Comparative Efficacy between Intravenous Iron and Oral Iron on Enhancing Hemoglobin Level among Pregnant Women with Iron Deficiency Anemia in Low and Middle Income Countries: A Meta-Analysis


  • Fiki Cahya Ningrum Masters Program in Public Health, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret
  • Vitri Widyaningsih Faculty of Medicine, Universitas Sebelas Maret


Background: Iron deficiency was a major cause of anemia in pregnancy. The incidence of large de­ficiency anemia was mostly experienced in pregnancy which can result in general hematological disorders with considerable complications both for the mother and the fetus. This study aimed to com­pare the efficacy of intravenous iron administration and oral iron for the treatment of iron de­fi­ci­ency anemia in pregnancy. 

Subjects and Method: This was a meta-analysis conducted using PRISMA systematic guide­li­nes. The process of searching articles was carried out between 2000 and 2018 using a database se­arch engine consisting of; PubMed, Science Direct, Springer Link, and Google Scholar. Based on da­tabase searches, nine articles that met the Randomized Control Trial (RCT) criteria and study we­re conducted in lower middle income countries. This study involved 967 samples divided into two groups of 484 intravenous iron and 483 oral iron. The analysis was carried out with Review Ma­nager (RevMan) software 5.3. The results were assessed for Mean Difference (MD) and the analysis was carried out for heterogeneity.

Results: There was a high heterogeneity between experiments (I2= 91%; p <0.001) so that Ran­dom Effects Model (REM) was used. Intravenous iron administration can increase hemoglobin levels 0.70 g / dL higher than oral iron administration, and it was statistically significant (MD 0.70; 95 % CI: 0.37 to 1.02; p<0.001).

Conclusion: Intravenous iron administration was more effective than oral iron for the treatment of iron deficiency anemia in pregnancy. Pregnant women given intravenous iron more quickly reach the desired hemoglobin level target than oral iron.

Keywords: anemia, iron deficiency, intravenous iron, oral iron, meta-analysis 

Correspondence: Fiki Cahya Ningrum. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile: 081­216494956.

Indonesian Journal of Medicine (2019), 4(2): 135-144


Abhilashini GD, Sagili H, Rani D (2014). Intravenous iron sucrose and oral iron for the treatment of iron deficiency anaemia in pregnancy. Journal Of Clinical and Diagnostic Research. 8(5): OC04–OC07. doi: 10.7860/jc-dr/2014/6568.4382.

Adewoyin AS (2015). Approach to anaemia, diagnosis in developing countries: focus on aetiology and laboratory work up. Int Blood Res Review. 4(1):1-13. Doi: 10.9734/IBRR/2015/19078.

Andriani Y, Respati SH, Astirin OP (2016). Effectiveness of pregnant woman class in the prevention of pregnancy anemia in Banyuwangi, East Java, Journal of Maternal and Child Health. 1(4): 230-241.

Arulkumaran S, Regan L, Papageorghiou A, Monga A (2011). Oxford Desk Reference: Obstetrics and Gynaecology. Oxford, UK. Oxford University Press.

Bhavi SB, JajuPB (2017). Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy and Childbirth, 17(1). doi: 10.1186/s12884-017-1313-9.

Bilimale A, Anjum J, Sangolli HN, Mallapur M (2010). Improving adherence to oral iron supplementation during pregnancy. Maternal Health, Nutrition, Anaemia. 3(5): 281-290. doi 10.4066/ AMJ.2010.291.

Camaschella C (2015). Iron deficiency anemia. New England Journal of Medicine.372(19): 1832–1843. doi: 10.1056/nejmra1401038.

CongdonEL, Westerlund A, Algarin CR, Peirano PD, Gregas M, Lozoff B, Nelson CA (2012). Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years. The Journal of Pediatrics. 160(6): 1027-1033. doi: 10.1016/

Darwish AM, Khalifa EE, Rashad E, Farghally E (2017). Total dose iron dextran infusion versus oral iron for treating iron deficiency anemia in pregnant women: A randomized controlled trial. The Journal of Maternal Fetal Neonatal Medicine. 32(3):398-403. doi: 10.1080/14767058.201.1379988.

Devasenapathy N, Neogi SB, Zodpey S (2012). Is intravenous iron sucrose the treatment of choice for pregnant anemic women?. Journal of Obstetrics and Gynaecology Research. 39(3): 619 626. doi: 10.1111/j.1447-0756.2012.02033.x.

Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru Granovsky S (2015). Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse mater-nal and neonatal outcomes.

Transfu-sion. 55(12): 2799–2806. doi: 10.1111-/trf.13252.

Goonewardene M, Shehata M, Hamad A (2012). Anaemia in pregnancy. Best Practice & Study Clinical Obstetrics Gynaecology. 26(1): 3-24. doi: 10.1016-/j.bpobgyn.2011.10.010.

Gupta A, Manaktala U, Rathore AM (2013). A randomised controlled trial to compare intravenous iron sucrose and oral iron in treatment of iron deficiency anemia in pregnancy. Indian Journal of Hematology and Blood Transfusion. 30(2): 120–125. doi: 10.1007/s12288-012-0224-1.

Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW (2013). Anemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 346(3): f3443–f3443. doi:10.1136/-bmj.f3443.

Khalafallah A, Dennis A, Bates J, Bates G, Robertson IK, Smith L, Rasko JEJ (2010). A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. Journal of Internal Medicine. 268(3): 286-295. doi:10.1111/j.1365-2796.2010.02251.x.

Khaskheli M, Baloch S, Baloch AS, Baloch S, Khaskheli FK (2016). Iron deficiency anaemia is still a major killer of pregnant women. Pakistan Journal of Medical Sciences. 32(3): 630–634. doi: 10.12669/pjms.323.9557.

Kochhar PK, Kaundal A, Ghosh P (2012). Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: A randomized clinical trial. Journal of Obstetrics and Gynaecology Research. 39(2): 504–510. doi:10.1111/j.1447-0756.2012.01982.x.

Kurniati A, Astirin OP, Suryani N (2016). Effect of maternal education, family income, mother midwife interface, and the incidence of iron deficiency anemia in Pemalang, Central Java, Journal of Maternal of Child Health. 1(4): 220-229.

Mehta MN, Shah JM (2014). Iron deficiency anemia in pregnancy: Intravenous versus oral route. Natl J Community Med. 5(1): 10-12. doi: 10.1007/s13224-012-0222-0.

Murti B (2018). Prinsip dan metode riset epidemiologi. Edisi IV. Surakarta: Bintang Fajar Offset.

Neeru S, RaiL, Nair N (2012). Iron Sucrose Versus Oral Iron Therapy in Pregnancy Anemia. Indian Journal of Community Medicine. 37(4): 214. doi:10.4103/0970-0218.103467.

Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA(2013). Control of iron deficiency anemia in low and middle income countries. Blood. 121 (14): 2607 2617. doi:10.1182/blood201209453522.

Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C (2012). UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology. 156(5): 588–600. doi:10.1111/j.13652141.2011.09012.x.

Prahesti R, Indarto D, Akhyar M (2016). Analysis of factors associated with anemia in pregnant women at Pram-banan Community Health Center, Sleman, Yogyakarta, Journal Maternal and Child Health. 1(2): 131-137.

Qassim A, Mol BW, Grivell RM, Grzesko wiak LE (2017). Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review. Australian and New Zealand Journal of Obstetrics and Gynaecology.58(1): 22–39. doi:10.1111/ajo.12695.

Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, Shibuya K (2016). Maternal anemia and risk of adverse birth and health outcomes in low and middle income countries: systematic review and meta analysis. The American Journal of Clinical Nutrition. 103(2): 495–504. doi:10.3945-/ajcn.115.107896.

Renzo GCD, Spano F, Giardina I, Brillo E, Clerici G, Roura LC (2015). Iron deficiency anemia in pregnancy. Women’s Health. 11(6): 891–900. doi: 10.2217/-whe.15.35.

Reveiz L, Gyte GM, Cuervo LG, Casas buenas A (2011). Treatments for iron deficiency anaemia in pregnancy. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003-094.pub3.

Rohina A, Mishra VV, Panchal NA, Patel NH, Deshchougule VV, Jasani AF (2012). Evaluation of iron sucrose and oral iron in management of iron deficiency anemia in pregnancy. Natl J Community Med. 1:55–60. Available at:

Shafi D, Purandare SV, Sathe AV (2012). Iron deficiency anemia in pregnancy: intravenous versus oral route. The Journal of Obstetrics and Gynecology of India. 62(3): 317–321. doi:10.10-07/s13224-012-0222-0.

Tolkien Z, Stecher L, Mander AP, Pereira DIA, Powell JJ (2015). Ferrous sulfate supplementation causes significant gastrointestinal side effects in adults: A Systematic Review and Meta Analysis. PLOS ONE. 10(2): e0117383. doi: 10.1371/journal.pone.0117383.