Study raises questions about iron treatment during pregnancy
13 Oct 2026
A new study has raised questions about whether oral iron should remain the first treatment offered to pregnant women with iron deficiency anaemia (IDA). Researchers found that intravenous (IV) iron was linked to better maternal iron levels and a lower need for blood transfusions during childbirth.
Published in JAMA Network Open, the review analysed data from almost 12,000 pregnant women with IDA in the United States and other countries.
Women who received IV iron had higher haemoglobin and ferritin levels at delivery than those who took oral iron. They were also 37% less likely to need a blood transfusion during their hospital stay for childbirth.
The researchers found no significant difference in birth weight or the length of pregnancy between the two treatment groups. However, babies born to women who received IV iron had higher ferritin levels, indicating better iron stores.
IV treatment also improved haemoglobin and ferritin levels more quickly. Women receiving IV iron reported 43% fewer side effects, particularly digestive problems such as nausea, constipation and stomach discomfort.
These side effects can make it difficult for some women to continue taking oral iron as prescribed.
Current Australian guidance generally recommends oral iron as the first treatment for iron deficiency during pregnancy. However, the findings have raised the question of whether more women should be offered iron infusions earlier.
Dr Rebekah Hoffman, chair of the RACGP NSW and ACT, told newsGP that the findings could support changes to existing treatment guidelines. She said women who meet the clinical criteria may not always need to try oral iron first before being considered for an infusion.
Anaemia during pregnancy is a major health concern. It affects an estimated 38.2% of pregnant women worldwide, while Australian estimates suggest a prevalence of around 25%. Aboriginal and Torres Strait Islander women face an even greater risk.
Iron deficiency is responsible for about half of all anaemia cases worldwide. Iron deficiency anaemia also contributes to hospital admissions in Australia, with around 68,900 potentially preventable hospitalisations recorded in 2024–25.
The use of IV iron has increased in Australia. One study reported a 17-fold rise in its use among women aged 18–44 between 2013 and 2024.
Although GPs write around two-thirds of IV iron prescriptions in Australia, infusions for pregnant women have traditionally been provided in hospital settings.
Australian guidance generally advises against IV iron during the first trimester. From the second trimester onwards, it may be considered when oral iron causes side effects, does not work well enough or a faster improvement in iron levels is needed.
Serious allergic reactions to modern IV iron preparations are uncommon. However, treatment during pregnancy requires careful consideration of possible risks to both the mother and baby.
Dr Hoffman said the study did not discuss foetal bradycardia, a rare complication involving an unusually slow foetal heart rate. This is one reason some GPs may prefer hospital-based treatment.
She explained that hospitals may monitor the baby's heart rate using ultrasound or a Doppler device after an infusion. GPs offering this treatment would need the appropriate skills, monitoring arrangements and informed consent procedures.
The cost and availability of iron infusions are further challenges. There is currently no dedicated Medicare Benefits Schedule (MBS) item for iron infusions performed in general practice.
Providing the treatment requires staff time, nursing support and monitoring for possible complications, which can make it expensive for both practices and patients.
Dr Hoffman said the cost of nursing staff is a key barrier, as patients need to be monitored during infusions for rare reactions and possible skin staining if iron leaks outside the vein.
She said GPs would welcome a dedicated MBS item to help make iron infusions more accessible through general practice.
Study raises questions about iron treatment during pregnancy
Source: newsGP, reporting on research published in JAMA Network Open.