Iron‑deficiency anemia (IDA) is a global health concern in pregnancy associated with adverse fetal and maternal outcomes. The present study aimed to evaluate and compare the therapeutic response and tolerability of intravenous (IV) iron sucrose and ferric carboxymaltose (FCM) administered to pregnant women with IDA. The present prospective observational study was conducted among 334 pregnant women who were in the second or third trimester of pregnancy with moderate to severe IDA and who were treated with IV iron sucrose or FCM at a large tertiary care center between April, 2018 and March, 2024. The therapeutic response was assessed by analyzing the increase in hemoglobin (Hb) and serum ferritin levels at 3 and 6 weeks following the first dose of IV iron treatment. Tolerability was assessed by analyzing the adverse events to drug administration. A statistically significant increase in the mean Hb and serum ferritin levels was observed in both the iron sucrose and FCM groups at 3 and 6 weeks post‑infusion (P<0.0001 for all); however, the increase in the FCM group was significantly higher (P<0.0001) than that in the iron sucrose group. Minor temporary adverse drug reactions were comparable (P=0.232) between the both treatment groups, with no major serious adverse events observed in any group. IV iron sucrose and FCM both were efficacious and well tolerated in pregnant women with moderate to severe IDA during the second and third trimester. However, there was an improved overall response to FCM as it caused a greater increase in the Hb and serum ferritin levels than iron sucrose. Therefore, FCM is recommended as an effective and safe alternative to iron sucrose for the treatment of IDA during pregnancy.

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