# Efficacy and Safety of Intravenous Versus Oral Iron in Treating Maternal Anaemia During Pregnancy: A Systematic Review and Meta-Analysis

## TL;DR

This study compares IV and oral iron for treating maternal anemia during pregnancy, finding IV iron more effective and better tolerated.

## Contribution

The study provides a systematic review and meta-analysis comparing IV and oral iron efficacy and safety in pregnant women with anemia.

## Key findings

- IV iron increased maternal hemoglobin levels significantly compared to oral iron.
- IV iron improved anemia correction rates and reduced gastrointestinal adverse events.
- Neonatal outcomes were similar, but IV iron showed a trend toward higher birthweight.

## Abstract

Maternal anaemia is a major global health issue linked to adverse maternal and neonatal outcomes; while oral iron is widely used, its gastrointestinal side effects limit adherence, and intravenous (IV) formulations may offer faster correction with better tolerability. We conducted a systematic review and meta-analysis at a tertiary academic centre (January-June 2024) of studies published from January 2015 to January 2025, searching PubMed, Scopus, Web of Science, and Cochrane Library in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Eligible studies were randomised controlled trials (RCTs) and cohort studies comparing IV with oral iron in anaemic pregnant women. Risk of bias was assessed using the Newcastle-Ottawa Scale (cohorts) and the Cochrane tool (RCTs). Random-effects models yielded pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI). Six studies (n = 3,842) were included. IV iron increased maternal haemoglobin versus oral iron (MD +1.21 g/dL; 95% CI 0.83-1.59; p < 0.001) and improved anaemia correction (OR 2.47; 95% CI 1.69-3.61; p < 0.001). Neonatal outcomes did not differ significantly, though mean birthweight tended to be higher with IV iron, and adverse events - particularly gastrointestinal symptoms - were fewer. Overall, IV iron, especially ferric carboxymaltose and iron sucrose, appears more effective and well-tolerated than oral iron; larger trials are needed to clarify long-term maternal and neonatal benefits.