2026 Eastern States Conference

Authors: Simran Kaur, PharmD; Jeffrey Hare, PharmD; Brianna Schafer, PharmD, BCPPS; Sewit Araia, PharmD 
Objective: At the conclusion of this presentation, the participant will be able to describe the incidence of severe adverse effects associated with intravenous iron dextran compared with iron sucrose in pregnancy
Pre-assessment question: Which IV iron formulation is associated with a higher risk of severe AE in pregnancy? (A. Iron sucrose B. Iron dextran C. Both have similar risk D. Not sure) 
Background: Intravenous iron is used when oral therapy is inadequate; however, comparative safety data among formulations are limited. This study compares the incidence of severe adverse effects between iron dextran and iron sucrose in pregnant women. 
Methods: This retrospective cohort study included pregnant women of any gestational age who received intravenous iron dextran or iron sucrose within the Geisinger Health System during the iron sucrose shortage from March 25, 2024, to February 20, 2025. Patients were identified using electronic health record medication and diagnosis codes. The primary outcome was the incidence of severe adverse effects, including anaphylaxis, circulatory failure, shock, etc. occurring within 24 hours of iron administration. Secondary outcomes included pre-treatment medications, emergency department admission, hospital admission, and administration of rescue medications. Adverse effects were categorized using Common Terminology Criteria for Adverse Events grading. Primary and secondary outcome incidence rates were compared using fisher’s exact test. 
Results: Data from 150 patients per group were analyzed. Median age was 27 years, with gestational age 33 weeks (iron dextran) and 32 weeks (iron sucrose). Inpatient administration was less frequent with iron dextran (1.33%) vs iron sucrose (9.33%). Adverse events occurred in 2.7% of iron dextran patients and 0% with iron sucrose (p=0.1225). In the dextran group, 38% received premedication, with one ED visit (p=1), no hospitalizations, and 4 patients requiring rescue medications (p=0.1225).
Conclusion: In conclusion, Iron sucrose had zero incidence of adverse events, and they were more often observed in the patients that received iron dextran, however severe adverse events were uncommon. Iron dextran can be considered a safe alternative treatment for iron deficiency anemia in pregnancy when iron sucrose is not readily available as the preferred agent