Effectiveness and Safety of Intravenous Iron Therapy in Outpatient Obstetrical Clinic for Treatment of Iron-Deficiency Anemia During Pregnancy.

Background: Iron-deficiency anemia (IDA) affects over one-third of pregnant patients globally, contributing to severe maternal morbidity and adverse neonatal outcomes. Oral iron supplementation, while cost-effective, is limited by poor absorption, significant gastrointestinal side effects, and poor adherence. The use of intravenous (IV) iron addresses many of these concerns, including eliminating GI side effects and the need for daily therapy. However, administration of IV iron in pregnant patients is typically restricted to specialized infusion centers or hospitals due to concerns about acute side effects, cost, resource utilization, the need for fetal heart rate monitoring, and extended infusion times. Methods: This descriptive study evaluated the implementation, safety, and feasibility of outpatient IV iron infusions for pregnant patients with IDA, with maternal hemoglobin response and outcomes reported as secondary findings. Patients received a single or series of doses of IV iron spaced weekly, with hemoglobin levels monitored before and after treatment. No fetal heart tracing was performed. Antepartum patients treated with IV iron at our outpatient obstetric clinic from 2017 to 2024 were identified retrospectively, and their charts were reviewed. Results: A total of 417 pregnant patients received IV iron (87.3% iron sucrose; 12.7% Ferric Carboxymaltose); 65.9% received ≥600 mg total dose (2-3 dose protocol), while 34.1% received lower cumulative doses (1-2 infusions). Therapy was well-tolerated with no anaphylactic reactions reported. Side effects were experienced in only 11.5% of patients and were relatively minor, with dizziness (6.2%), headache (1.9%), and hypotension (1.7%) being the most common. Adverse maternal outcomes (PPH, ICU admission, blood transfusions, and re-admissions) were low, particularly in patients who received the last infusion more than 10 days before delivery. Neonatal outcomes included a 7.4% NICU admission rate and a 3.5% rate of infants weighing less than 2500 g. Mean hemoglobin increased by 1.5 g/dL, consistent with prior studies. Conclusion: This study demonstrates that IV iron therapy can be safely given in obstetrical clinics without significant maternal or fetal safety concerns. This obviates the need for more resource-intensive and costly settings such as infusion or hospital-based centers.