Effectiveness of intravenous versus oral iron on gestational iron deficiency anemia: a systematic review
DOI:
https://doi.org/10.47464/MetroCiencia/vol34/2/2026/31-42Keywords:
Anemia, Iron-Deficiency, Pregnancy, Iron, Administration, Oral, Infusions, IntravenousAbstract
Introduction: Iron deficiency anemia in pregnancy is a common condition associated with maternal and perinatal complications. Although oral iron is the first-line treatment, its efficacy may be limited by problems of tolerance and adherence, prompting the use of intravenous iron as an alternative. Methodology: A systematic review with qualitative synthesis was conducted in accordance with the PRISMA 2020 recommendations. Randomized clinical trials comparing the efficacy and safety of intravenous iron versus oral iron in pregnant women with iron deficiency anemia were included. The search was conducted in electronic databases. Study selection, data extraction, and risk of bias assessment were performed systematically. The results were synthesized using a narrative approach. Development: Intravenous iron obtained better results for increasing hemoglobin and serum ferritin in particular, compared to oral iron, with no consistent differences in maternal or neonatal clinical outcomes, and a higher adverse effect profile for oral iron. Conclusion: Intravenous iron demonstrated greater efficacy in the treatment of pregnant women with iron deficiency anemia in relation to maternal hematological parameters. Further studies are needed that also address maternal and neonatal clinical outcomes.
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References
World Health Organization. WHO. 2025 [cited 2026 Jan 14]. Anaemia. Available from: https://www.who.int/news-room/fact-sheets/detail/anaemia
World Health Organization. WHO. 2024 [cited 2026 Jan 14]. Daily iron and folic acid supplementation during pregnancy (ELENA evidence summary) . Available from: https://www.who.int/tools/elena/interventions/daily-iron-pregnancy
Finkelstein JL., Cuthbert A., Weeks J., Venkatramanan S., Larvie DY., De-Regil LM., et al. Daily oral iron supplementation during pregnancy. Cochrane Database of Systematic Reviews [Internet]. 2024 Jul 15 [cited 2026 Jan 17];(8). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004736.pub6/full/es
Lewkowitz AK, Gupta A, Simon L, Sabol BA, Stoll C, Cooke E, et al. Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. Journal of Perinatology. 2019 Apr 28;39(4):519–32.
Govindappagari S, Burwick R. Treatment of Iron Deficiency Anemia in Pregnancy with Intravenous versus Oral Iron: Systematic Review and Meta-Analysis. Am J Perinatol. 2019 Mar 19;36(04):366–76.
Maria Younis, Tariq Masood, Ammar Ahmed butt, Mishal Saleem, Maham Tariq, Sidra Fazal, et al. Comparing Efficacy of Intravenous Versus Oral Iron Therapy in Iron Deficiency Anaemia: A Comparative Prospective Study. Journal of Health and Rehabilitation Research. 2024 Sep 29;4(3):1–5.
Sarhan AM, Madkour NM, Salih SMA, Zaitoun MM. Intravenous Iron versus Oral Iron in Correction of Iron Deficiency Anemia during Third Trimester of Pregnancy. Egypt J Hosp Med. 2023 Jan 1;90(2):3273–7.
Govindappagari S, Burwick R. Treatment of Iron Deficiency Anemia in Pregnancy with Intravenous versus Oral Iron: Systematic Review and Meta-Analysis. Am J Perinatol. 2019 Mar 19;36(04):366–76.
Nicholson L, Axon E, Daru J, Rogozińska E. Effect and safety of intravenous iron compared to oral iron for treatment of iron deficiency anaemia in pregnancy. Cochrane Database of Systematic Reviews. 2024 Dec 9;2025(1).
Yıldız Ş, Türkgeldi E. Oral iron versus intravenous ferric carboxymaltose in the treatment of iron deficiency anemia in pregnancy: a retrospective study. Perinatal Journal. 2021 Oct 31;29(3).
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Rev Esp Cardiol. 2021 Sep;74(9):790–9.
Universidad de Navarra. Biblioguías. 2025. Revisiones sistemáticas: Covidence.
Crocker TF, Lam N, Jordão M, Brundle C, Prescott M, Forster A, et al. Risk-of-bias assessment using Cochrane’s revised tool for randomized trials (RoB 2) was useful but challenging and resource-intensive: observations from a systematic review. J Clin Epidemiol. 2023 Sep;161:39–45.
Awomolo AM, McWhirter A, Sadler LC, Coppola LM, Hill MG. Neonatal outcomes from a randomized controlled trial of maternal treatment of iron deficiency anemia with intravenous ferumoxytol vs oral ferrous sulfate. Am J Obstet Gynecol MFM. 2023 Sep;5(9):101063.
Ray S, Neogi SB, Singh R, Devasenapathy N, Zodpey S. Is IV iron sucrose a cost-effective option for treatment of severe anaemia in pregnancy as compared with oral iron? Health Policy Plan. 2021 Feb 16;35(10):1339–46.
Afolabi BB, Babah OA, Adeyemo TA, Balogun M, Banke-Thomas A, Abioye AI, et al. Intravenous versus oral iron for anaemia among pregnant women in Nigeria (IVON): an open-label, randomised controlled trial. Lancet Glob Health. 2024 Oct;12(10):e1649–59.
Arzoo S, Yousof S, Rahman J, Chowdhury S. Iron Deficiency Anemia in Pregnancy: Intravenous Iron Sucrose versus Oral Iron Sulfate. Bangladesh Journal of Obstetrics & Gynaecology. 2020 Jul 3;33(1):40–4.
Awomolo AM, McWhirter A, Sadler LC, Coppola LM, Hill MG. Intravenous infusions of ferumoxytol compared to oral ferrous sulfate for the treatment of anemia in pregnancy: a randomized controlled trial. Am J Obstet Gynecol MFM. 2023 Sep;5(9):101064.
Chauhan N, Dogra P, Sharma R, Kant S, Soni M. Randomized Controlled Trial Comparing Ferrous Sulfate and Iron Sucrose in Iron Deficiency Anemia in Pregnancy. Cureus. 2023 Feb 11;
Chavan S, Rana P, Tripathi R, Tekur U. Comparison of efficacy & safety of iron polymaltose complex & ferrous ascorbate with ferrous sulphate in pregnant women with iron-deficiency anaemia. Indian Journal of Medical Research. 2021 Jul;154(1):78–84.
Derman RJ, Bellad MB, Somannavar MS, Bhandari S, Mehta S, Mehta S, et al. Single-dose intravenous iron vs oral iron for treatment of maternal iron deficiency anemia: a randomized clinical trial. Am J Obstet Gynecol. 2025 Aug;233(2):120.e1-120.e18.
Hansen R, Sommer VM, Pinborg A, Krebs L, Thomsen LL, Moos T, et al. Intravenous ferric derisomaltose versus oral iron for persistent iron deficient pregnant women: a randomised controlled trial. Arch Gynecol Obstet. 2022 Sep 15;308(4):1165–73.
Lewkowitz AK, Stout MJ, Cooke E, Deoni SC, D’Sa V, Rouse DJ, et al. Intravenous versus Oral Iron for Iron-Deficiency Anemia in Pregnancy (IVIDA): A Randomized Controlled Trial. Am J Perinatol. 2022 Jun 28;39(08):808–15.
Pasricha SR, Mwangi MN, Moya E, Ataide R, Mzembe G, Harding R, et al. Ferric carboxymaltose versus standard-of-care oral iron to treat second-trimester anaemia in Malawian pregnant women: a randomised controlled trial. The Lancet. 2023 May;401(10388):1595–609.
Vanobberghen F, Lweno O, Kuemmerle A, Mwebi KD, Asilia P, Issa A, et al. Efficacy and safety of intravenous ferric carboxymaltose compared with oral iron for the treatment of iron deficiency anaemia in women after childbirth in Tanzania: a parallel-group, open-label, randomised controlled phase 3 trial. Lancet Glob Health. 2021 Feb;9(2):e189–98.
Muhammad Saqib, Meer Murtaza, Muhammad Bilal Khanzada, Khan SIY, Shahid H. Intravenous vs. Oral Iron for Anemia in Pregnancy: A Meta-Analysis of Efficacy and Safety. Journal of Health, Wellness and Community Research. 2025 Apr 21;e96.
Kumari K, Kumari K, Jones C, Kloecker G. More Effective Route of Treatment for Iron Deficiency Anemia in Pregnancy Intravenous Vs Oral Iron. Blood. 2024 Nov 5;144(Supplement 1):5260–5260.
Kuitunen I, Vepsäläinen K, Seppälä L, Toivonen E, Nikkilä A. The effect of intravenous iron supplementation compared to oral iron supplementation during pregnancy on neonatal outcomes—a systematic review of randomized controlled trials. Eur J Pediatr. 2025 Oct 13;184(11):684.
Mubarak M, Rehman FU. Efficacy and Safety of Intravenous Versus Oral Iron in Treating Maternal Anaemia During Pregnancy: A Systematic Review and Meta-Analysis. Cureus. 2025 Sep 20;
Pandey AK, Gautam D, Tolani H, Neogi SB. Clinical outcome post treatment of anemia in pregnancy with intravenous versus oral iron therapy: a systematic review and meta-analysis. Sci Rep. 2024 Jan 2;14(1):179.
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Copyright (c) 2026 Saverio Stiven Albán Velasco, Wilson Fernando Arce Verdugo, Noelya Isabela García Vargas, Evelyn Alexandra Gómez Aguirre, Juddy Tatiana Ilbay Llangarí
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