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Introduction: Anemia during pregnancy can lead to preterm birth, low fetal birthweight, and poorer neonatal neurological outcomes. The purpose of this study was to compare maternal and fetal outcomes following intravenous (IV) versus oral iron supplementation for iron-deficiency anemia during pregnancy.

Methods: We searched MEDLINE, OVID, Scopus,, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) comparing IV versus oral iron supplementation for iron-deficiency anemia during pregnancy. Studies were included in this meta-analysis if they reported maternal and fetal hematologic outcomes. The relative risk (RR) or standard mean difference (SMD) of IV iron supplementation was calculated for notable outcomes.

Results: Eleven studies, with a total of 1621 women in the IV group and 1640 women in the oral group, were included in this meta-analysis. Fetal birthweight, was higher in the IV iron group (SMD 58.60g, 95% confidence interval (CI) 2.63,114.58). There was no significant difference in the rate of preterm birth or gestational age at birth between the two groups. Maternal hemoglobin at delivery was significantly higher in the IV group compared to the oral group (SMD 0.85 g/dL (95% CI (0.15, 1.55)). The IV group experienced 40 (2.5%) cases of gastrointestinal distress, compared to 69 (4.2%) cases in the oral group (RR 0.60 (95% CI (0.40,0.89)).

Discussion: Intravenous iron supplementation for iron-deficiency anemia during pregnancy results in higher neonatal birthweight, higher maternal hemoglobin levels, and minimal adverse effects. Future studies are needed to investigate the cost-effectiveness of IV iron.