Anemia in Pregnancy: 

When Do We Use IV Iron?

Oral iron is the first-line treatment for iron deficiency anemia in pregnancy.

However, not all women respond adequately — and delays can increase maternal and fetal risks.

According to international guidelines (including World Health Organization and major obstetric societies):

IV iron is recommended when:

🔴 Moderate to severe anemia

Hemoglobin < 9 g/dL, especially in the 2nd or 3rd trimester

🔴 Poor response to oral iron

Hb fails to rise by ~1 g/dL after 2–4 weeks of compliant oral therapy

🔴 Intolerance or non-compliance

• Severe gastrointestinal side effects
• Inability to tolerate oral iron

🔴 Late pregnancy

When rapid correction is needed before delivery

🔴 High-risk situations

• Previous postpartum hemorrhage
• Planned cesarean section with low Hb

Why IV iron?

✔️ Faster hemoglobin correction

✔️ Better replenishment of iron stores

✔️ Reduced need for blood transfusion

✔️ Improved maternal well-being before delivery

📌 Modern IV iron preparations are safe, effective, and well tolerated when properly indicated.

Clinical Pearl

Blood transfusion should not be the first option for stable pregnant women with anemia.

Correcting iron deficiency early is safer — and smarter.

💬 Do you routinely reassess Hb after starting oral iron?

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