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For pregnant women with moderate iron deficiency anemia, single-dose intravenous iron shows potential benefits over oral iron in reducing low birthweight risk and improving maternal iron status.
In a large multicenter trial, a single-dose infusion of intravenous iron (ferric carboxymaltose) as a first-line treatment for moderate maternal iron deficiency anemia reduced the incidence of low birth weight (LBW) infants when compared to oral iron. Additionally, IV iron (ferric carboxymaltose and ferric derisomaltose) increased the likelihood of achieving maternal non-anemic state without the need for additional iron or blood transfusion.
The randomized clinical trial, conducted across four sites, sought to investigate whether IV iron infusion offers better outcomes than standard oral iron. Pregnant women at 14–17 weeks gestation (Hb 7.0–9.9 g/dL) were randomly assigned to one of three groups:
All participants were provided with folic acid supplementation and anti-helminthic therapy throughout pregnancy. The main focus was on reducing LBW (<2500 g) and improving maternal iron levels (Hb ≥11.0 g/dL) by 30–34 weeks or delivery. Secondary outcomes encompassed safety assessments and broader maternal and infant health measures. Those with severe anemia (Hb <7 g/dL) or inadequate response received rescue IV iron or blood transfusion. A sensitivity analysis further examined anemia resolution without additional interventions.
Findings revealed that IV ferric carboxymaltose led to a notable reduction in LBW rates when compared to oral iron. On the other hand, IV ferric derisomaltose showed no significant advantage (Table 1).
IV iron therapy did not considerably improve the overall achievement of a non-anemic state (Hb ≥11.0 g/dL) compared to oral iron, with both IV infusions showing similar effectiveness. However, sensitivity analysis revealed a notable advantage—both IV infusions led to a higher non-anemic state rate when excluding participants requiring additional rescue therapy.
These findings suggest that a single-dose IV iron infusion, particularly ferric carboxymaltose, could be a more effective intervention for maternal anemia, reducing the risk of LBW and improving iron status without additional treatment. Experts suggest that clinical guidelines should reconsider IV iron as a primary intervention for moderate iron deficiency anemia in pregnancy.
American Journal of Obstetrics and Gynecology
Single dose intravenous iron versus oral iron for treatment of maternal iron deficiency anemia: A randomized clinical trial
R J Derman et al.
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