Background: Intravenous iron sucrose and oral iron therapy are the main therapies for iron deficiency anaemia (IDA), but there is still a debate regarding their efficacy and especially as to which one is the best choice during pregnancy. Methods: A meta-analysis of randomised controlled trials comparing patients treated with intravenous iron sucrose (intravenous group) with those treated with oral iron (oral group) for IDA during pregnancy was performed. The primary outcomes of interest were mean maternal haemoglobin and serum ferritin levels at the end of treatment. Secondary outcomes were treatment-related adverse events and foetal birth weight. Results: Six randomised controlled trials, involving a total of 576 women, were included in the present review. Significant increases in haemoglobin [mean difference (MD), 0.85; 95% confidence interval (CI), 0.31-1.39; p = 0.002] and ferritin levels (MD, 63.32; 95% CI, 39.46-87.18; p < 0.00001) were observed in the intravenous group. Compared with the oral group, there were fewer adverse events in the intravenous group (risk ratio, 0.50; 95% CI, 0.34-0.73; p = 0.0003). There was no significant difference in birth weight between the two groups. Conclusion: For pregnant women who could not tolerate the side effects of oral treatment or required a rapid replacement of iron stores, intravenous iron sucrose was associated with fewer adverse events and was more effective than regular oral iron therapy.

Khalafallah AA, Dennis AE: Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy 2012;2012:630519.
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al: Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Global Health 2013;1:e16-e25.
WHO: Guideline: intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva, World Health Organization, 2012.
Khalalafallah A, Dennis A, Bates J, Bates G, Robertson LK, Smith L, et al: A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Intern Med 2010;268:286-295.
Devasenapathy N, Neogi SB, Zodpey S: Is intravenous iron sucrose the treatment of choice for pregnant anemic women? J Obstet Gynaecol Res 2013;39:619-626.
Auerbach M, Ballard H, Glaspy J: Clinical update: intravenous iron for anaemia. Lancet 2007;369:1502-1504.
Auerbach M, Rodgers GM: Intravenous iron. N Engl J Med 2007;357:93-94.
Auerbach M, Goodnough LT, Picard D, Maniatis A: The role of intravenous iron in anemia management and transfusion avoidance. Transfusion 2008;48:988-1000.
Breymann C: Iron deficiency anemia in pregnancy. Expert Rev Obstet Gynecol 2013;8:587-596.
Reveiz L, Gyte GM, Cuervo LG, Casasbuenas A: Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database Syst Rev 2011;10:CD003094.
Khalafallah AA, Dennis AE, Ogden K, Robertson I, Charlton RH, Bellette JM, et al: Three-year follow-up of a randomized clinical trial of intravenous versus oral iron for anemia in pregnancy. BMJ Open 2012;2:e000998.
Dan H, Limin F: Laparoscopic ovarian cystectomy versus fenestration/coagulation or laser vaporization for the treatment of endometriomas: a meta-analysis of randomized controlled trials. Gynecol Obstet Invest 2013;76:75-82.
Schulz KF, Chalmers I, Hayes RJ, Altman DG: Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408-412.
Higgins J, Green S: Cochrane handbook for systematic reviews of interventions 5.1.0. Copenhagen, The Nordic Cochrane Centre, 2011.
Matsaseng T, Kruger T, Steyn W: Mild ovarian stimulation for in vitro fertilization: are we ready to change? A meta-analysis. Gynecol Obstet Invest 2013;76:233-240.
Aggarwal RS, Mishra VV, Panchal NA, Deshchougule VV, Jasani AF: Evaluation of iron sucrose and oral iron in management of iron deficiency anemia in pregnancy. Natl J Commun Med 2012;3:55-60.
Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC: Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol 2002;186:518-522.
Kochhar PK, Kaundal A, Ghosh P: Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. J Obstet Gynaecol Res 2013;39:504-510.
Al RA, Unlubilgin E, Kandemir O, Yalvac S, Cakir L, Haberal A: Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial. Obstet Gynecol 2005;106:1335-1340.
Shafi D, Purandare SV, Sathe AV: Iron deficiency anemia in pregnancy: intravenous versus oral route. J Obstet Gynaecol India 2012;62:317-321.
Neeru S, Nair NS, Rai L: Iron sucrose versus oral iron therapy in pregnancy anemia. India J Community Med 2012;37:214-218.
Benoist B, Mclean E, Egli I, Cogswell M: Worldwide prevalence of anaemia 1993-2005. WHO global database on anaemia. Geneva, World Health Organization, 2008.
Horowitz KM, Ingardia CJ, Borgida AF: Anemia in pregnancy. Clin Lab Med 2013;33:281-291.
Khan KS, Wojdyla D, Say L, et al: WHO analysis of causes of maternal deaths: a systematic review. Lancet 2006;367:1066-1074.
Rasmussen KM: Is there a causal relationship between iron deficiency or iron deficiency anaemia and weight at birth, length of gestation, and perinatal mortality? J Nutr 2001;131:590S-601S.
Haram K, Nilsen ST, Ulwik RJ: Iron supplementation in pregnancy - evidence and controversies. Acta Obstet Gynaecol Scand 2001;80:683-688.
Goonewardene M, Shehata M, Hamad A: Anemia in pregnancy. Best Pract Res Clin Obstet Gynaecol 2012;26:3-24.
Kumar A, Jain S, Singh NP, Singh T: Oral versus high dose parenteral iron supplementation in pregnancy. Int J Gynecol Obstet 2005;89:7-13.
Ruiz-Arguelles GJ, Diaz-Hernandez A, Manzano C, Ruiz-Delgado GJ: Ineffectiveness of oral iron hydroxide polymaltose in irondeficiency anemia. Hematology 2007;12:255-256.
Singh S, Singh S, Singh PK: A study to compare the efficacy and safety of intravenous iron sucrose and intramuscular iron sorbitol therapy for anemia during pregnancy. J Obstet Gynaecol India 2013;63:18-21.
Kriplani A, Mahey R, Dash BB, Kulshreshta V, Agarwal N, Bhatla N: Intravenous iron sucrose therapy for moderate to severe anemia in pregnancy. Indian J Med Res 2013;138:78-82.
Perewusnyk G, Huch R, Huch A, Breymann C: Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex. Br J Nutr 2002;88:3-10.
Savajol E, Burquet A, Grimaldi M, Godoy F, Sagot P, Semama DS: Maternal hemoglobin and short-term neonatal outcome in preterm neonates. PLoS One 2014;9:e89530.
Stoltzfus R, Mullany L, Black R: Iron deficiency anemia. World Health Organization 2004.
Little M, Brocard P, Eliott P, Steer PJ: Hemoglobin concentration in pregnancy and perinatal mortality: a London-based cohort study. Am J Obstet Gynecol 2005;193:220-226.
Steer P, Alam MA, Wadsworth J, Welch A: Relation between maternal hemoglobin concentration and birth weight in different ethnic groups. BMJ 1995;310:489-491.
Pena-Rosas JP, Viteri FE: Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev 2009;4:CD004736.
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW, et al: Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013;346:f3443.
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