics/anaemia

World Health Organization. Anemia

http://www.who.int/health-topics/maternal-health

World Health Organization. Maternal health

http://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-women-of-reproductive-age-(-)

World Health Organization. Prevalence of anaemia in women of reproductive age (aged 15-49) (%)

http://www.who.int/publications/i/item/WHO-HIS-HSI-Rev.2012.03

World Health Organization. The World Health Organization Quality of Life (WHOQOL). 2012.

http://apps.who.int/iris/bitstream/handle/10665/113048/WHO_NMH_NHD_14.1_eng.pdf;jsessionid=639F57F1C9B591D01291EECF0D9E632A?sequence=1

World Health Organization. WHA65.6. Comprehensive implementation plan on maternal, infant and young child nutrition as passed by the World Health Assembly at the Sixty-fifth World Health Assembly meeting.2012.

Other Identifiers

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CP PRIORITY

Identifier Type: -

Identifier Source: org_study_id