This study aims to address this evidence gap by comparing a step-up oral-first strategy with an early IV iron strategy in pregnant women diagnosed with anemia after 34 weeks of gestation.
• Women aged 18 years or older.
Singleton pregnancy.
Gestational age ≥34+0 weeks at the time of anemia diagnosis.
Hemoglobin <11 g/dL measured as part of routine antenatal care.
• Known anemia not primarily due to iron deficiency.
Known hemoglobinopathies.
Severe anemia requiring immediate blood transfusion.
Previous severe hypersensitivity reaction to IV iron formulations.
Parallel
Oral iron supplementation
DrugParticipants randomized to this group will begin oral iron therapy immediately after diagnosis. The formulation and dosage will follow institutional practice and guideline recommendations
IV iron administration
DrugParticipants randomized to this group will receive IV iron within 7 days of diagnosis. The dose will be calculated based on body weight and estimated iron deficit. Oral iron supplementation is not mandated following IV administration.
Hemoglobin concentration (g/dL) measured at hospital admission for delivery.
Hemoglobin concentration (g/dL) at 38+0 weeks of gestation
Postpartum hemoglobin concentration (g/dL)
Absolute change in hemoglobin
Peripartum Blood Transfusion
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