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Oral iron is recommended but often suboptimal, particularly late in pregnancy. Intravenous ferric carboxymaltose (FCM) could treat anemia in women in the third trimester in sub-Saharan Africa. In an open-label, individually randomized trial in antenatal clinics in southern Malawi, we randomized 590 women at 27\u201335 weeks of gestation with capillary hemoglobin &lt;10.0\u2009g dl<jats:sup>\u22121<\/jats:sup> to FCM (20\u2009mg kg<jats:sup>\u22121<\/jats:sup> up to 1,000\u2009mg, once at enrollment) or standard of care (60\u2009mg elemental iron, twice daily for 90 days). Participants and their infants were followed to 4 weeks postpartum. Primary outcomes were maternal anemia at 36 weeks\u2019 gestation or delivery (whichever occurred first) and neonatal birthweight. At the primary timepoint, 126 of 270 (46.7%) of women in the FCM group were anemic, compared to 170 of 271 (67.3%) women in the standard-of-care group (PR, 0.74 (95% CI 0.64, 0.87); <jats:italic>P<\/jats:italic>\u2009=\u20090.0002). There was no difference between groups in birthweight (mean difference 10.9\u2009g (\u221265.7, 87.5\u2009g); <jats:italic>P<\/jats:italic>\u2009=\u20090.78). No serious infusion-related reactions occurred, and there were no differences in adverse events between groups. In Malawian women in late pregnancy, FCM effectively and safely reduced anemia before childbirth. Australia New Zealand Clinical Trial registration: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?ACTRN=ACTRN12621001239853\" ext-link-type=\"uri\">ANZCTR12621001239853<\/jats:ext-link>\n          <\/jats:p>","DOI":"10.1038\/s41591-024-03385-w","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T10:02:32Z","timestamp":1736157752000},"page":"197-206","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Ferric carboxymaltose for anemia in late pregnancy: a randomized controlled trial"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5502-0434","authenticated-orcid":false,"given":"Sant-Rayn","family":"Pasricha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Moya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Ata\u00edde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glory","family":"Mzembe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4267-716X","authenticated-orcid":false,"given":"Rebecca","family":"Harding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-4448","authenticated-orcid":false,"given":"Martin N.","family":"Mwangi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Truwah","family":"Zinenani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khic-Houy","family":"Prang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justina","family":"Kaunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen P. 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The other authors have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}