Published: 2022-03-25

Intravenous verses oral iron supplementation for anaemia of pregnancy in the arid region of Western India: a retrospective cohort study

Yogesh K. Jain, Nitin K. Joshi, Kalpana R. Shah, Isha Chittora, Vibha Joshi


Background: India has a high prevalence of anemia in pregnant females, resulting greater risk of blood transfusion and its associated complications during the peripartum period. Administration of intravenous iron sucrose may reduce such a risk. Due to a greater prevalence in western arid region of India, this study was planned to compare efficacy and safety of intravenous iron sucrose and oral ferrous ascorbate in the treatment of iron deficiency anemia of pregnancy in a community health center of rural Jodhpur.

Methods: A retrospective cohort study was conducted in Community Health Center of Jodhpur to review the heamoglobin values of pregnant females in 28 to 37 weeks of gestation, treated with either intravenous iron sucrose or oral iron ascorbate. Cohorts were matched based on parity and age, and the hemoglobin values after 2, 4 and 6 weeks of start of therapy were compared using independent t-test.  

Results: Of the 152 pregnant females’ records included in the study, 82 were provided intravenous therapy and 70 were given oral iron therapy. Both the modes of administration showed marked increase in heamoglobin values, with statistically more significant rise through parenteral route at each point of measurement. Overall change in mean heamoglobin was 2.43 g/dl through iv route and 0.61 g/dl through oral route (p<0.001). Adverse events following therapy were reported by 9 females from intravenous group and 31 women from oral group.

Conclusions: The study provided evidence that parenterally administered iron sucrose elevated hemoglobin and restored iron stores better than oral ferrous ascorbate with lesser adverse reactions.


Pregnancy, Peripartum period, Anemia, Iron sucrose, Ferrous ascorbate, Western India

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WHO. Anaemia, 2019. Available at: Accessed on 10 February 2022.

Candio F, Hofmeyr GJ. Treatments for iron deficiency anemia in pregnancy. The WHO Reproductive Health Library. 2007.

Melku M, Addis Z, Alem M, Enawgaw B. Prevalence and Predictors of Maternal Anemia during Pregnancy in Gondar, Northwest Ethiopia: An Institutional Based Cross-Sectional Study. Anemia. 2014;2014:108593.

Hooja N, Arora S, Bhargava S, Mital P. Socioeconomic–demographic Factors in Varying Degrees of Anemia in Pregnancy. J Basic Clin Appl Health Sci. 2020;3(3):122-4.

UNICEF, UNO, WHO. Iron deficiency anemia: assessment, prevention and control. WHO. 2001.

Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009;130(5):627-33.

WHO. The global prevalence of anaemia in 2011, 2015. Available at: Accessed on 10 February 2022.

Shafi D, Purandare SV, Sathe AV. Iron deficiency anemia in pregnancy: intravenous versus oral route. J Obstet Gynaecol India. 2012;62(3):317-21.

Ministry of Health and Family Welfare. National Family Health Survey (NFHS-3), India; 2005–2006, 2007. Available at: Accessed on 10 February 2022.

10. WHO. Maternal mortality, 2019. Available at: Accessed on 10 February 2022.

Cho GJ, Oh MS, Oh MJ, Park KV, Han SW, Chae YK. Peripartum Blood Transfusions are Associated with Increased Risk of Cancer: A National Retrospective Cohort Study. Clin Epidemiol. 2020;12:659-66.

Cançado RD, Muñoz M. Intravenous iron therapy: how far have we come? Rev Bras Hematol Hemoter. 2011;33(6):461-9.

Kalaivani K. Use of intravenous iron sucrose for treatment of anaemia in pregnancy. Indian J Med Res. 2013;138(1):16-7.

Danielson BG, Salmonson T, Derendorf H, Geisser P. Pharmacokinetics of iron(III)-hydroxide sucrose complex after a single intravenous dose in healthy volunteers. Arzneimittelforschung. 1996;46(6):615-21.

Yee J, Besarab A. Iron sucrose: the oldest iron therapy becomes new. Am J Kidney Dis. 2002;40(6):1111-21.

Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr. 2010;91(5):1461-7.

Sabatier M, Rytz A, Husny J, Dubascoux S, Nicolas M, Dave A, et al. Impact of Ascorbic Acid on the In Vitro Iron Bioavailability of a Casein-Based Iron Fortificant. Nutrients. 2020;12(9):2776.

Singh MB, Fotedar R, Lakshminarayana J. Micronutrient deficiency status among women of desert areas of western Rajasthan, India. Public Health Nutr. 2009;12(5):624-9.

Kothari R, Bokariya P, Kothari V. A Study of Erythron Status in Pregnant & Non-Pregnant Age Matched Females of Jodhpur Region. IOSRPH. 2013;3:2250-3013.

Momen AK, Meshari A, Nuaim L, Saddique A, Abotalib Z, Khashogji T, et al. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1996;69(2):121-4.

Bayoumeu F, Buisset C, Baka NE, Legagneur H, Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol. 2002;186(3):518-22.

Bencaiova G, Mandach U, Zimmermann R. Iron prophylaxis in pregnancy: intravenous route versus oral route. Eur J Obstet Gynecol Reprod Biol. 2009;144(2):135-9.

Bonovas S, Fiorino G, Allocca M, Lytras T, Tsantes A, Biroulet L, et al. Intravenous Versus Oral Iron for the Treatment of Anemia in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore). 2016;95(2):2308.

Rizvi S, Schoen RE. Supplementation with oral vs. intravenous iron for anemia with IBD or gastrointestinal bleeding: is oral iron getting a bad rap?. Am J Gastroenterol. 2011;106(11):1872-9.

Loughery TG. Safety of Oral and Intravenous Iron. Acta Haematol. 2019;142(1):8-12.