Comparative Effectiveness of Iron Supplementation in Indian Pregnant Women: A Network Meta-Analysis of Randomized Controlled Trials

Abstract

Anemia prevalence in Indian pregnant women remains at 52.2% (The National Family Health Survey-5), necessitating rigorous comparison of standard versus newer iron formulations to optimize treatment in India. To evaluate the comparative effectiveness of oral and parenteral iron preparations in Indian pregnant women, focusing on hemoglobin and serum ferritin improvement. We searched PubMed, Embase, Cochrane Library, and Google Scholar for Randomized Controlled Trials (RCTs) published up to 2024. Only RCTs from India were included. Data from 17 trials ( N = 2,228) were synthesized using network meta-analysis to estimate mean differences (MDs) in hemoglobin and serum ferritin levels. Within oral formulations, newer salts significantly outperformed the standard of care; specifically, ferrous asparto glycinate demonstrated the highest hemoglobin improvement (MD: 1.21 g/dL; 95% confidence interval [CI] 0.04–2.38) (hypothesis-generating; small sample), followed by ferrous bisglycinate and iron polymaltose complex, compared to ferrous sulfate. Among parenteral formulations, iron sucrose emerged as the superior agent (MD: 0.76 g/dL; 95% CI 0.52–1.00) for hemoglobin recovery. While the comparison between modes confirmed the known superiority of parenteral over oral iron (MD: 0.88 g/dL at 4 weeks), the network ranking highlights that newer oral molecules offer significantly better efficacy than the current standard, ferrous sulfate. Iron sucrose shows the highest efficacy for rapid hemoglobin correction. Among oral options, ferrous asparto glycinate, ferrous bisglycinate, and iron polymaltose complex provide better hemoglobin improvement than ferrous sulfate. These findings support a review of iron-molecule choices within the Anemia Mukt Bharat strategy.

PROSPERO Registration Number: CRD42024570537