Ferric Citrate in Iron Deficiency Anemia During Pregnancy

Inclusion Criteria: * Pregnant women aged 18 to 35 years. * Gestational age between 13 and 26 completed weeks, confirmed by last menstrual period and/or early ultrasound dating. * Diagnosed with moderate to severe iron deficiency anemia (IDA), defined as: Hemoglobin concentration between 7.0 g/dL and \<9.9 g/dL, and Serum ferritin concentration \<30 μg/L * Singleton intrauterine pregnancy confirmed by ultrasonography. * Willing to comply with study procedures and follow-up schedule up to 6 weeks postpartum. * Euthyroid or euthyroid with medications * Normal in anomaly scan * Received ANC check up duly * History of folic acid intake in ANC visit * Willing to conduct delivery at the study center or at a facility within the study catchment area. * No known plans to leave the study area before completion of follow-up. Exclusion Criteria: * Known hypersensitivity or intolerance to ferric citrate, ferrous fumarate, or any excipients in the formulations. * Presence of non-iron deficiency anemia (e.g., megaloblastic anemia, hemoglobinopathies, hemolytic anemia, anemia of chronic disease) estimated by PBF * Baseline hemoglobin concentration \<7.0 g/dL or requiring urgent transfusion according to the best clinical judgement of the consultants * Serum ferritin ≥30 μg/L at baseline. * Severe concurrent medical conditions including: Chronic kidney disease (Stage 3 or higher) Decompensated liver disease Active tuberculosis or other chronic infections Diagnosed malignancy * Pre-existing preeclampsia, or eclampsia, or gestational hypertension * Gestational diabetes or type 2 diabetes mellitus in the current pregnancy. * Multiple pregnancy (e.g., twins, triplets). * Gastrointestinal conditions affecting iron absorption (e.g., inflammatory bowel disease, celiac disease, previous gastric or intestinal surgery). * Use of intravenous iron therapy within previous 2 weeks of the present trial. * Any other condition which, in the opinion of the investigator, may jeopardize the participant's safety or interfere with study outcomes or compliance.