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Rachel V Thomas

4 Indian States Roll Out IV Iron Therapy To Curb Anemia In Pregnant Women: How It Works

Amid rising <span>anemia</span> in India, especially among pregnant women, the government has initiated the use of intravenous (IV) iron therapy to combat a condition that continues to be a significant public health challenge. 

To date, four high-burden states have rolled out IV Ferric Carboxymaltose (FCM) therapy under the Anemia Mukt Bharat (AMB) initiative. Rajasthan was the first to launch the FCM Pink Drive in November 2025, followed by Andhra Pradesh (February 2026), Bihar (March 2026), and Uttar Pradesh (April 2026). 

“The use of intravenous (IV) iron therapy has emerged as a scientifically sound alternative to restore iron levels and improve outcomes,” said Aradhana Patnaik, IAS, Additional Secretary and Mission Director (NHM). She added that it addresses moderate-to-severe anemia in pregnant women more effectively, particularly where oral iron is poorly tolerated or ineffective. 

Anemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet the body's physiological needs. 

<span>Anemia during pregnancy</span> is associated with postpartum hemorrhage, neural tube defects, low birth weight, premature births, stillbirths, and maternal and neonatal mortality. It can continue to affect women in the postpartum period and may worsen due to blood loss during and after delivery. This contributes to an intergenerational cycle of poor health and suboptimal growth. 

According to the National Family Health Survey (NFHS-5), anemia remains a major public health issue in India, affecting: 

<ul><li>52.2 per cent of pregnant women </li></ul><ul><li>60.6 per cent of lactating mothers </li></ul>Thus, health authorities are increasingly turning to IV Ferric Carboxymaltose (IV-FCM) as a faster way to replenish iron stores in women with moderate-to-severe anemia. 

In an interview with <strong><em>HealthandMe</em></strong>, Prof. Dr. Sanjay Pandey, Head of the Department of Community and Family Medicine at AIIMS Patna, explained the rationale behind the therapy and its rollout in Bihar. 

<h2>Why Are Women More Vulnerable to Anemia ? </h2>

<strong>Dr. Sanjay: </strong>Women are especially vulnerable to anemia because of menstrual blood loss, increased iron requirements during <span>pregnancy</span>, blood loss during childbirth, repeated pregnancies, poor dietary iron intake, infections, and certain genetic blood disorders. 

<strong>Dr. Sanjay: </strong>Ferric Carboxymaltose (IV-FCM) is an injectable form of iron administered directly into the bloodstream. It is used to treat moderate-to-severe anemia when oral iron tablets are insufficient or poorly tolerated. 

Unlike tablets, which depend on the gut to absorb iron slowly, a single IV-FCM infusion can deliver a full therapeutic dose in around 15 minutes, correcting hemoglobin levels within weeks. 

<h2>How Is <span rel="noindex">IV Iron Therapy</span> Better Than Oral Iron? </h2>

<strong>Dr. Sanjay: </strong>One of the key advantages of FCM is that it can deliver up to 1,000 mg of iron in a single infusion lasting about 15 minutes, often resulting in a significant improvement in hemoglobin levels within two to four weeks. 

<ul><li>multiple hospital visits,  </li><li>improves treatment compliance,  </li><li>causes fewer gastrointestinal side effects than oral iron,  </li><li>carries a lower risk of hypersensitivity reactions than older formulations such as iron dextran </li><li>It also requires fewer infusions than iron sucrose. </li></ul>

<strong>Dr. Sanjay: </strong>IV-FCM is recommended for: 

<ul><li><strong>Pregnant Women: </strong>IV-FCM is recommended from the second trimester onwards, particularly in cases of moderate-to-severe anemia (Hb 5–9.9 g/dL). Studies indicate that FCM does not cross the placenta and does not negatively impact neonatal outcomes, including birth weight or fetal growth. </li></ul><ul><li><strong>Dose in Pregnancy: </strong>IV-FCM is given as an infusion of up to 1,000 mg in one sitting, mixed in 100 mL of normal saline over approximately 15 minutes. It should not be administered more than once a week. </li></ul>If additional iron is required, further doses may be given after seven or 14 days. A woman should not receive more than 1,500 mg of IV-FCM during a single pregnancy. 

<h2>How Safe Is IV Iron Therapy for Mother and Baby? </h2>

<strong>Dr. Sanjay:</strong> IV-FCM is considered safe and effective during pregnancy, with growing evidence supporting its use from the second trimester onwards. 

<ul><li><strong>Maternal Outcomes: </strong>FCM corrects anemia rapidly. In the large Indian real-world PROMISE study involving 1,191 pregnant women, a single course of IV-FCM increased hemoglobin by approximately 2.8 g/dL within four weeks and by 3.6 g/dL among women with severe anemia , alongside significant improvement in iron stores. </li></ul>

<ul><li><strong>Neonatal Outcomes: </strong>FCM does not cross the placenta and has not been shown to adversely affect the baby. Studies report no negative impact on birth weight, five-minute Apgar scores, or fetal growth. </li></ul>

<strong>Dr. Sanjay: </strong>Women are typically observed for 30 minutes after infusion, and hemoglobin levels are reassessed after four weeks. IV-FCM is generally well tolerated. Mild side effects such as nausea, headache, dizziness, temporary increases in blood pressure and infusion-site reactions may occur.

<h2>How Bihar Is Expanding Access to IV-FCM Therapy </h2>

<strong>Dr. Sanjay: </strong>Bihar has procured around 2 lakh doses of IV-FCM. The rollout is expected to strengthen anemia management closer to communities through district hospitals and community health centers. 

The program will improve access to advanced anemia  treatment, particularly in rural areas where anemia  prevalence among pregnant women exceeds 63 per cent.

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Amid rising anemia in India, especially among pregnant women, the government has initiated the use of intravenous (IV) iron therapy to combat a condition that continues to be a significant public health challenge. To date, four high-burden states have rolled out IV Ferric Carboxymaltose (FCM) therapy under the Anemia Mukt Bharat (AMB) initiative. Rajasthan was the first to launch the FCM Pink Drive in November 2025, followed by Andhra Pradesh (February 2026), Bihar (March 2026), and Uttar Pradesh (April 2026). “The use of intravenous (IV) iron therapy has emerged as a scientifically sound alternative to restore iron levels and improve outcomes,” said Aradhana Patnaik, IAS, Additional Secretary and Mission Director (NHM). She added that it addresses moderate-to-severe anemia in pregnant women more effectively, particularly where oral iron is poorly tolerated or ineffective. What Is Anemia ? Anemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet the body's physiological needs. Anemia during pregnancy is associated with postpartum hemorrhage, neural tube defects, low birth weight, premature births, stillbirths, and maternal and neonatal mortality. It can continue to affect women in the postpartum period and may worsen due to blood loss during and after delivery. This contributes to an intergenerational cycle of poor health and suboptimal growth. According to the National Family Health Survey (NFHS-5), anemia remains a major public health issue in India, affecting: 52.2 per cent of pregnant women 60.6 per cent of lactating mothers Thus, health authorities are increasingly turning to IV Ferric Carboxymaltose (IV-FCM) as a faster way to replenish iron stores in women with moderate-to-severe anemia. In an interview with HealthandMe, Prof. Dr. Sanjay Pandey, Head of the Department of Community and Family Medicine at AIIMS Patna, explained the rationale behind the therapy and its rollout in Bihar. Why Are Women More Vulnerable to Anemia ?    Dr. Sanjay: Women are especially vulnerable to anemia because of menstrual blood loss, increased iron requirements during pregnancy, blood loss during childbirth, repeated pregnancies, poor dietary iron intake, infections, and certain genetic blood disorders. What Is IV-FCM and How Does It Work? Dr. Sanjay: Ferric Carboxymaltose (IV-FCM) is an injectable form of iron administered directly into the bloodstream. It is used to treat moderate-to-severe anemia when oral iron tablets are insufficient or poorly tolerated. Unlike tablets, which depend on the gut to absorb iron slowly, a single IV-FCM infusion can deliver a full therapeutic dose in around 15 minutes, correcting hemoglobin levels within weeks. How Is IV Iron Therapy Better Than Oral Iron? Dr. Sanjay: One of the key advantages of FCM is that it can deliver up to 1,000 mg of iron in a single infusion lasting about 15 minutes, often resulting in a significant improvement in hemoglobin levels within two to four weeks. The therapy reduces the need for  multiple hospital visits,  improves treatment compliance,  causes fewer gastrointestinal side effects than oral iron,  carries a lower risk of hypersensitivity reactions than older formulations such as iron dextran It also requires fewer infusions than iron sucrose. When Is IV-FCM Recommended? Dr. Sanjay: IV-FCM is recommended for: Pregnant Women: IV-FCM is recommended from the second trimester onwards, particularly in cases of moderate-to-severe anemia (Hb 5–9.9 g/dL). Studies indicate that FCM does not cross the placenta and does not negatively impact neonatal outcomes, including birth weight or fetal growth. Dose in Pregnancy: IV-FCM is given as an infusion of up to 1,000 mg in one sitting, mixed in 100 mL of normal saline over approximately 15 minutes. It should not be administered more than once a week. If additional iron is required, further doses may be given after seven or 14 days. A woman should not receive more than 1,500 mg of IV-FCM during a single pregnancy. How Safe Is IV Iron Therapy for Mother and Baby? Dr. Sanjay: IV-FCM is considered safe and effective during pregnancy, with growing evidence supporting its use from the second trimester onwards. Maternal Outcomes: FCM corrects anemia rapidly. In the large Indian real-world PROMISE study involving 1,191 pregnant women, a single course of IV-FCM increased hemoglobin by approximately 2.8 g/dL within four weeks and by 3.6 g/dL among women with severe anemia , alongside significant improvement in iron stores. Neonatal Outcomes: FCM does not cross the placenta and has not been shown to adversely affect the baby. Studies report no negative impact on birth weight, five-minute Apgar scores, or fetal growth. Are There Any Side Effects? Dr. Sanjay: Women are typically observed for 30 minutes after infusion, and hemoglobin levels are reassessed after four weeks. IV-FCM is generally well tolerated. Mild side effects such as nausea, headache, dizziness, temporary increases in blood pressure and infusion-site reactions may occur.How Bihar Is Expanding Access to IV-FCM Therapy Dr. Sanjay: Bihar has procured around 2 lakh doses of IV-FCM. The rollout is expected to strengthen anemia management closer to communities through district hospitals and community health centers. The program will improve access to advanced anemia  treatment, particularly in rural areas where anemia  prevalence among pregnant women exceeds 63 per cent.

4 indian states roll out iv iron therapy to curb anemia in pregnant women: how it works

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