Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 14 , ISSUE 3 ( May-June, 2022 ) > List of Articles


Ferric Carboxymaltose for the Treatment of Anemia during Antenatal and Postpartum Period: Expert Opinion

PC Mahapatra, Sanjay Gupte, PM Gopinath, Suchitra N Pandit, Sunita Tandulwadkar, Mahesh Gupta, Sheela Shenoy, Vidya V Bhat, Arun M Boruah, Kawita Bapat, Milind R Shah, Onkar Swami

Keywords : Antenatal care, Ferric carboxymaltose, Iron-deficiency anemia, Postpartum anemia, Pregnancy

Citation Information : Mahapatra P, Gupte S, Gopinath P, Pandit SN, Tandulwadkar S, Gupta M, Shenoy S, Bhat VV, Boruah AM, Bapat K, Shah MR, Swami O. Ferric Carboxymaltose for the Treatment of Anemia during Antenatal and Postpartum Period: Expert Opinion. J South Asian Feder Obs Gynae 2022; 14 (3):292-301.

DOI: 10.5005/jp-journals-10006-2026

License: CC BY-NC 4.0

Published Online: 27-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Iron therapy is a cornerstone for treating iron-deficiency anemia (IDA) in pregnancy and in the postpartum period. Oral iron is the first choice of iron preparation around the globe. However, intolerating gastrointestinal side effects with oral iron seriously affect the compliance. Intravenous (IV) iron, such as ferric carboxymaltose (FCM) is a useful alternative to oral iron for treatment of IDA. Use of FCM in the second and third trimesters of pregnancy and in postpartum anemia (PPA) is associated with a significant rise in hemoglobin (Hb) and replenishment of iron stores. With increasing use of FCM in IDA of pregnancy and PPA, there is a need for a unified approach. With this context, nearly 250 experts from the field of obstetrics and gynecology (ObGy) discussed the current evidence and their experiences with FCM use. After a series of expert meetings on an online platform, key opinions were formulated for the use of FCM in management of IDA in these subgroups. This paper brings out current evidence along with expert opinions for the use of FCM in the management of IDA in pregnancy and postpartum periods.

PDF Share
  1. World Health Organization. Vitamin and Mineral Nutrition Information System (VMNIS) Worldwide prevalence on anaemia 1993–2005 Summary of the worldwide prevalence on anaemia. Available from: [Accessed December 24, 2020].
  2. National Family Health Survey Key findings from NFHS-5. Available from: [Accessed December 24, 2020].
  3. Breymann C, Bian XM, Blanco-Capito LR, et al. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med 2011;39(2):113–121. DOI: 10.1515/jpm.2010.132.
  4. VanderMeulen H, Strauss R, Lin Y, et al. The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study. BMC Pregnancy Childbirth 2020;20(1):1. DOI: 10.1186/s12884-020-02886-z.
  5. Selvaraj R, Ramakrishnan J, Sahu SK, et al. High prevalence of anemia among postnatal mothers in Urban Puducherry: a community-based study. J Family Med Prim Care 2019;8(8):2703–2707. DOI: 10.4103/jfmpc.jfmpc_386_19.
  6. Rakesh P, Gopichandran V, Jamkhandi D, et al. Determinants of postpartum anemia among women from a rural population in southern India. Int J Womens Health 2014;6:395–400. DOI: 10.2147/IJWH.S58355.
  7. Nguyen PH, Scott S, Avula R, et al. Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006–2016. BMJ Glob Health 2018;3(5):e001010. DOI: 10.1136/bmjgh-2018-001010.
  8. Helmy ME, Elkhouly NI, Ghalab RA. Maternal anemia with pregnancy and its adverse effects. Menoufia Med J 2018;31(1):7–11. DOI: 10.4103/1110-2098.234258.
  9. Smith C, Teng F, Branch E, et al. Maternal and perinatal morbidity and mortality associated with anemia in pregnancy. Obstetrics and Gynecol 2019;134(6):1234–1244. DOI: 10.1097/AOG.0000000000003557.
  10. Di Renzo GC, Gratacos E, Kurtser M, et al. Good clinical practice advice: iron deficiency anemia in pregnancy. Int J Gynecol Obstet 2019;144(3):322–324. DOI: 10.1002/ijgo.12740.
  11. Tandon R, Jain A, Malhotra P. Management of iron deficiency anemia in pregnancy in India. Indian J Hematol Blood Transfus 2018;34(2):204–215. DOI: 10.1007/s12288-018-0949-6.
  12. Auerbach M. Commentary: iron deficiency of pregnancy–a new approach involving intravenous iron. Reprod Health 2018;15 (Suppl 1):96. DOI: 10.1186/s12978-018-0536-1.
  13. Pavord S, Myers B, Robinson S, et al. British Committee for Standards in Haematology. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2012;156(5):588–600. DOI: 10.1111/j.1365-2141.2011.09012.x.
  14. Christoph P, Schuller C, Studer H, et al. Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose vs. iron sucrose. J Perinat Med 2012; 40(5):469–474. DOI: 10.1515/jpm-2011-0231.
  15. Jose A, Mahey R, Sharma JB, et al. Comparison of ferric Carboxymaltose and iron sucrose complex for treatment of iron deficiency anemia in pregnancy-randomised controlled trial. BMC Pregnancy Childbirth 2019;19(1):1–8. DOI: 10.1186/s12884-019-2200-3.
  16. Naqash A, Ara R, Bader GN. Effectiveness and safety of ferric carboxymaltose compared to iron sucrose in women with iron deficiency anemia: phase IV clinical trials. BMC Womens Health 2018;18(1):6. DOI: 10.1186/s12905-017-0506-8.
  17. Kant S. Do we have a magic bullet to treat moderate and severe anemia in pregnant women? Indian J Public Health 2019;63(3): 165–170. DOI: 10.4103/ijph.IJPH_409_19.
  18. FOGSI general clinical practice recommendations management of iron deficiency anemia in pregnancy. Available from: [Accessed December 24, 2020].
  19. Bentley ME, Griffiths PL. The burden of anemia among women in India. Eur J Clin Nutr 2003;57(1):52–60. DOI: 10.1038/sj.ejcn.1601504.
  20. Shobeiri F, Begum K, Nazari M. A prospective study of maternal hemoglobin status of Indian women during pregnancy and pregnancy outcome. Nutr Res 2006;26(5):209–213. DOI: 10.1016/j.nutres.2006.05.008.
  21. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization; 2011.
  22. Chauhan A, Prasad M. Outcome of pregnancy with hemoglobinopathy in a tertiary care center. J Obstet Gynaecol India 2018;68(5):394–399. DOI: 10.1007/s13224-017-1073-5.
  23. Bukar M, Audu BM, Sadauki HM, et al. Prevalence of iron deficiency and megaloblastic anaemia at booking in a secondary health facility in north eastern Nigeria. Niger Med J 2009;50(2):33–37.
  24. Tripathi R, Tyagi S, Singh T, et al. Clinical evaluation of severe anemia in pregnancy with special reference to macrocytic anemia. J Obstet Gynaecol Res 2012;38(1):203–207. DOI: 10.1111/j.1447-0756.2011.01679.x.
  25. Vehapoglu A, Ozgurhan G, Demir AD, et al. Hematological indices for differential diagnosis of beta thalassemia trait and iron deficiency anemia. Anemia 2014(7):576738. DOI: 10.1155/2014/576738.
  26. Zafar M, Tabassum A, Cheema QA, et al. Role of red cell distribution width and Mentzer index in differentiating iron deficiency anemia from anemia due to β thalassemia trait. J South Asian Feder Obstet Gynaecol 2019;11(5):298–300. DOI: 10.5005/jp-journals-10006-1718.
  27. Anemia Mukt Bharat. Anemia management protocol for pregnant women. Available from: [Accessed December 24, 2020].
  28. Myers B, Myers O, Moore J. Comparative efficacy and safety of intravenous ferric carboxymaltose (Ferinject) and iron (III) hydroxide dextran (Cosmofer) in pregnancy. Obstet Med 2012;5(3):105–107. DOI: 10.1258/om.2012.110095.
  29. Pels A, Ganzevoort W. Safety and efficacy of ferric carboxymaltose in anemic pregnant women: a retrospective case control study. Obstet Gynecol Int 2015;2015:728952. DOI: 10.1155/2015/728952.
  30. Froessler B, Collingwood J, Hodyl NA, et al. Intravenous ferric carboxymaltose for anaemia in pregnancy. BMC Pregnancy Childbirth 2014;14(1):115. DOI: 10.1186/1471-2393-14-115.
  31. Aporta Rodriguez R, García Montero M, Lorente Aporta JP, et al. Retrospective case reports of anemic pregnant women receiving intravenous ferric carboxymaltose: experience from a tertiary hospital in Spain. Obstet Gynecol Int 2016;2016:5060252. DOI: 10.1155/2016/5060252.
  32. Breymann C, Milman N, Mezzacasa A, et al. Ferric carboxymaltose vs. oral iron in the treatment of pregnant women with iron deficiency anemia: an international, open-label, randomized controlled trial (FER-ASAP). J Perinat Med 2017;45(4):443–453. DOI: 10.1515/jpm-2016-0050.
  33. Shim JY, Kim MY, Kim YJ, et al. Efficacy and safety of ferric carboxymaltose versus ferrous sulfate for iron deficiency anemia during pregnancy: subgroup analysis of Korean women. BMC Pregnancy Childbirth 2018;18(1):1–8. DOI: 10.1186/s12884-018-1817-y.
  34. Froessler B, Gajic T, Dekker G, et al. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet 2018;298(1):75–82. DOI: 10.1007/s00404-018-4782-9.
  35. Khalafallah AA, Hyppa A, Chuang A, et al. A prospective randomised controlled trial of a single intravenous infusion of ferric carboxymaltose vs single intravenous iron polymaltose or daily oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy. Semin Hematol 2018;55(4):223–234. DOI: 10.1053/j.seminhematol.2018.04.006.
  36. Wani S, Noushad M, Ashiq S. REGAIN STUDY: retrospective study to assess the effectiveness, tolerability, and safety of ferric carboxymaltose in the management of iron deficiency anemia in pregnant women. Anemia 2019;2019:4640635. DOI: 10.1155/2019/4640635.
  37. Oskovi-Kaplan ZA, Kilickiran H, Buyuk GN, et al. Comparison of the maternal and neonatal outcomes of pregnant women whose anemia was not corrected before delivery and pregnant women who were treated with intravenous iron in the third trimester. Arch Gynecol Obstet 2021;303:1–5. DOI: 10.1007/s00404-020-05817-7.
  38. Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose. Drugs 2009;69(6):739–756.
  39. Ganzoni AM. Intravenous iron-dextran: therapeutic and experimental possibilities. Schweiz Med Wochenschr 1970;100(7):301–303. PMID: 5413918.
  40. Institute of Medicine (US) Committee on Nutritional Status during Pregnancy and Lactation. Nutrition during pregnancy: Part I weight gain: Part II nutrient supplements. Washington (DC): National Academies Press (US); 1990. 14, Iron nutrition during pregnancy. Available from: [Accessed December 26, 2020].
  41. Hämäläinen H, Hakkarainen K, Heinonen S. Anaemia in the first but not in the second or third trimester is a risk factor for low birth weight. Clin Nutr 2003;22(3):271–275. DOI: 10.1016/s0261-5614(02)00209-1.
  42. Mohanty D, Gorakshakar AC, Colah RB, et al. Interaction of iron deficiency anemia and hemoglobinopathies among college students and pregnant women: a multi center evaluation in India. Hemoglobin 2014;38(4):252–257. DOI: 10.3109/03630269.2014.913517.
  43. Oluboyede OA. Iron studies in pregnant and non-pregnant women with haemoglobin SS or SC disease. Br J Obstet Gynaecol 1980;87(11):989–996. DOI: 10.1111/j.1471-0528.1980.tb04463.x.
  44. Derek N. Transfusion ten commandments. In: Handbook of transfusion medicine. 5th ed. Norwich: TSO Publishers; 2013. p. 1–3.
  45. Chawla S, Bal MHK, Vardhan BS, et al. Blood transfusion practices in obstetrics: our experience. J Obstet Gynaecol India 2018;68(3): 204–207. DOI: 10.1007/s13224-018-1092-x.
  46. Biswas S, Rengaraj S. Pattern of blood transfusion among women undergoing caesarean section in a tertiary health care centre in South India. J Gynec Obstet 2019;1:029.
  47. Bergmann RL, Richter R, Bergmann KE, et al. Prevalence and risk factors for early postpartum anemia. Eur J Obstet Gynecol Reprod Biol 2010;150(2):126–131. DOI: 10.1016/j.ejogrb.2010.02.030.
  48. Bodnar LM, Scanlon KS, Freedman DS, et al. High prevalence of postpartum anemia among low-income women in the United States. Am J Obstet Gynecol 2001;185(2):438–443. DOI: 10.1067/mob.2001.115996.
  49. Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol 2011;90(11):1247. DOI: 10.1007/s00277-011-1279-z.
  50. Milman N. Postpartum anemia II: prevention and treatment. Ann Hematol 2012;91(2):143–154. DOI: 10.1007/s00277-011-1381-2.
  51. Clinical transfusion. Obstetric anaemia. Available from: [Accessed December 26, 2020].
  52. South Australian perinatal practice guidelines anaemia in pregnancy. Clinical practice guideline on the treatment for women with anaemia in the peripartum period. Department of Health, Government of South Australia; 2016. Available from: [Accessed December 26, 2020].
  53. Sultan P, Bampoe S, Shah R, et al. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol 2019;221(1):19–29. DOI: 10.1016/j.ajog.2018.12.016.
  54. Van Wyck DB, Martens MG, Seid MH, et al. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstet Gynecol 2007;110(2):267–278. DOI: 10.1097/01.AOG.0000275286.03283.18.
  55. Seid MH, Derman RJ, Baker JB, et al. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol 2008;199(4): 435.e1–435.e7. DOI: 10.1016/j.ajog.2008.07.046.
  56. Breymann C, Gliga F, Bejenariu C, et al. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. Int J Gynecol Obstet 2008;101(1):67–73. DOI: 10.1016/j.ijgo.2007.10.009.
  57. Pfenniger A, Schuller C, Christoph P, et al. Safety and efficacy of high-dose intravenous iron carboxymaltose vs. iron sucrose for treatment of postpartum anemia. J Perinat Med 2012;40(4):397–402. DOI: 10.1515/jpm-2011-0239.
  58. Becuzzi N, Zimmermann R, Krafft A. Long-term efficacy of postpartum intravenous iron therapy. Biomed Res Int 2014;2014:815437. DOI: 10.1155/2014/815437.
  59. Rathod S, Samal SK, Mahapatra PC, et al. Ferric carboxymaltose: a revolution in the treatment of postpartum anemia in Indian women. Int J App Basic Med Res 2015;5(1):25–30. DOI: 10.4103/2229-516X.149230.
  60. Damineni SC, Thunga S. IV ferric carboxymaltose vs oral iron in the treatment of post-partum iron deficiency anaemia. J Clin Diagn Res 2016;10(11):QC08–QC10. DOI: 10.7860/JCDR/2016/19375.8937.
  61. Mishra V, Roy P, Gandhi K, et al. Safety and efficacy of intravenous ferric carboxy maltose in iron deficiency anaemia during postpartum period. J Nepal Health Res Counc 2017;15(3):208–211. DOI: 10.3126/jnhrc.v15i3.18841.
  62. Sharma N, Thiek JL, Natung T. Comparative study of efficacy and safety of ferric carboxymaltose versus iron sucrose in post-partum anaemia. J Obstet Gynecol India 2017;67(4):253–257. DOI: 10.1007/s13224-017-0971-x.
  63. Carroli G, Cuesta C, Abalos E, et al. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008;22(6):999–1012. DOI: 10.1016/j.bpobgyn.2008.08.004.
  64. Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. British Medical Association 2013;347:f4822. DOI: 10.1136/bmj.f4822.
  65. Chua S, Gupta S, Curnow J, et al. Intravenous iron vs blood for acute post-partum anaemia (IIBAPPA): a prospective randomised trial. BMC Pregnancy Childbirth 2017;17(1):424. DOI: 10.1186/s12884-017-1596-x.
  66. Rognoni C, Venturini S, Meregaglia M, et al. Efficacy and safety of ferric carboxymaltose and other formulations in iron-deficient patients: a systematic review and network meta-analysis of randomised controlled trials. Clin Drug Investig 2016;36(3):177–194. DOI: 10.1007/s40261-015-0361-z.
  67. Schaefer B, Tobiasch M, Viveiros A, et al. Hypophosphataemia after treatment of iron deficiency with intravenous ferric carboxymaltose or iron isomaltoside–a systematic review and meta-analysis. Br J Clin Pharmacol 2021;87(5):2256. DOI: 10.1111/bcp.14643.
  68. Toblli JE, Angerosa M. Optimizing iron delivery in the management of anemia: patient considerations and the role of ferric carboxymaltose. Drug Des Devel Ther 2014;8:2475–2491. DOI: 10.2147/DDDT.S55499.
  69. Al-Shaghana M, Brooke E, Sinha A, et al. Efficacy and cost effectiveness of ferric carboxymaltose (Ferinject) in the treatment of pregnant women with iron deficiency anaemia. Eur J Obstet Gynecol Reprod Biol 2016;206:e6. DOI: 10.1016/j.ejogrb.2016.07.046.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.