Comparative Efficacy, Safety, and Quality-of-Life Outcomes of Oral Ferrous Sulfate Versus Intravenous Ferric Carboxymaltose in the Management of Iron Deficiency Anemia During Pregnancy

BACKGROUND: Iron deficiency anemia (IDA) in pregnancy requires effective treatment to ensure maternal and fetal well-being. While oral iron is a first-line therapy, its efficacy is often limited by poor absorption and gastrointestinal (GI) intolerance. This study compares the therapeutic efficacy, safety, and impact on quality of life of oral ferrous sulfate versus intravenous (IV) ferric carboxymaltose for IDA in pregnancy. MATERIALS AND METHODS: A comparative analysis was conducted on 60 pregnant women with IDA. Participants were allocated to receive either oral ferrous sulfate or IV ferric carboxymaltose. Key outcomes measured included changes in hemoglobin (Hb), packed cell volume, serum ferritin, red cell indices, fatigue scores, and adverse effect profiles. RESULTS: IV iron demonstrated significantly superior hematological correction. The mean Hb rise was substantially greater in the IV group (3.56 g/dL) compared to the oral group (2.52 g/dL; P < 0.001), a finding consistent with other studies. Replenishment of iron stores was profoundly better with IV therapy, with serum ferritin rising to 73.13 ng/mL versus 22.70 ng/mL in the oral group (P < 0.001). Improvement in fatigue scores was also markedly greater with IV iron (P < 0.001). GI side effects were common with oral iron, whereas IV administration was well tolerated, with minimal adverse events. CONCLUSION: IV ferric carboxymaltose provides a faster, more robust, and better-tolerated in pregnancy compared to oral ferrous sulfate. It ensures rapid Hb rise, effective repletion of iron stores, and significant improvement in patient-reported fatigue, making it a highly effective therapeutic option, particularly for women with poor oral tolerance, severe anemia, or advanced gestation.