Comparison of Iron Sucrose Complex Versus Ferric Carboxymaltose for Establishment of Effective Breastfeeding: A Quasi-Experimental Study

Abstract

Objectives: To compare iron sucrose complex (ISC) versus ferric carboxymaltose (FCM) for establishment of effective breastfeeding

Methodology: This quasi-experimental study was conducted at Sir Ganga Ram Hospital Lahore from January to April 2025. Total 70 pregnant women with moderate-severe iron deficiency anemia were assigned, without randomization, into two equal size groups i.e. ISC and FCM. Baseline data were collected upon enrollment and outcome data at day-21 after intervention. Mann-Whitney U test used for comparing median (IQR), and Chi square test for frequency (percentage) between ISC and FCM groups. Linear regression analyses performed for neonatal weight gain and lactation initiation time; and multivariate binary logistic regression analyses for lactation adequacy.

Results: The distribution of baseline demographic and obstetric characteristics across study groups was equivalent (all p >0.05). At the day-21 follow-up, the ISC group, compared to the FCM group, showed less improvement in hemoglobin levels (0.8 vs. 1.9 g/dL, p <0.001) and serum ferritin (19.0 vs. 21.5 ng/mL, p 0.780). The ISC group also experienced a longer time to initiate breastfeeding (20 vs. 9 hours, p <0.001), but demonstrated higher lactation sufficiency (59.0% vs. 41.0%, p 0.072) and greater neonatal weight gain (680 vs. 31 grams, p <0.001). Being in FCM group showed negative association with neonatal weight gain (β -321.251, p <0.001) early breastfeeding initiation (β -8.396, p 0.004) and greater risk of lactation insufficiency (aOR 5.593, p 0.050).

Conclusion: Both ISC and FCM treatments offer unique benefits. FCM was better at improving maternal hemoglobin levels, while ISC showed advantages in terms of neonatal growth and early breastfeeding initiation. Therefore, selection of treatment should consider both maternal hematologic goals and neonatal well-being.

Keywords: Breastfeeding, Ferric carboxymaltose, Iron sucrose, Pregnancy