TOPLINE

Antenatal intravenous (IV) iron therapy was significantly associated with lower odds of requiring red blood cell (RBC) transfusion and postpartum IV iron therapy among women with iron deficiency anaemia (IDA), and these effects were more pronounced in those with the lowest baseline haemoglobin levels. Neonates born to treated mothers were less likely to require NICU admission or treatment for jaundice.

METHODOLOGY

• Researchers conducted a retrospective cohort study to evaluate whether giving IV iron therapy in pregnant women with IDA before delivery is linked to better blood management outcomes and improved neonatal outcomes.
• They included 851 women with IDA at two tertiary referral centres across Italy between 2019 and 2025; 490 women (median age, 35 years) received IV ferric carboxymaltose (FCM) before delivery, and 361 untreated women (median age, 33 years) served as control individuals.
• FCM was given through an IV drip as a 500-mg dose mixed with saline solution and infused over about 15 minutes. The dose was adjusted on the basis of body weight, with a maximum of 1000 mg/wk, usually given across one or two sessions.
• The primary endpoint was the need for RBC transfusion; secondary maternal endpoints were postpartum haemorrhage (PPH) and the requirement for postpartum IV iron therapy.
• Neonatal secondary endpoints included an Apgar score at 5 minutes, umbilical artery pH, admission to the NICU or high-dependency care, perinatal death, and the need for jaundice treatment.

TAKEAWAY

• After adjustment, women who received antenatal IV iron therapy had 58% (adjusted odds ratio [aOR], 0.42; P = .05) and 72% (aOR, 0.28; P < .001) lower odds of requiring RBC transfusion and postpartum IV iron therapy, respectively, than control women. No significant association was observed with PPH.
• The benefit of transfusion reduction was greatest among women with baseline haemoglobin levels < 8.9 g/dL, who had 91% lower odds of RBC transfusion when treated with antenatal IV iron (aOR, 0.09; P < .01); however, no significant association was seen among those with higher baseline haemoglobin levels.
• Neonatal outcomes were generally similar between the two groups; however, neonates of IV iron-treated women had lower odds of NICU or high-dependency care admission (aOR, 0.43; P < .001) and jaundice requiring treatment (aOR, 0.44; P < .05) than those of control women.
• An Apgar score at 5 minutes, umbilical artery pH, perinatal death, and birth weight did not differ significantly between the two groups.

IN PRACTICE

"[O]ur results support a potential role of antenatal IV iron therapy as an effective hematologic optimization strategy in pregnant women with IDA, and, in light of existing safety evidence, suggest an association with reduced transfusion exposure and potentially lower healthcare resource utilization," the authors wrote.

SOURCE

This study was led by Eleonora Romani, University of Florence, Florence, Italy. It was published online on September 26, 2026, in Nutrients.

LIMITATIONS

The retrospective study design may have introduced residual confounding and prevented causal association. Because the control group included women with less severe anaemia, true differences between the two groups may have been underestimated. Data on adherence to oral iron therapy and the timing of anaemia onset were not documented consistently.

DISCLOSURES

This study received partial support from the Italian Ministry of Health. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.