Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis

Adam K. Lewkowitz, Anjlie Gupta, Laura Simon, Bethany A. Sabol, Carrie Stoll, Emily Cooke, Roxanne A. Rampersad, Methodius G. Tuuli

Research output: Contribution to journalReview articlepeer-review

43 Scopus citations


Objective: To assess the effect of intravenous versus oral iron on hematologic indices and clinical outcomes for iron-deficiency anemia (IDA) in pregnancy. Study design: Searches in Ovid Medline, Embase, SCOPUS, Cochrane Database, and identified randomized-controlled trials comparing intravenous to oral iron for treating IDA in pregnancy. Primary outcomes were maternal hematologic indices at delivery. Secondary outcomes were blood transfusion, cesarean delivery, neonatal outcomes, and medication reactions. Results: Of 15,637 studies, 20 randomized trials met inclusion criteria and were analyzed. Mean hemoglobin at delivery (9 studies: WMD 0.66 g/dL (95% confidence Interval 0.31 –1.02 g/dL)) was significantly higher after intravenous iron therapy. Intravenous iron was associated with higher birthweight (8 studies: WMD 58.25 g (95% CI: 5.57–110.94 g)) but no significant differences in blood transfusion, cesarean delivery, or neonatal hemoglobin. There were fewer medication reactions with intravenous iron (21 studies: RR 0.34% (95% CI: 0.20–0.57)). Conclusion: Intravenous iron therapy is associated with higher maternal hemoglobin at delivery with no difference in blood transfusion and fewer mild medication reactions.

Original languageEnglish (US)
Pages (from-to)519-532
Number of pages14
JournalJournal of Perinatology
Issue number4
StatePublished - Apr 1 2019
Externally publishedYes

Bibliographical note

Funding Information:
Acknowledgments Dr. Lewkowitz is supported in part by a National Institutes of Health training grant T32-HD-55172-9. Dr. Tuuli is supported by National Institutes of Health U01 (U01HD077384-03) and R01 (1Ro1HD0867001-01) grants. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.

Publisher Copyright:
© 2019, Springer Nature America, Inc.


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