Clinical Efficacy of Single-Dose Intravenous Ferric Carboxymaltose versus Oral Ferrous Fumarate for Iron Deficiency Anemia in the Second Trimester

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 891–902

DOI: 10.46882/2026/IJOG/000555

Original Research Article

Title: Clinical Efficacy of Single-Dose Intravenous Ferric Carboxymaltose versus Oral Ferrous Fumarate for Iron Deficiency Anemia in the Second Trimester

Names of Authors: Chidi E. Eze¹, Aisha M. Umar²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
² Department of Obstetrics and Gynecology, Federal Medical Centre, Katsina, Nigeria

Abstract:
Maternal Iron Deficiency Anemia (IDA) during the second trimester is strongly linked with restricted fetal growth patterns and an elevated risk of preterm birth. This open-label, randomized controlled trial compared the clinical efficacy, hematological response velocity, and gastrointestinal safety of a single total-dose infusion of intravenous (IV) ferric carboxymaltose against standard oral ferrous fumarate therapy. Two hundred and forty pregnant women in their second trimester (20 to 24 weeks of gestation) presenting with a baseline hemoglobin (Hb) between 8.0 and 9.5 g/dL and serum ferritin < 12 μg/L were randomized into two equal groups (n = 120 per group). The IV group received a single 1,000 mg infusion of ferric carboxymaltose, while the oral group received oral ferrous fumarate (200 mg) twice daily for a duration of six weeks. The primary outcome was the mean increase in Hb levels from baseline to delivery. At the 4-week post-treatment evaluation, the mean Hb increase was significantly higher in the IV group compared to the oral group (2.25 ± 0.45 g/dL vs. 1.15 ± 0.32 g/dL, p < 0.001). Target Hb levels (≥ 11.0 g/dL) at delivery were achieved by 92.5% of women in the IV group compared to 64.2% in the oral group (p < 0.001). Serum ferritin stores were significantly more restored in the IV cohort (median 114.2 μg/L vs. 22.5 μg/L, p < 0.001). Gastrointestinal adverse effects occurred in 42.5% of the oral cohort, leading to non-compliance in 16.7% of cases. A single total-dose infusion of ferric carboxymaltose in the second trimester provides superior hematological correction and iron reserve restoration with excellent compliance and safety compared to oral iron.

Keywords: Iron Deficiency Anemia; Ferric Carboxymaltose; Ferrous Fumarate; Hemoglobin; Ferritin; Second Trimester.

Manuscript Timeline: Received: August 06, 2026; Revised: September 05, 2026; Accepted: September 15, 2026; Published: September 24, 2026.

Citation: Eze CE, Umar AM. Clinical Efficacy of Single-Dose Intravenous Ferric Carboxymaltose versus Oral Ferrous Fumarate for Iron Deficiency Anemia in the Second Trimester. International Journal of Obstetrics and Gynecology. 2026; 14(9): 891–902.

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