Background: Iron deficiency is the most common single-nutrient deficiency worldwide. According to the US Centers for Disease Control and Prevention (CDC) recommendations, the diagnosis of anemia during pregnancy must be based on hemoglobin (Hb) values lower than 11 mg/dl during the first and the third trimester or lower than 10.5 mg/dl during the second trimester. Ferrous gluconate that has to be administered to patients with iron deficiency anemia in large quantities due to the poor bioavailability of inorganic iron. Moreover, oral administration of ferrous gluconate causes many side effects, including gastrointestinal discomfort, nausea, vomiting, diarrhea and constipation. Lactoferrin is a multifunctional iron-binding protein possessing anti-inflammatory and anti-microbial effects. 
Aim of the Study: The study aims to compare between lactoferrin with ferrous gluconate versus ferrous gluconate alone in treatment of iron deficiency anemia during pregnancy.
Patients and Methods: This was a randomized controlled clinical trial that was conducted in Ain Shams University Maternity Hospital (ASUMH) from March 2023 to November 2023 on 40 pregnant women who had iron deficiency anemia during pregnancy recruited from inpatient/outpatient antenatal clinic of ASUMH. 
Results: Group B had a significant increase in hemoglobin, hematocrit and serum ferritin level, group A had significantly more nausea than group B (p = 0.013), while there was no significant difference between the groups in terms of constipation or non-compliance (p > 0.05), there is no significant difference between the groups in terms of age or gestational age. 
Conclusion: In our study we compared between lactoferrin with ferrous gluconate versus ferrous gluconate in treatment of iron deficiency anemia during pregnancy. Accordingly, we found that Oral lactoferrin with ferrous gluconate is better tolerated with higher increase in mean hemoglobin and lower side effects (nausea) when compared to oral iron therapy alone.