Comparative Study on the Efficacy of IV Iron Sucrose and Oral Ferrous Fumarate in Managing Moderate to Severe Anemia in Pregnant Women

Introduction: Anaemia affects 35.5% of the pregnant women globally (WHO, 2023), where the prevalence is notably higher in low and middle income countries. 1 In India, 52.2% of pregnant women are anaemic (NFHS-5), with iron deficiency causing over 60% of cases and contributing to complications like PPH, preeclampsia, sepsis, and up to 40% of maternal deaths.2Oral Iron (Ferrous sulphate/fumarate) are the First-line treatment for mild to moderate anaemia because it is Cheap, widely available but limited by Gastrointestinal side effects such as Nausea, constipation, metallic taste, Poor compliance due to intolerance.3 Intravenous Iron sucrose is indicated when oral iron is not tolerated due to GI side effects. IV Iron sucrose is a water-soluble iron (III)-hydroxide complex allowing slow, safe iron release without a test dose. IV Iron Sucrose is safer with fewer hypersensitivity reactions. It is proven to raise haemoglobin and ferritin faster than oral iron; improves iron stores and fatigue.3  Aims and objectives: To compare hemoglobin improvement between IV iron sucrose and oral ferrous fumarate in moderately to severely anemic pregnant women. To assess adverse effects, patient compliance, and satisfaction associated with each treatment  Methods: This is a prospective comparative study which is conducted at Navodaya Medical College Hospital & Research Centre, Raichur, enrolling 100 antenatal women aged 18–35 years with moderate to severe iron-deficiency anemia (Hb 7.0–10.0 g/dL) between 14–28 weeks of gestation. Participants were allocated into two groups:  Group I (n=50) received IV iron sucrose, administered on alternate days, with total dose calculated using the standard formula.  Group II (n=50) received oral ferrous fumarate (100 mg elemental iron) twice daily for four weeks. Baseline and follow-up hematological parameters (hemoglobin, ferritin, serum iron, TIBC, and hematocrit) were measured at 0, 2, and 4 weeks. Adverse effects, patient compliance, and maternal and neonatal outcomes were also recorded  Results: Both groups showed significant improvement in hemoglobin and iron indices, but the group I demonstrated superior outcomes: Hemoglobin levels at 4 weeks: Group I showed an rise in haemoglobin value by 2.1 g/dL vs Group II showed an rise in hemoglobin by 1.1 g/dL which showed statistical significance (p<0.001). Serum ferritin increased by 221.8% in the Group I versus 96.4% in the Group II which is statistically significant (p < 0.001). Adverse events were more frequent in the Group I (e.g., nausea, constipation), while the Group II had minimal side effects (e.g., mild staining, myalgia).  Conclusion: Intravenous iron sucrose is significantly more effective than oral ferrous fumarate in improving hemoglobin levels, replenishing iron stores, and achieving better maternal and neonatal outcomes in pregnant women with moderate to severe anemia. It also has a better tolerability profile. IV iron therapy should be considered the preferred modality in cases where rapid correction of anemia is necessary or when oral iron is poorly tolerated, particularly in resource-limited antenatal settings.