Iron
Iron is a trace element for haemoglobin, myoglobin and many enzymes; human studies show benefit mainly in iron deficiency, anaemia and heart failure.
We evaluated 280 human studies on Iron, including 198 randomised controlled trials and 66 meta-analyses or systematic reviews; the controlled studies include 70,680 participants in total. As of 3 October 2026.
1. What Is Iron? Occurrence, Origin and Forms
Iron is a trace element the body needs above all for the red blood pigment haemoglobin, which carries oxygen, and also for the muscle pigment myoglobin and many enzymes. Iron is stored as ferritin, whose blood level serves as a measure of the iron reserves.
Readily absorbed haem iron occurs in meat, liver and fish; plant iron from pulses, whole grains, seeds and green vegetables is absorbed less well, better together with vitamin C.
Oral supplements contain ferrous iron (such as ferrous sulfate, fumarate, gluconate, bisglycinate) or ferric iron in complexes. In severe deficiency or intolerance, iron is given as an infusion.
Forms and Preparations Studied
- Oral iron salts (sulfate, fumarate, gluconate, bisglycinate)
- Oral ferric iron complexes and liposomal iron
- Iron infusions, such as ferric carboxymaltose
- Iron-fortified foods
- Combination products with iron – the other ingredients are named in each case
Not covered on this page:
- Iron removal with chelators in iron overload (deferasirox, deferoxamine, deferiprone)
- Iron oxide nanoparticles as contrast agents and in technology
2. What Does Iron Do? Results by Area
| Area | Result in controlled studies | Strength of evidence | Studies | Participants |
|---|---|---|---|---|
| Iron deficiency and anaemia | mostly improved | high | 40 meta-analyses · 163 controlled · 15 other | 49,713 |
| Fatigue and physical performance | mostly improved | high | 12 meta-analyses · 24 controlled · 0 other | 5,186 |
| Heart failure | mixed | high | 18 meta-analyses · 15 controlled · 0 other | 10,421 |
| Infants and children | mostly no difference | high | 4 meta-analyses · 16 controlled · 3 other | 14,516 |
| Sleep and restless legs | mostly improved | high | 3 meta-analyses · 2 controlled · 1 other | 176 |
| Concentration and cognitive development | mixed | moderate | 1 meta-analyses · 17 controlled · 2 other | 7,673 |
| Pregnancy | mixed | low | 3 meta-analyses · 11 controlled · 4 other | 10,556 |
| Other outcomes | mixed | high | 24 meta-analyses · 95 controlled · 24 other | 30,425 |
How to read the table: counted are human studies whose results concern the area. “High” means at least one meta-analysis and two controlled studies showing improvement, or at least three controlled studies of which three quarters show improvement, with at least 300 participants in total. “Moderate” means at least two controlled studies showing improvement, as a majority, or one meta-analysis alongside controlled studies. “Low” means one controlled study showing improvement. Where an area has no controlled study, the strength of evidence is at most “low” (result “reviews only” or “observational data only”). Everything else is “unclear”. A study counts as showing improvement when at least half of its outcomes in this area improved. Reviews of combination products do not count as meta-analyses; results that only describe side effects or shares of users do not count as an effect. The same study is counted only once.
3. What the Studies Show in Detail
Iron, Iron Deficiency and Anaemia: Human Studies
In iron deficiency and anaemia, haemoglobin rose more with iron infusions in several controlled studies than with placebo or oral iron 518202224. Oral iron reduced iron deficiency and iron deficiency anaemia in pregnancy compared with placebo or no administration 2864162. The strength of evidence is high; studied were iron sulfate, fumarate, gluconate and bisglycinate for oral intake, trivalent complexes, liposomal iron as well as infusions such as ferric carboxymaltose. Iron infusions reduced the need for transfusion around operations and during chemotherapy compared with placebo or oral iron 182732383940. In tumour-related anaemia, iron in addition to erythropoiesis-stimulating agents improved the blood count more than these agents alone 57.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 1 van et al. 2024 | systematic review · 930,436 participants | Oral and intravenous iron preparations; cumulative monthly IV: 108–750 mg (HD) vs. 65–250 mg (PD); vs. hemodialysis versus peritoneal dialysis | prevalence of intravenous iron supplementation: improved (11.7% to 84.4% in HD patients, compared to 1.6% to 49.0% in PD patients); cumulative monthly IV iron dose: improved (108 to 750 mg in the HD group, compared to 65 to 250 mg in the PD group); hemoglobin levels: no difference (10.0 to 12.0 g/dL in HD patients, versus 9.6 to 11.9 g/dL in PD patients) |
| 2 Hou et al. 2026 | meta-analysis · 18,376 participants | 12 phosphorus-lowering drugs, including iron-containing phosphate binders; vs. Placebo and other phosphorus-lowering drugs | serum phosphorus: improved; iron parameters: improved |
| 3 Zheng et al. 2023 | meta-analysis · 14,737 participants | HIF-PHIs (e.g., roxadustat) versus erythropoiesis-stimulating agents (ESAs); vs. HIF-PHIs versus ESAs | Transferrin saturation: no difference (MD, 0.65; 95%CI, -0.45 to 1.75); Ferritin: no difference (SMD, -0.03; 95% CI, -0.13 to 0.07); Iron: improved (MD, 2.30; 95% CI, 1.40 to 3.20) |
| 5 Awad et al. 2024 | meta-analysis · 7,813 participants | intravenous iron; vs. placebo | serum ferritin: improved; haemoglobin: improved |
| 8 Du et al. 2026 | meta-analysis · 7,009 participants | Intravenous iron therapy; vs. Control group | All-cause mortality in anemic patients: unclear (RR = 0.84, 95% CI: 0.70–1.01, P = 0.06); All-cause mortality in non-anemic patients: unclear (RR = 1.28, 95% CI: 0.90–1.81, P = 0.16) |
| 17 Tanrıverdi et al. 2025 | meta-analysis · 4,757 participants | Ferric carboxymaltose vs. iron sucrose, intravenous; vs. Ferric carboxymaltose versus iron sucrose | Change in hemoglobin: improved (MD: 0.45 g/dL, 95% CI: 0.08 to 0.83, p=0.02); Change in ferritin: improved (MD: 37.32 ng/mL, 95% CI: 18.98 to 55.65, p<0.01) |
| 18 Xue et al. 2026 | meta-analysis · 4,688 participants | Intravenous iron preparations, including ferric carboxymaltose and iron isomaltoside; vs. Placebo or other intravenous iron preparations in the network | Hemoglobin concentration: improved (MD 0.76 g/dL, 95 % CrI 0.56 to 0.96); Hemoglobin concentration: improved (MD 0.65 g/dL, 95 % CrI 0.33 to 0.97); Transfusion requirements: improved (OR 0.72, 95 % CrI 0.55 to 0.91) |
| 19 Chen et al. 2025 | meta-analysis · 4,257 participants | intravenous iron; high-dose versus low-dose IV iron; vs. placebo/usual care, oral iron, varying IV iron doses | all-cause mortality versus placebo/usual care: no difference (OR: 1.36; 95% CI: 0.60-3.09); all-cause mortality versus oral iron: no difference (OR: 0.58; 95% CI: 0.18-1.90); all-cause mortality high-dose versus low-dose IV iron: improved (OR: 0.81; 95% CI: 0.67-0.97) |
Further studies in this area: 20 21 22 23 24 27 28 29 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 52 54 55 56 57 58 59 60 61 62 63 64 66 67 69 70 71 72 73 77 79 80 81 86 88 89 90 91 93 94 95 96 97 98 100 101 102 103 105 106 108 110 112 113 115 116 117 118 119 120 121 122 123 126 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 146 147 148 149 150 151 152 153 154 155 156 157 159 160 161 162 163 164 165 166 168 169 170 171 172 173 174 175 176 179 180 181 182 183 184 185 186 187 188 189 190 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 212 214 215 216 217 218 219 220 221 222 223 225 226 227 228 229 230 231 233 234 235 237 238 239 240 241 242 243 244 245 247 249 250 251 253 255 256 257 258 259 261 262 263 264 265 266 267 268 271 272 275 276 277 279 280
Iron, Fatigue and Physical Performance: Human Studies
In heart failure with iron deficiency, exercise capacity improved more with iron infusions than with placebo or standard treatment 531. After childbirth, fatigue decreased more with iron infusions than with oral iron 20. Studied were predominantly people with iron deficiency and underlying diseases such as heart failure, anaemia or tumour disease; on healthy people without iron deficiency, the evaluated studies allow no statement.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 5 Awad et al. 2024 | meta-analysis · 7,813 participants | intravenous iron; vs. placebo | 6-min walk test: improved (MD 34.87, 95% CI [20.02, 49.72], p < 0.00001); peak VO2: improved |
| 6 Liu et al. 2025 | meta-analysis · 7,786 participants | intravenous iron therapy; vs. control/placebo | 6-minute walking test distance: improved (WMD = 18.99 [7.41, 30.57]) |
| 10 Mejía-Zambrano et al. 2024 | meta-analysis · 6,717 participants | Iron supplementation (form not specified); vs. Placebo | 6-minute walk test: improved (OR, 0.79; 95%CI, 0.64-0.98) |
| 12 Mhanna et al. 2024 | meta-analysis · 6,614 participants | intravenous iron therapy; vs. standard of care | 6-minute walk test: improved |
| 14 Ahmed et al. 2026 | meta-analysis · 6,493 participants | Intravenous ferric carboxymaltose (FCM); Follow-up at 1 year and maximum follow-up; vs. Placebo or standard care | 6-minute walk test: improved (MD 29.19 m, 95% CI 11.95-46.43) |
| 15 Mohamed et al. 2026 | meta-analysis · 6,405 participants | Ferric carboxymaltose (FCM); vs. Control group | 6-minute walk test: improved |
| 16 Padda et al. 2024 | meta-analysis · 5,132 participants | Intravenous ferric carboxymaltose; vs. Placebo or standard of care | Change in 6-min walk test distance: no difference (WMD of 14.03 (95% CI: -10.94 to 38.99, p = 0.27)) |
| 18 Xue et al. 2026 | meta-analysis · 4,688 participants | Intravenous iron preparations, including ferric carboxymaltose and iron isomaltoside; vs. Placebo or other intravenous iron preparations in the network | Quality of life: fatigue and dyspnea (QLQ-C30): improved; Physical functioning (SF-36): improved |
Further studies in this area: 20 31 47 60 72 101 112 132 145 147 157 166 174 175 176 198 200 205 208 222 225 232 239 252 255 258 259 264
Iron and Heart Failure: Human Studies
In heart failure with iron deficiency, iron infusions, including ferric carboxymaltose, improved the combined endpoint of heart failure hospitalisation and cardiovascular death in several meta-analyses 678101112. Heart failure hospitalisation alone also decreased in several meta-analyses 567121314. Regarding cardiovascular death, meta-analyses reported both improvements 67 and no differences 1525. NYHA class was better with iron infusions than with control in several meta-analyses 51225. For quality of life, two meta-analyses found an advantage 512, two others found no confirmed difference 1516. In acute heart failure, one meta-analysis found no difference in repeat hospital admissions and mortality 24. For cardiovascular hospital admissions and deaths combined, another meta-analysis showed no confirmed difference 16. Ejection fraction increased in two meta-analyses on iron infusions 525 and in one on oral iron 47; another meta-analysis found no substantial effect 12. In preserved ejection fraction, ferric carboxymaltose improved diastolic function in a placebo-controlled study 198. In a controlled study, ferric carboxymaltose improved NYHA class and self-assessment compared with standard treatment; the advantage in oxygen uptake was not robust 146. In a placebo-controlled study, oral ferrous sulfate lengthened walking distance 211, whereas a meta-analysis on oral iron found no difference 47. Mostly intravenous iron preparations such as ferric carboxymaltose were studied in heart failure with reduced ejection fraction; the certainty of evidence is considered high. The benefit in acute heart failure as well as the best dose and the rhythm of administration remain open.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 5 Awad et al. 2024 | meta-analysis · 7,813 participants | intravenous iron; vs. placebo | Kansas City Cardiomyopathy Questionnaire: improved (MD 7.39, 95% CI [3.55, 11.22], p = 0.0002); left ventricular ejection fraction: improved (MD 3.76, 95% CI [2.32, 5.21], p < 0.00001); NYHA class: improved |
| 6 Liu et al. 2025 | meta-analysis · 7,786 participants | intravenous iron therapy; vs. control/placebo | Composite of total HF hospitalization and cardiovascular death: improved (RR = 0.82 [0.72, 0.92]); Total hospitalization for heart failure: improved (RR = 0.78 [0.66, 0.91]); First hospitalization for heart failure and cardiovascular death: improved (OR = 0.78 [0.65, 0.93]) |
| 7 Shalabi et al. 2025 | meta-analysis · 7,491 participants | Intravenous ferric carboxymaltose; vs. Placebo | Heart failure hospitalization or cardiovascular death: improved (RR 0.89, 95 % CI 0.83-0.96; P = 0.0016); Heart failure hospitalizations: improved (RR 0.82, 95 % CI 0.77-0.87; P < 0.0001); Cardiovascular death: improved (RR 0.89, 95 % CI 0.80-0.99; P = 0.0384) |
| 8 Du et al. 2026 | meta-analysis · 7,009 participants | Intravenous iron therapy; vs. Control group | First heart failure hospitalization or cardiovascular death: improved (RR = 0.79, 95% CI: 0.72–0.86, P < 0.001); Heart failure hospitalization or cardiovascular death: improved (RR = 0.85, 95% CI: 0.75–0.98, P = 0.02) |
| 10 Mejía-Zambrano et al. 2024 | meta-analysis · 6,717 participants | Iron supplementation (form not specified); vs. Placebo | Hospitalization for heart failure or cardiovascular death: improved (OR, 0.62; 95%CI, 0.54-0.70) |
| 11 Ahmed et al. 2025 | meta-analysis · 6,651 participants | intravenous iron therapy; vs. placebo or standard of care | Composite of first heart failure hospitalization or cardiovascular mortality: improved (OR = 0.73, 95% CI: 0.58 to 0.92); Cardiovascular mortality: unclear (OR = 0.88, 95% CI: 0.76 to 1.01); First heart failure hospitalization: unclear (OR = 0.73, 95% CI: 0.51 to 1.05) |
| 12 Mhanna et al. 2024 | meta-analysis · 6,614 participants | intravenous iron therapy; vs. standard of care | composite of HF hospitalizations or cardiovascular mortality: improved (RR: 0.84, 95% CI: 0.73, 0.96; P = 0.01); HF hospitalizations: improved (RR: 0.74, 95% CI: 0.61, 0.89; P = 0.002); all-cause, HF, and cardiovascular mortality: no difference |
| 13 Wang et al. 2024 | meta-analysis · 6,511 participants | intravenous iron therapy; subgroup analysis: treatment duration ≥ 24 weeks; vs. placebo or control | heart failure hospitalizations and cardiovascular death: improved (21% relative reduction (P<0.01)); heart failure hospitalization: improved (24% relative reduction (P<0.01)); cardiovascular hospitalizations and cardiovascular death: improved (28% relative reduction (P<0.01)) |
Further studies in this area: 14 15 16 19 24 25 26 31 47 65 72 74 79 82 83 84 146 198 206 209 211 218 232 255 258
Iron, Infants and Children: Human Studies
Birth weight differed neither between iron infusion and oral iron in anaemia in pregnancy 4896 nor between iron supplementation and placebo or no supplementation 64. Preterm births, low birth weight and small-for-gestational-age newborns were also not less frequent with iron supplementation than with placebo or no supplementation 64. A systematic review found low birth weight and small-for-gestational-age newborns less often with oral iron than without iron in non-anaemic pregnant women with normal iron status 28. In fully breastfed healthy infants, weight and head circumference increased somewhat less with iron supplementation than without iron according to a meta-analysis 43. In children with iron deficiency without anaemia, the authors of a placebo-controlled study also report more favourable growth with liposomal iron; the summary does not provide measured values for this 109. In children with iron deficiency anaemia, weight at the end of the study was higher with liposomal iron than with conventional iron polymaltose complex 140. A drink enriched with iron, zinc and other micronutrients as well as spirulina, by contrast, did not change length growth and body size 86143. Newborns of mothers who took ferrous fumarate had higher cord ferritin than after placebo 162. In one study, a micronutrient powder with much zinc and little iron slowed the decline in length-for-age z-score somewhat more than placebo 73, in another a similar powder did not change growth 69. For birth weight and growth, findings without difference predominated. Oral iron salts, liposomal iron, iron-enriched foods as well as infusions with ferric carboxymaltose and iron sucrose were studied. It remains open for which subgroups and administration rhythms a benefit nevertheless exists.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 28 Hansen et al. 2023 | systematic review · 2,822 participants | Oral iron supplements; vs. No iron supplements | Low birthweight newborns: improved (RR: 0.30, 95% CI: 0.13-0.68); Small for gestational age newborns: improved (RR: 0.39, 95% CI: 0.17-0.86) |
| 43 Tian et al. 2025 | meta-analysis · 685 participants | Oral iron supplementation; Daily until 6 or 12 months; vs. No iron supplementation | Weight gain: worsened (MD = -0.04, 95%CI -0.07 to -0.01, p = 0.004); Head circumference gain: worsened (MD = -0.14, 95% CI -0.18 to -0.09, p < 0.001) |
| 48 Shi et al. 2015 | meta-analysis · 576 participants | Intravenous iron sucrose vs. oral iron; vs. intravenous iron sucrose versus oral iron | Foetal birth weight: no difference |
| 61 Apte et al. 2025 | systematic review | Probiotics and/or prebiotics, with or without oral iron; vs. Placebo or iron | Hemoglobin, ferritin and fractional iron absorption in children: no difference (did not result in any significant change) |
| 64 Cantor et al. 2024 | systematic review | Oral iron supplements; vs. Placebo or no iron supplementation | Preterm birth: no difference; Infant low birth weight: no difference; Infants small for gestational age: no difference |
| 69 Barffour et al. 2019 | randomised controlled · 3,407 participants | Daily zinc tablet, micronutrient powder with zinc and iron, therapeutic zinc, placebo; Powder: 10 mg zinc, 6 mg iron daily; about 9 months; vs. preventive zinc, therapeutic zinc, placebo | Stunting: no difference (P = .37) |
| 70 Rattigan et al. 2025 | randomised controlled · 3,332 participants | MMN, MQ-LNS or IFA (iron supplements); MMN 30 mg iron; MQ-LNS 30 mg iron; IFA 60 mg iron; Pregnancy, second and third trimesters; vs. MMN or MQ-LNS vs. IFA | birth weight: no difference (mean difference MMN vs IFA=39 g, 95% CI -55, 134; mean difference MQ-LNS vs IFA=50 g, 95% CI -55, 156) |
| 73 Islam et al. 2022 | randomised controlled · 2,886 participants | Micronutrient powder with zinc and iron or zinc tablets; Iron 10 mg or 6 mg daily or every other day; 24 weeks; vs. Placebo powder daily | Change in length-for-age z-score: improved (P < 0.05) |
Further studies in this area: 75 86 90 96 103 107 108 109 140 143 157 162 170 236 278
Iron, Sleep and Restless Legs: Human Studies
In adults with restless legs syndrome, iron, taken orally or as an infusion, improved the IRLS score more than placebo in a meta-analysis and a systematic review 5053. RLS quality of life improved compared with placebo 5053; for self-rated sleep quality, one meta-analysis found an advantage 50, one review found no difference 53. In blood donors with iron deficiency, sleep quality, fatigue and leg restlessness improved after ferric carboxymaltose as after oral ferrous fumarate; there was no group without iron 145. In children with autism spectrum disorder and sleep disorders, iron preparations showed hardly any effect on sleep in a network meta-analysis 30. In restless legs syndrome with iron deficiency anaemia, oral ferrous sulfate and a ferumoxytol infusion improved the symptoms equally markedly in a double-blind study 248. It remains open which iron compound, which daily amount and which administration rhythm are most favourable for sleep disorders and restless legs.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 30 Sirao et al. 2026 | meta-analysis · 2,700 participants | Iron supplements as adjunctive therapy; vs. Melatonin, parent education, behavioral interventions, physical activity | Sleep disturbances: no difference (had little impact) |
| 50 Mahmoud et al. 2025 | meta-analysis · 511 participants | various iron supplements, including ferric carboxymaltose; vs. placebo | IRLS score: improved (MD = -5.28; 95% CI -7.66, -2.90; P < 0.0001); patients with improved IRLS score: improved (RR = 2.06; 95% CI 1.49, 2.84; P < 0.0001); RLS-QOL: improved (MD = 7.42; 95% CI 1.32, 13.51; P = 0.02) |
| 51 González-Parejo et al. 2024 | systematic review · 482 participants | Dietary supplements, including oral iron; vs. various supplements or control | RLS symptoms and sleep quality: improved (promising results) |
| 53 Trotti et al. 2019 | systematic review · 428 participants | Oral or parenteral iron, various formulations; Follow-up 2 to 16 weeks; vs. Placebo, pramipexole, or no treatment | Restlessness or uncomfortable leg sensations (IRLS): improved (MD -3.78, 95% CI -6.25 to -1.31); Restlessness (different scale): improved (SMD -0.74, 95% CI -1.26 to -0.23); RLS severity versus pramipexole: no difference (MD -0.40, 95% CI -5.93 to 5.13) |
| 145 Macher et al. 2020 | randomised controlled · 176 participants | 1 g ferric carboxymaltose i.v. or 10 g oral iron fumarate (100 capsules); 1 g i.v. or 10 g oral iron fumarate as 100 capsules; Follow-up after 8-12 weeks; vs. intravenous versus oral iron | Restless legs syndrome severity: improved (p < 0.001); Sleep quality: improved (p < 0.001) |
| 248 Short et al. 2024 | randomised controlled | oral ferrous sulfate versus intravenous ferumoxytol; 6 weeks; vs. oral versus intravenous iron (double-blind, double-dummy) | improvement in RLS symptoms (IRLS severity): improved (marked improvement in RLS symptoms); difference between oral and intravenous iron: no difference (no statistically significant difference between treatment groups) |
Iron, Concentration and Cognitive Development: Human Studies
In children with iron deficiency without anaemia, liposomal iron improved developmental scores more than placebo 109. In preterm infants who all received iron, care by a pharmacist, better adherence and higher developmental scores went hand in hand 185. In fully breastfed infants, iron did not change the Mental Development Index at twelve months 43. In a follow-up of pregnant women with iron deficiency anaemia, better iron values went hand in hand with better mood and mental health; the iron polymaltose infusion raised iron values more than oral iron 157. Weekly iron with folic acid lowered the score for frequent mental complaints in adolescent girls more than no supplementation 114.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 4 Sajedi et al. 2020 | systematic review · 11,559 participants | Zinc alone or zinc with iron; up to 9 years follow-up; vs. Placebo or control | mental development (Bayley Scales): no difference; motor development (Bayley Scales): no difference |
| 43 Tian et al. 2025 | meta-analysis · 685 participants | Oral iron supplementation; Daily until 6 or 12 months; vs. No iron supplementation | Mental development index at 12 months: no difference |
| 71 Larson et al. 2023 | randomised controlled · 3,300 participants | Daily iron syrup (12.5 mg iron) or multiple micronutrient powders with 12.5 mg iron; 12.5 mg iron daily; 3 months intervention, follow-up at 12 months; vs. Placebo (double-blind, double-dummy, 3 arms) | Mismatch response amplitude (ERP) at month 3: no difference (MD = 0.07μV [95% CI: -1.22, 1.37]); Mismatch response amplitude (MNP vs placebo) at month 3: no difference (MD = 0.58μV [95% CI: -0.74, 1.90]); Secondary ERP outcomes at months 3 and 12: no difference |
| 77 Nguyen et al. 2026 | randomised controlled · 1,599 participants | Weekly iron and folic acid (IFA) or multiple micronutrients (MM) vs. folic acid alone; Weekly before conception, daily IFA during pregnancy; vs. Folic acid alone | Perceptual reasoning: improved (MM: 1.68 (0.01, 3.35); IFA: 2.04 (0.33, 3.74)); Reading scores: improved (0.78 (0.11, 1.44)); Full-scale IQ: no difference |
| 99 Gutema et al. 2024 | randomised controlled · 504 participants | Intermittent iron supplementation vs. placebo, plus vitamin A; vs. Placebo iron or placebo vitamin A in 2x2 design | Cognitive development (Raven, digit span, Tower of London, visual search): no difference; Performance index of visual search task: worsened (-0.17 SD, 95% confidence interval: -0.32, -0.02); Digit span z-score (vitamin A vs. placebo): improved (0.30 SD (95% confidence interval: 0.14, 0.46)) |
| 109 Bahbah et al. 2025 | randomised controlled · 433 participants | Liposomal iron versus placebo; four months; vs. placebo in non-anemic iron deficiency; plus IDA group | developmental total score change: improved (+29.57 versus +0.96 (P < 0.001)); final developmental score: improved (181.5, compared to the IDA group, 175.0 (P < 0.001)) |
| 114 Kedir et al. 2026 | randomised controlled · 306 participants | weekly iron-folic acid supplementation (WIFAS); endline 6 months after WIFAS completion; vs. control group without WIFAS | common mental disorder score (SRQ-20): improved (β = -1.12; 95% CI: -1.68, -0.55) |
| 124 Ayete et al. 2025 | randomised controlled · 231 participants | Prenatal iron-folic acid supplements vs. maternal and child SQ-LNS; Prenatally to 6 months postpartum; child 6–18 months; vs. Iron-folic acid group vs. SQ-LNS group | Total gray matter volume: no difference; Cortical gray matter thickness/volume: no difference; Right caudal anterior cingulate cortex thickness: improved (2.78 (2.73, 2.84) vs. 2.72 (2.67, 2.77); effect size = 0.21) |
Further studies in this area: 125 127 134 150 157 177 185 189 213 214 232 269
Iron and Pregnancy: Human Studies
In healthy pregnant women, low-dose ferrous bisglycinate caused fewer gastrointestinal complaints and less often black stool than fumarate or sulfate in a randomised study 104. The highest tested amount of fumarate led more often to constipation and laxative use than lower amounts 104. Compared with placebo or oral iron, there were no differences in bleeding and transfusions 2264, in maternal disease frequency 6475 as well as in quality of life, gestational diabetes and caesarean section 64. In one study, multimicronutrient preparations were taken more faithfully than iron with folic acid 78 and in another they slightly increased mean birth weight compared with iron with folic acid 246. The certainty of evidence is overall low; mainly oral iron salts (sulfate, fumarate, gluconate, bisglycinate), iron infusions (ferric carboxymaltose, iron sucrose) and iron-enriched foods were studied, often in mixed preparations with other micronutrients.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 9 Tolkien et al. 2015 | meta-analysis · 6,831 participants | oral ferrous sulfate; not reported; not reported; vs. placebo or intravenous iron | GI side-effects in pregnant women (OR = 3.33, 95% CI 1.19-9.28, p = 0.02, I2 = 66.1%) |
| 22 Nicholson et al. 2024 | systematic review · 3,939 participants | Intravenous iron (sucrose, carboxymaltose, derisomaltose, ferumoxytol) vs oral iron (sulfate, fumarate, gluconate); Follow-up 3–6 weeks after start, around birth and postpartum; vs. Intravenous iron versus oral iron | Postpartum haemorrhage: no difference (RR 1.44, 95% CI 0.50 to 4.20); Need for blood transfusion: no difference (RR 0.97, 95% CI 0.58 to 1.60) |
| 59 Guerra et al. 2026 | systematic review | Intravenous iron (ferric carboxymaltose, iron sucrose) vs. oral iron preparations (ferrous sulfate); vs. Intravenous iron vs. oral iron or one intravenous formulation vs. another | Major maternal and neonatal outcomes: no difference |
| 64 Cantor et al. 2024 | systematic review | Oral iron supplements; vs. Placebo or no iron supplementation | Maternal quality of life: no difference; Gestational diabetes: no difference; Maternal hemorrhage: no difference |
| 70 Rattigan et al. 2025 | randomised controlled · 3,332 participants | MMN, MQ-LNS or IFA (iron supplements); MMN 30 mg iron; MQ-LNS 30 mg iron; IFA 60 mg iron; Pregnancy, second and third trimesters; vs. MMN or MQ-LNS vs. IFA | total weight gain in pregnancy: no difference (p values >0.05); rate of weight gain per week during second and third trimesters: no difference (p values >0.05); adequacy of gestational weight gain: no difference (p values >0.05) |
| 75 Neogi et al. 2019 | randomised controlled · 2,018 participants | Intravenous iron sucrose vs. oral iron (100 mg elemental iron twice daily); Iron sucrose by formula based on bodyweight and Hb deficit; oral 100 mg twice daily; follow-up to 6 weeks post-randomisation; vs. standard oral iron | Primary maternal composite outcome: no difference (adjusted odds ratio 0·95, 95% CI 0·70-1·29); Serious maternal adverse events (16 (2%) of 958 vs 13 (1%) of 976) |
| 76 Chan et al. 2023 | randomised controlled · 1,729 participants | Supplement with myo-inositol, probiotics, micronutrients (incl. iron) vs. standard; up to 12 months; vs. standard supplement (folic acid, iron, calcium, iodine, β-carotene) | time to natural conception: no difference (90.5 days (95% confidence interval: 80.7, 103.5) in the intervention group compared with 92.0 days (76.0, 105.1) in the control group); cumulative pregnancy rate at 12 months: no difference; time to conception in overweight women: improved (12-month HR=1.47 [1.07, 2.02], P=.016; 20% conceived by 84.5 vs. 117.0 days) |
| 78 Sauer et al. 2025 | randomised controlled · 1,546 participants | Iron and folic acid (IFA) vs. multiple micronutrient supplements (MMS); IFA 90 days; MMS 180 days; vs. IFA-90 vs. MMS-180 vs. MMS-90 (cluster-randomized) | Adherence rate: improved (3.9% (1.7, 6.2)); ANC visits: no difference (0.0 (-0.1, 0.2)); Acceptability of MMS (6 domains): improved (90%-100% "agreement") |
Further studies in this area: 87 104 107 162 236 246 254 268 274 279
Iron: Further Outcomes in Studies
In dialysis patients, high-dose iron as an infusion did not lead to more infections than low-dose iron in a randomised study 74. Before heart surgery, ferric carboxymaltose did not reduce transfusions and infections in people without anaemia; the prematurely terminated study was manufacturer-funded 190.
| Study | Design · participants | Preparation · dose · duration · comparison | Result |
|---|---|---|---|
| 2 Hou et al. 2026 | meta-analysis · 18,376 participants | 12 phosphorus-lowering drugs, including iron-containing phosphate binders; vs. Placebo and other phosphorus-lowering drugs | intact parathyroid hormone: improved; risk of hypercalcemia: improved; gastrointestinal discomfort: worsened |
| 5 Awad et al. 2024 | meta-analysis · 7,813 participants | intravenous iron; vs. placebo | all-cause death: improved |
| 6 Liu et al. 2025 | meta-analysis · 7,786 participants | intravenous iron therapy; vs. control/placebo | All-cause mortality: no difference (OR = 0.93 [0.83, 1.04]) |
| 7 Shalabi et al. 2025 | meta-analysis · 7,491 participants | Intravenous ferric carboxymaltose; vs. Placebo | Total all-cause hospitalization: no difference (RR 0.93, 95 % CI 0.85-1.01; P = 0.0830) |
| 8 Du et al. 2026 | meta-analysis · 7,009 participants | Intravenous iron therapy; vs. Control group | Relevant biomarkers: improved |
| 9 Tolkien et al. 2015 | meta-analysis · 6,831 participants | oral ferrous sulfate; not reported; not reported; vs. placebo or intravenous iron | GI side-effects vs. placebo (OR 2.32 [95% CI 1.74-3.08, p<0.0001, I2 = 53.6%]); GI side-effects vs. i.v. iron (OR 3.05 [95% CI 2.07-4.48, p<0.0001, I2 = 41.6%]); GI side-effects in IBD vs. i.v. iron (OR = 3.14, 95% CI 1.34-7.36, p = 0.008, I2 = 0%) |
| 10 Mejía-Zambrano et al. 2024 | meta-analysis · 6,717 participants | Iron supplementation (form not specified); vs. Placebo | Adverse events (OR, 0.78; 95%CI, 0.67-0.91) |
| 11 Ahmed et al. 2025 | meta-analysis · 6,651 participants | intravenous iron therapy; vs. placebo or standard of care | 1-year all-cause mortality: unclear (OR = 0.85, 95% CI: 0.71 to 1.02) |
Further studies in this area: 12 13 15 16 17 18 20 25 26 31 32 33 35 36 38 39 40 41 42 44 45 46 48 50 52 53 58 59 60 66 67 68 72 74 75 77 79 81 85 86 88 91 92 95 100 101 103 105 106 108 111 112 113 116 119 121 122 128 130 132 133 136 138 140 141 142 145 146 148 149 150 153 155 157 158 159 160 166 167 169 170 171 172 173 174 176 178 179 180 182 184 185 188 189 190 191 192 194 195 198 201 202 204 207 208 215 216 217 219 221 223 224 225 226 228 237 238 239 241 242 243 245 249 251 252 253 255 259 260 261 262 264 270 273 276
4. How Is Iron Dosed? Preparation, Dose and Duration in Studies
Studied were oral iron salts such as sulfate, fumarate and bisglycinate 104211, ferric citrate 35, liposomal iron 140, fortified foods as well as infusions such as ferric carboxymaltose and iron sucrose 48146. The studies compared in part infusion with oral intake 7581, in part different daily amounts 29 or intake rhythms 73. Often combination preparations with folic acid, zinc or other micronutrients were used, for example in pregnancy 70246 and in children 73.
| Preparation or form | Dose | Duration | Study |
|---|---|---|---|
| multiple micronutrient powder (MNP) with 6 mg iron and 10 mg zinc | daily 6 mg iron, 10 mg zinc, 13 other micronutrients | 9 months | 67 |
| Daily multiple micronutrient powder with 6 mg iron and 10 mg zinc | 6 mg iron daily | about 36 weeks | 68 |
| Daily zinc tablet, micronutrient powder with zinc and iron, therapeutic zinc, placebo | Powder: 10 mg zinc, 6 mg iron daily | about 9 months | 69 |
| MMN, MQ-LNS or IFA (iron supplements) | MMN 30 mg iron; MQ-LNS 30 mg iron; IFA 60 mg iron | Pregnancy, second and third trimesters | 70 |
| Daily iron syrup (12.5 mg iron) or multiple micronutrient powders with 12.5 mg iron | 12.5 mg iron daily | 3 months intervention, follow-up at 12 months | 71 |
| Ferric carboxymaltose vs placebo | — | 6 months follow-up | 72 |
| Micronutrient powder with zinc and iron or zinc tablets | Iron 10 mg or 6 mg daily or every other day | 24 weeks | 73 |
| intravenous iron infusion | high-dose versus low-dose regimen | — | 74 |
| Intravenous iron sucrose vs. oral iron (100 mg elemental iron twice daily) | Iron sucrose by formula based on bodyweight and Hb deficit; oral 100 mg twice daily | follow-up to 6 weeks post-randomisation | 75 |
| Supplement with myo-inositol, probiotics, micronutrients (incl. iron) vs. standard | — | up to 12 months | 76 |
| Weekly iron and folic acid (IFA) or multiple micronutrients (MM) vs. folic acid alone | — | Weekly before conception, daily IFA during pregnancy | 77 |
| Iron and folic acid (IFA) vs. multiple micronutrient supplements (MMS) | — | IFA 90 days; MMS 180 days | 78 |
| Iron isomaltoside 1000 (ferric derisomaltose) vs. iron sucrose | 1000 mg single dose vs. 200 mg up to five times | eight weeks follow-up | 79 |
| Daily iron supplementation (60 mg) | 60 mg iron daily | from first trimester to delivery | 80 |
| Single i.v. dose ferric carboxymaltose vs. oral ferrous sulphate 200 mg (65 mg elemental iron) | 20 mg/kg i.v. up to max 1000 mg once; oral one tablet twice daily | Oral until 6 weeks postpartum; i.v. single dose | 81 |
5. Is Iron Safe? Side Effects in Studies
Several meta-analyses found no more serious adverse events with iron infusions than with control 121316; in restless legs syndrome, milder adverse events occurred more often with iron than with placebo 50. Hypersensitivity reactions occurred more often with ferric carboxymaltose than with iron sucrose 17; with oral iron, dark stool was common 81. Details are shown in the table.
| Study | Reported side effects |
|---|---|
| 2 Hou et al. 2026 | Colestilan, tenapanor and PA21 posed higher risk of gastrointestinal discomfort |
| 8 Du et al. 2026 | Long-term safety unclear, further trials needed |
| 9 Tolkien et al. 2015 | gastrointestinal side-effects significantly increased |
| 10 Mejía-Zambrano et al. 2024 | Fewer adverse events with iron (OR 0.78; 95%CI 0.67-0.91) |
| 12 Mhanna et al. 2024 | adverse events remained stable |
| 13 Wang et al. 2024 | no additional risk of treatment-related complications (P = 0.93) |
| 16 Padda et al. 2024 | No significant difference in serious adverse events (OR 0.73; 95% CI 0.49-1.10; p = 0.13) |
| 17 Tanrıverdi et al. 2025 | More hypersensitivity reactions with ferric carboxymaltose; severe adverse events and hypophosphatemia not significantly different |
| 18 Xue et al. 2026 | No significant differences in adverse events; hypersensitivity and hypophosphatemia assessed |
| 19 Chen et al. 2025 | all-cause mortality and major adverse cardiovascular events (MACEs) |
| 20 Caljé et al. 2024 | Total adverse events reduced with IV-iron vs. oral iron (RR 0.63) |
| 21 Elías et al. 2026 | No serious events; mainly mild gastrointestinal symptoms |
6. What Remains Open: Limits of the Evidence
- Whether iron infusions prevent repeat hospital admissions in acute heart failure is open 24.
- Which iron compound, daily amount and which intake rhythm are most favourable in sleep disorders and restless legs remains open 5053248.
- Whether the hepcidin value predicts the response is open: in chronic inflammatory bowel diseases it succeeded 240, in chronic kidney disease it did not 93.
- Combination preparations with folic acid, zinc or several micronutrients make it difficult to attribute individual effects 4.
7. Bottom Line: What Is Established About Iron
Iron is a trace element that the body needs for haemoglobin, myoglobin and numerous enzymes and stores as ferritin. The benefit is best documented in iron deficiency and anaemia: iron infusions raised haemoglobin and ferritin more than placebo or oral iron and reduced the need for transfusion around operations 518222732. Oral iron reduced iron deficiency and iron deficiency anaemia in pregnancy compared with placebo or no administration 2864162. In restless legs syndrome, iron improved the symptoms more than placebo 5053, after childbirth iron infusions alleviated fatigue more than oral iron 20.
In heart failure with iron deficiency, iron infusions reduced hospital admissions due to heart failure and lengthened the walking distance; for cardiovascular death the results were inconsistent 67121525. Iron in pregnancy had predominantly no influence on birth weight 486496. The strength of evidence ranges from high to low depending on the area; form, dose and intake rhythm differed between the studies, and individual studies were manufacturer-funded 190.
Frequently Asked Questions
How well has Iron been studied in humans?
We evaluated 280 human studies on Iron, including 198 randomised controlled trials and 66 meta-analyses or systematic reviews; the controlled studies include 70,680 participants in total. As of 3 October 2026.
Does Iron help with iron deficiency and anaemia? What the studies show
Does Iron help with fatigue and physical performance? What the studies show
Does Iron help with heart failure? What the studies show
Does Iron help with infants and children? What the studies show
Does Iron help with sleep and restless legs? What the studies show
Does Iron help with concentration and cognitive development? What the studies show
What is iron and what does the body need it for?
Iron is a trace element that is needed above all for the red blood pigment haemoglobin, which transports oxygen. It is also contained in the muscle pigment myoglobin and in many enzymes. Iron is stored as ferritin, whose blood value serves as a measure of the iron reserves.
Which forms of iron were studied in the studies?
Do human studies show a benefit in anaemia?
In iron deficiency and anaemia, haemoglobin rose more with iron infusions in several controlled studies than with placebo or oral iron 518202224. Oral iron reduced iron deficiency and iron deficiency anaemia in pregnancy compared with placebo or no administration 2864162. Iron infusions also reduced the need for transfusion around operations and during chemotherapy 182732383940.
How do the studies report side effects?
Which questions are still open?
On fatigue and performance in healthy people without iron deficiency, the evaluated studies allow no statement; studied were people with heart failure or anaemia 520. Whether iron infusions prevent repeat hospital admissions in acute heart failure is open 24. It remains open which iron compound, daily amount and which intake rhythm are most favourable in sleep disorders and restless legs 5053248. Whether the hepcidin value predicts the response is open: in chronic inflammatory bowel diseases it succeeded 240, in chronic kidney disease it did not 93.
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Every statement on this page carries its evidence tier — proven, plausible or hypothesis — and leads to the original work. The decision in the individual case rests with the practitioner; we provide the connections.