Publication:

Comparison of oral and intravenous iron for the prevention and management of iron deficiency anaemia in pregnancy: a systematic review and meta-analysis

Iron-deficiency anaemia (IDA) affects nearly 38% of pregnant women worldwide and is linked to maternal complications and poor birth outcomes. Although oral iron is the standard treatment, its use is often limited by gastrointestinal side effects and poor adherence. Intravenous (IV) iron may offer faster and better-tolerated correction of anaemia. This systematic review and meta-analysis compared IV and oral iron for the prevention and management of IDA in pregnancy. This review was registered with PROSPERO and conducted according to PRISMA guidelines. A total of 4,216 articles were screened, and 17 eligible studies, including 16 randomized controlled trials, were included. Two reviewers independently performed data extraction and quality assessment. Random-effects meta-analysis using the DerSimonian and Laird method was conducted. Primary outcomes were haemoglobin and serum ferritin; secondary outcomes included maternal and neonatal outcomes and treatment-related adverse events. IV iron produced significantly greater improvements in haemoglobin (mean difference 0.7 g/dl; 95% CI: 0.4-1.0) and serum ferritin (mean difference 79.4 ng/ml; 95% CI: 21.8-137) than oral iron. The odds of maternal anemia were reduced by 71% with IV therapy (OR 0.29; 95% CI: 0.08-1.00). No significant differences were observed in cord haemoglobin or cord ferritin, although ferritin showed a favourable non-significant trend. Adverse events were less frequent with IV iron, but the difference was not statistically significant. IV iron was more effective than oral iron in improving haematological outcomes in pregnant women with IDA and may be preferred in moderate-to-severe anemia, oral iron intolerance, or late gestation.