Iron deficiency anemia (IDA) is a frequent medical condition that causes disturbing pregnancies, especially in low-resource nations, and it contributes considerably to morbidity and mortality. As a result, early detection and treatment of IDA are strongly advised. Objective: This study was conducted to evaluate the effectiveness, safety and acceptability of ferrous sulphate alone in comparison to combination of ferrous sulphate and lactoferrin for the treatment of iron deficiency anemia during pregnancy and their effect on neonatal iron store. Patients and methods: This randomized prospective cohort study was conducted on 300 pregnant women from the second trimester with IDA who were enrolled and randomly separated on 2 groups; ferrous sulphate group: 150 pregnant women received 150 mg of dried ferrous sulphate capsules. Combined ferrous sulphate and lactoferrin group: 150 pregnant women received combined 200 mg lactoferrin and 30 mg iron once daily for eight consecutive weeks. Results: Total increase in CBC with combined ferrous sulphate and lactoferrin was higher compared to ferrous sulfate alone (p value < 0.05). Gastrointestinal adverse effects occurred more frequently with ferrous sulphate than the combined ferrous sulphate and lactoferrin (p < 0.05). Neonatal iron store significantly increased in combined ferrous sulphate and lactoferrin than in ferrous sulphate alone (p value < 0.001). Conclusion: Combined ferrous sulphate and lactoferrin was more effective than ferrous sulfate in pregnant women with IDA, with fewer gastrointestinal adverse effects and better effect on neonatal iron store.