A Retrospective Propensity-Matched Cohort Study of Intravenous Versus Oral Iron Formulations for Management of Iron Deficiency Anemia in Pregnancy
Authors' conclusion
Compared to oral iron, IV iron may be preferable for increasing Hb, resolving IDA, and reducing maternal complications.
Study context
- Population
- Pregnant patients aged ≥18 years with iron deficiency anemia (IDA) in the second trimester (ferritin <30 ng/mL, hemoglobin (Hb) <11 g/dL), January 2000 to November 20251,693 postmatch per cohort
- Participants
- 1,693 vs 1,693
- Exposure
- IV iron vs oral iron
- IV ironn = 1,693
- Oral ironn = 1,693reference
- Outcome
- Blood transfusions, maternal mortality, preeclampsia, cesarean section (CS) and preterm labor
Methodological detailspropensity-score matched, large database (TriNetX Research Network)
- Propensity-score matched
- Large database (TriNetX Research Network)
Main finding
As reported in the abstract
Preterm labor and CS
IV iron vs Oral ironRelative risk (CI)
Preterm labor
0.77(0.62–0.96)
CS
0.84(0.74–0.96)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | RR (CI) | |
|---|---|---|
| Preterm labor (subgroup: IV iron excluding iron sucrose vs oral iron) | 0.57 (0.40–0.80) | |
| 0.512Relative risk (log scale) |
| Outcome | P value |
|---|---|
| Posttreatment Hb · 3 months after treatmentPropensity-matched cohort | adj. P = .0001 |
| Posttreatment ferritin · 3 months after treatmentPropensity-matched cohort | adj. P = .0001 |
| Posttreatment Hb (subgroup: IV iron excluding iron sucrose vs oral iron) | adj. P = .0001 |
| Posttreatment ferritin (subgroup: IV iron excluding iron sucrose vs oral iron) | adj. P = .0001 |
- Posttreatment Hb — Posttreatment Hb, IV iron vs oral iron
- 10.6 vs 9.7
- Posttreatment ferritin — Posttreatment ferritin, IV iron vs oral iron
- 138 vs 39
- Preterm labor (subgroup: IV iron excluding iron sucrose vs oral iron) — Preterm labor, IV iron (excluding iron sucrose) vs oral iron
- 5.25% vs 9.30%
- Posttreatment Hb (subgroup: IV iron excluding iron sucrose vs oral iron) — Posttreatment Hb, IV iron (excluding iron sucrose) vs oral iron
- 10.7 vs 9.8
- Posttreatment ferritin (subgroup: IV iron excluding iron sucrose vs oral iron) — Posttreatment ferritin, IV iron (excluding iron sucrose) vs oral iron
- 175 vs 42
- Preterm labor (subgroup: IV iron excluding iron sucrose vs oral iron): 914 postmatch patients per cohort
Adverse outcome composite (gastritis, nausea/vomiting or anaphylactic shock) · 3 months after treatment
- No difference in other outcome measures
Other outcomes (subgroup: IV iron excluding iron sucrose vs oral iron)
- All other outcomes not significant
Safety
Adverse outcome composite (gastritis, nausea/vomiting or anaphylactic shock)
- No difference
Original publication
A Retrospective Propensity-Matched Cohort Study of Intravenous Versus Oral Iron Formulations for Management of Iron Deficiency Anemia in Pregnancy. Anesth Analg. Published 17 July 2026. doi:10.
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