IV FCM superior to oral iron for postpartum anaemia

Single-dose intravenous ferric carboxymaltose (IV FCM) is more effective than oral iron in treating postpartum anaemia and improving haemoglobin (Hb) at 6 weeks, a study has shown.

“Use of IV FCM in the postpartum period can rapidly address maternal anaemia with lasting effects that have important implications for future reproductive health,” said study co-author Dr Rupsa C Boelig, associate professor, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, US, who presented the findings at SMFM 2026.

Boelig and her team conducted PRIORITY, a parallel two-arm multicentre randomized controlled trial aimed at determining whether a single infusion of IV FMC up to 1 g is superior to oral iron 60 mg twice daily for the treatment of postpartum anaemia.

A total of 4,857 mothers at eight international sites in the NICHD Global Health Network for Women’s and Children’s Health Research were randomly allocated to receive either IV FCM (n=2,428) or oral iron (n=2,429). Participants were screened for moderate anaemia (Hb, 7.0‒9.9 g/dL) at 6‒48 h postpartum.

The primary outcome was a non-anaemic state, defined as Hb ≥11.0 g/dL at 6 weeks postpartum. Secondary outcomes, analysed in hierarchical manner, were as follows: Hb change and postpartum depression (PPD, Ediburgh PPD scale >10) at 6 weeks; Hb change and PPD at 6 months.

“All analyses were intention to treat, and relative risks (RR)/mean differences (MD) were adjusted for site,” according to Boelig.

Baseline maternal characteristics did not significantly differ between groups (mean age 25.8 years; BMI at randomization 24.83 kg/m²; maternal weight at randomization <50 kg, n=918 [18.9 percent]; Hb at randomization, 9.1 g/dL; gestational age delivery, 38.0 weeks; multiple birth, mean 84 [1.7 percent]).

Baseline neonatal characteristics were also comparable between groups (caesarean, n=2,130 [43.2 percent]; male, n=2,567 [52.1 percent]; preterm [<37 weeks], n=942 [19.1 percent]; birth weight <2,500 g, n=713 [14.5 percent]).

Mothers who were assigned to the IV FCM group were significantly more likely to achieve a non-anaemic state at 6 weeks overall (RR, 1.25, 95 percent confidence interval [CI], 1.20‒1.29) and regionally (South Asia: RR, 1.20, 95 percent CI, 1.14‒1.25; sub-Saharan Africa: RR, 1.37, 95 percent CI, 1.29‒1.46). [SMFM 2026; abstract LB01]

Hb concentration

Furthermore, participants who received IV FCM achieved significantly greater improvements in serum Hb concentration at week 6 (MD, 0.69, 95 percent CI, 0.60‒0.77). This finding was sustained at 6 months (MD, 0.45, 95 percent CI, 0.36‒0.54), but no statistical significance could be determined due to hierarchical testing.

Notably, no difference was observed in the risk of PPD at 6 weeks (RR, 0.87, 95 percent CI, 0.64‒1.19) or 6 months (RR, 1.06, 95 percent CI, 0.73‒1.54).

“Anaemia remains a persistent contributor to maternal morbidity and mortality worldwide,” Boelig said. “Postpartum anaemia impacts future reproductive health.”

The high prevalence of anaemia among women of reproductive age persists, particularly in low- and middle-income countries, but progress toward global anaemia reduction goals remains scarce. [J Nutr 2001;131:604S-615S]

In previous reviews and meta-analyses, the use of IV iron has exhibited its efficacy in managing anaemia due to the rapid increase in Hb and the safety of FCM formulations. [Cochrane Database Syst Rev 2015;2015:CD010861; Am J Obstet Gynecol 2019;221:19-29.e3]