In women after childbirth, blood levels and iron stores are more quickly corrected and safe when iron is given through the vein than by mouth: a novel Nigerian study
Researchers across multidisciplinary specialities at the College of Medicine, University of Lagos, Nigeria, led by Professor Bosede B Afolabi as Principal Investigator, in collaboration with scientists from the United Kingdom, conducted the IVON-PP TRIAL.
In the trial, the team tested a medicine (ferric carboxymaltose) to treat low blood levels (anaemia) in women after childbirth (postpartum). This medicine is not commonly used in Nigeria or most of sub-Saharan Africa for this group. This drug was given just once through the vein as an infusion (drip), and it was compared with the standard treatment medication, ferrous sulphate tablets, which are given by mouth, twice daily for 6 weeks.
The team assessed the effectiveness, tolerability, and safety of these treatment options for postpartum anaemia in Nigeria. Results showed that iron given by vein, ferric carboxymaltose, corrects blood levels faster and restores iron stores more effectively. It is tolerable and safe when compared with oral iron tablets during the postpartum period, and its effect lasts for up to six months postpartum. This important discovery was published in The Lancet Global Health, March 18, 2026 (link to article here).
Why are the findings of this research important?
Anaemia is a prevalent concern, particularly in sub-Saharan Africa and South-East Asia, affecting more than half of postpartum women. This condition can lead to fatigue, weakness, and difficulties with daily activities, significantly impacting mothers’ quality of life and their bond with their infants.
Many women do not adhere to oral treatments due to forgetfulness or gastrointestinal side effects, often dismissing their symptoms as merely the stress of motherhood. This can result in serious health risks and extend to subsequent pregnancies. Existing iron therapies, such as drips or injections, may require frequent administration and carry a risk of severe side effects, underscoring the urgent need for a safer and more effective alternative.
How was the study performed?
The IVON-PP TRIAL enrolled 1,400 postpartum women, aged 15 – 49 years, who were between six and 48 hours after childbirth and had anaemia with red blood cell level (haemoglobin) measurement less than 100g/L.
The team used a web-based platform to assign them to one of the treatment groups (one group of women received a single dose of iron by drip through the veins at enrolment, while the other group received iron tablets by mouth twice daily for six weeks after birth). Their haemoglobin and iron levels, as well as phosphate and other markers of bone metabolism, were checked.
The team also assessed how they coped with fatigue, bonded with their babies, experienced depression, and reported on their quality of life using standard instruments at specific time points. They were followed up at two, six, twelve, and up to 24 weeks.
What did the research find?
The team found that a single dose of iron (ferric carboxymaltose) administered intravenously results in a quicker increase in red blood cell and blood iron levels at six weeks after childbirth, compared to oral iron tablets taken twice daily for 6 weeks. The intravenous method also demonstrates superior improvement in low body iron stores and is associated with fewer side effects, especially gastrointestinal issues, which are common with oral iron and often discourage compliance.
Notably, both treatment options showed no adverse effects on newborns or concerns related to bone metabolism. This injectable iron offers a promising solution for postpartum women, particularly in regions with high postpartum anaemia rates, such as Nigeria, as it provides an effective, safer alternative for addressing anaemia.
What next now that the IVON-PP TRIAL is over? –
While the IVON-PP TRIAL was ongoing, implementation research was conducted on the acceptance and feasibility of the routine use of iron by vein by healthcare workers for maternal anaemia. This will be published soon.
This clinical trial demonstrated the effectiveness and safety of intravenous iron administration among postpartum women. Finding supports the study on anaemia treatment among pregnant women and will aid efforts to treat maternal anaemia. It will strengthen liaison with the Federal Ministry of Health in Nigeria to ensure it is included on the essential drug list so that it can be made available for use of anaemic postpartum women.
Publication details: Bosede B Afolabi, Victoria O Adaramoye, Titilope A Adeyemo, Mobolanle R Balogun, Ajibola I Abioye, Eleanor J Mitchell, Aduragbemi Banke-Thomas, Kate F Walker, Ochuwa A Babah, Opeyemi R Akinajo, Gbenga Olorunfemi, Chisom F Chieme, Yewande O Oshodi, Monsuru O Badmus, Ejemai A Eboreime, Hadijat O Raji, Ngozi C Orazulike, Hadiza S Galadanci, Folasade T Ogunsola, Charles A Ameh, and the IVON PP trial Investigators. Intravenous ferric carboxymaltose versus oral ferrous sulphate for the treatment of moderate-to-severe postpartum anaemia in Nigerian women (IVON-PP): an open-label randomised controlled trial. Lancet Global Health. 2026.
Funding: Bill & Melinda Gates Foundation (Investment ID INV-032911).
Contact information :
Dr Victoria O. Adaramoye
Adjunct Lecturer,
Department of Obstetrics and Gynaecology,
College of Medicine, University of Lagos.
Consultant,
Department of Obstetrics and Gynaecology,
Lagos University Teaching Hospital.
Email: wunmiadaramoye@gmail.com
Doctoral Fellow,
Department of International Public Health,
Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
E-mail: victoria.adaramoye@lstmed.ac.uk
Phone: +2348060416764
Signed: Adejoke R. Alaga-Ibraheem,
Head, Communication Unit,
University of Lagos, Nigeria
