Publication:

Comparative efficacy and safety of oral ferrous fumarate versus intravenous iron sucrose in pregnancy with iron deficiency anemia: a prospective comparative study

Background Iron deficiency anemia (IDA) during pregnancy remains highly prevalent and is associated with maternal morbidity and adverse perinatal outcomes. Oral iron is widely used but limited by gastrointestinal intolerance and variable absorption, whereas intravenous (i.v.) iron sucrose may produce faster correction and improved iron stores. Objectives were to compare oral ferrous fumarate versus i.v. iron sucrose for improvement of hemoglobin and iron indices in pregnant women with IDA, and to compare adverse effects and pregnancy/neonatal outcomes.

Methods In this prospective comparative interventional study, 164 pregnant women with biochemical evidence of iron deficiency were allocated to group A (oral ferrous fumarate 300 mg/day ≈100 mg elemental iron + folic acid; n=82) or group B (i.v. iron sucrose 200 mg on alternate days + folic acid; n=82). Hemoglobin and iron profile were assessed at baseline and repeated at 3 and 8 weeks. Adverse effects and obstetric/neonatal outcomes were documented. Between‑group comparisons used appropriate parametric/non‑parametric tests; p<0.05 was significant.

Results Baseline characteristics and iron indices were comparable. Hemoglobin increased in both groups but was higher in group B at 3 weeks (10.05±0.73 versus 9.59±0.73 gm/dl; p<0.001) and 8 weeks (10.69±0.89 versus 10.32±0.77; p=0.006). Ferritin rose more in group B at 3 weeks (118.16±54.89 versus 58.87±16.99 ng/ml; p<0.001) and remained higher at 8 weeks (64.58±14.19 versus 56.59±14.82 ng/mL; p=0.001). Transferrin saturation improved more in group B at both follow‑ups (p<0.001). Oral iron caused more gastrointestinal adverse effects, whereas i.v. therapy showed more itching, thrombophlebitis and hypotension. Delivery and neonatal outcomes were comparable.

Conclusions I.v. iron sucrose achieved faster and greater improvement in hemoglobin and iron stores with a route‑specific adverse‑effect profile, supporting its use in selected pregnant women needing rapid correction or with poor tolerance/adherence to oral iron.