Background: Anemia in pregnancy is widespread and poses risks to both mother and fetus. This study aims to compare the efficacy of injection ferric carboxymaltose and oral iron supplementation in treating iron deficiency anemia during pregnancy. Aim: To compare the injection ferric carboxy maltose and oral iron in treating iron deficiency anaemia during pregnancy. Methods: This randomized control trial was conducted at department of Obstetrics & Gynecology, Institute of Child and Mother Health, for 9 months, following ethical clearance. A total of 156 pregnant women (16 to 34 weeks of gestation) diagnosed with anemia (Hb < 11 g%, low serum ferritin, and peripheral blood smear findings of IDA) were included after getting informed written consent and divided into Group-A (oral Ferrous Sulphate, n=78) and Group-B (Injection Ferric carboxy maltose, n=78). Data was collected in separated case-record form and analyzed by SPSS 26 version. Result: Demographic characteristics were similar across the two groups in terms of age and residence (p>0.05 in all cases). In both group-A and group-B, significant rise of Hb (mean difference= 1.018 and 1.664, respectively) and serum ferritin (mean difference= 205.22 and 227.37, respectively) were noted. However, TIBC was significantly decreased only in group-B (mean difference= -47.06, p=0.013), while group-A showed no significant improvement in TIBC (p>0.05). Overall, Hb≥ 11 gm% after 6-weeks of treatment was significantly higher in group-B than group-A (65.4% vs 44.9%, p=0.010). Besides, group-B patients had significantly lower gastrointestinal adverse events than group-A patients (p<0.05). Conclusion: Ferric carboxymaltose demonstrates superior effectiveness and safety compared to oral ferrous sulfate for treating anemia in pregnant women. However, further study is warranted.