Background: Iron deficiency anemia is the most common type of anemia among pregnant women, especially in developing countries. Indeed, a majority of women in the reproductive age group in the developing countries are anemic even before conception; pregnancy only tends to intensify it further. Objective: to compare the effectiveness and safety of intramuscular and intravenous iron therapy in pregnant women with severe iron deficiency anemia. Patients and Methods: This study is an interventional randomized study, comparing the effect of intravenous and intramuscular iron therapy on pregnant women with severe anemia. Allocation of patients in either group (I.V & I.M) was sealed and enveloped. The study was conducted at the Department of Obstetrics and Gynecology of General Helwan Hospital. Results: The results of our study proved that the intravenous iron, showed high effectiveness in the treatment of iron deficiency anemia during pregnancy.  Nearly no side effects were detected and thus, it can be considered as a useful and alternative formulation for the treatment of iron deficiency. Conclusion: The present study proved that the severity of iron deficiency anemia affects the maternal outcome by increasing the risk of postpartum hemorrhage and also affects the fetal outcome by increasing the risk of preterm delivery and low birth weight.