Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review

Alaa Qassim, Ben W. Mol, Rosalie M. Grivell, Luke E. Grzeskowiak*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

48 Citations (Scopus)


Background: Intravenous (IV) iron in pregnancy is useful where oral iron is not tolerated or a rapid replenishment of iron is required. Aims: To review the literature on the efficacy and safety of different IV iron preparations in the management of antenatal iron-deficiency anaemia (IDA). Materials and methods: We searched MEDLINE, Embase and Scopus from inception to June 2016. Eligible studies were randomised controlled trials (RCTs) and observational studies, involving administration of IV iron (ferric carboxymaltose (FCM), iron polymaltose (IPM) or iron sucrose (IS)), regardless of comparator, to manage antenatal IDA. Two independent reviewers selected studies, extracted data and assessed quality. Results: A total of 47 studies were eligible (21 RCTs and 26 observational studies), investigating IS (n = 2635; 41 studies), FCM (n = 276; four studies) and IPM (n = 164; three studies). All IV preparations resulted in significant improvements in haematological parameters, with a median increase of 21.8 g/L at 3–4 weeks and 30.1 g/L by delivery, but there was no evidence of any associated improvements in clinical outcomes. A greater median increase in Hb was observed with a high (25 g/L; range: 20–39.6 g/L) compared with low dose (20 g/L; range: 6.2–50.3 g/L). The median prevalence of adverse drug reactions for IPM (2.2%; range: 0–4.5%) was lower than FCM (5.0%; range: 0–20%) and IS (6.7%; range: 0–19.5%). Conclusion: While IV iron in pregnancy improves haematological parameters, there is an absence of evidence for improvements in important maternal or perinatal outcomes. No single preparation of IV iron appeared to be superior, with the current IV iron preparation of choice largely determined by cost and convenience around administration.

Original languageEnglish
Pages (from-to)22-39
Number of pages18
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Issue number1
Early online date5 Feb 2018
Publication statusPublished - Feb 2018

Bibliographical note

LEG and RMG are supported through an Australian National Health
and Medical Research Council (NHMRC) Early Career Fellowship
(ID 1070421 and ID 1073514, respectively), while BWM was supported through a NHMRC Practitioner Fellowship (ID 1082548).

Data Availability Statement

Additional Supporting Information may be found online in the
supporting information tab for this article.


  • anemia
  • ferric compounds/administration and dosage
  • iron-deficiency/drug therapy
  • pregnancy
  • treatment outcome


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