Intravenous Iron Sucrose Versus Oral Iron Therapy During Pregnancy: A Critical Appraisal of Reported Haematological Outcomes and Treatment Tolerability

Background: Iron-deficiency anaemia during pregnancy requires appropriate treatment to restore haemoglobin concentrations and iron stores while minimising treatment-related complications. Oral iron preparations are widely used, although gastrointestinal intolerance and inconsistent adherence may affect treatment response. Intravenous iron sucrose is an alternative for selected patients who require parenteral iron replacement.
Objective: To critically examine the reported haematological response, treatment adherence, adverse effects and pregnancy outcomes in a published comparison of intravenous iron sucrose and oral ferrous sulfate.
Methods: This manuscript presents a narrative critical appraisal of a previously published randomized comparative study by Kumari and colleagues. The reported study enrolled 100 pregnant women and allocated 50 participants to each treatment group. Its published results were reviewed descriptively, with attention to participant retention, haemoglobin response, other haematological measurements and treatment tolerability. No new participants were recruited, and no independent patient-level statistical analysis was performed.
Results: The source study reported that 48 participants in the intravenous iron sucrose group and 35 in the oral ferrous sulfate group were included in the six-week analysis. Mean haemoglobin concentration reportedly increased from 8.41 ± 0.13 to 11.63 ± 0.14 g/dL in the intravenous group and from 8.43 ± 0.15 to 10.09 ± 0.16 g/dL in the oral group. The corresponding reported increases were 3.22 and 1.66 g/dL. Two participants in the intravenous group were reported to have experienced hypersensitivity reactions, while 15 participants in the oral group were reported to have taken tablets irregularly. The publication also described differences in other haematological parameters and treatment-related adverse effects. However, several entries presented as p-values exceed the permissible statistical range, and detailed numerical pregnancy outcome data were not provided in the supplied material.
Conclusion: The published findings describe a larger reported haemoglobin increase with intravenous iron sucrose than with oral ferrous sulfate over the assessed period. However, unequal numbers of participants in the final analysis, unresolved statistical inconsistencies and incomplete information on pregnancy outcomes limit the strength of the conclusions. These findings should be interpreted as those of the published study and not as results from a new clinical investigation.