EFFICACY OF INTRAVENOUS FERRIC CARBOXYMALTOSE VERSUS IRON SUCROSE COMPLEX FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN PREGNANCY

Abstract

Background: Iron deficiency anemia (IDA) is common during pregnancy and may adversely affect maternal and fetal health. Intravenous iron is useful when rapid iron replacement is required or oral iron is poorly tolerated. Ferric carboxymaltose (FCM) permits administration of larger iron doses over a shorter infusion period than conventional iron sucrose. Objective: To compare the efficacy of intravenous ferric carboxymaltose with intravenous iron sucrose complex for treatment of IDA during pregnancy. Methods: This randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology, Memon Medical Institute Hospital, Karachi, from 15 November 2022 to 15 May 2023. One hundred pregnant women aged 18–40 years, at ≥16 weeks' gestation, with IDA were enrolled and allocated equally to iron sucrose (n=50) or FCM (n=50) using opaque sealed envelopes. Iron sucrose was administered at 100–200 mg weekly, diluted in 250 mL normal saline, with treatment stopped after a total of 400 mg. FCM was administered at 15 mg/kg, not exceeding 1000 mg per dose, intravenously over approximately 15 minutes and given weekly for three weeks. Efficacy was assessed on day 21 according to the study definition. Data were analyzed using SPSS version 25; categorical comparisons used chi-square/Fisher exact testing. Results: Mean age was 35.40±4.33 years in the iron sucrose group and 36.20±2.74 years in the FCM group. Efficacy was achieved in 15/50 (30.0%) participants receiving iron sucrose compared with 40/50 (80.0%) receiving FCM (p=0.001). The absolute difference in efficacy was 50 percentage points; the calculated risk ratio was 2.67 (95% CI 1.71–4.16). Stratified analyses also demonstrated higher efficacy with FCM across several age, BMI, gestational-age, residence, parity and gravida categories. Conclusion: Within this study population, intravenous FCM was associated with substantially greater treatment efficacy at day 21 than iron sucrose. The findings support FCM as a useful intravenous iron option for pregnant women with IDA when rapid iron repletion is clinically indicated, while larger studies with detailed safety, cost effectiveness and longer-term maternal and neonatal outcomes are warranted.