Intravenous Iron Compared with Oral Iron Supplementation for the Treatment of Postpartum Anemia: A Randomized Controlled Trial

Postpartum anemia is a significant maternal comorbidity that affects 50%of patients in the United States. It has been associated with maternal impaired cognition, depression, and fatigue, ultimately affecting mother-child bonding and neonatal care. Oral iron supplementation is currently the first-line treatment for women with iron-deficiency anemia postpartum. The effectiveness of oral iron is diminished by variability in absorption, discomforting side effects, and poor compliance, limitations that can be overcome with intravenous (IV) iron. However, IV iron is costly and needs to be administered under supervision in a hospital or outpatient clinical setting. We performed a pragmatic, double-blinded, feasibility randomized controlled trial of daily oral compared with IV iron administered after delivery but before hospital discharge. We found that patients randomized to IV iron had higher hemoglobin levels after 6 weeks postpartum than those randomized to oral iron. Our trial shows that it is feasible to administer IV iron during the delivery admission and that larger multicenter clinical trials are warranted.CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT05047211.