Iron deficiency anemia in pregnancy is treated with which oral iron preparation that has the best absorption and what is the recommended elemental iron dose per day in severe deficiency?

• A Ferrous sulfate; 200 mg elemental iron daily
• B Ferrous sulfate; 100–200 mg elemental iron daily (in 1–3 divided doses) ✓
• C Ferric polymaltose; 200 mg elemental iron daily
• D Ferrous gluconate; 60 mg elemental iron three times daily

Explanation

Ferrous (Fe2+) salts, particularly ferrous sulfate, have superior bioavailability compared to ferric (Fe3+) preparations because Fe2+ is directly absorbed without requiring reduction. For treatment of iron deficiency anemia in pregnancy, 100–200 mg elemental iron daily (in divided doses) is recommended. Ferrous sulfate 200 mg tablet contains ~65 mg elemental iron; thus 1–3 tablets provide 65–195 mg elemental iron daily. Ferric polymaltose (Fe3+) has lower absorption but fewer GI side effects; it is used when ferrous is not tolerated.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.