Lay summary
Iron-deficiency anaemia in pregnancy is linked to maternal fatigue, depression, and babies being born early, small, or stillborn. Traditional high-daily-dose approaches of oral iron for anaemia cause nausea and constipation, often leading to stopping treatment. Intravenous-(IV)iron is increasingly used for maternal anaemia, often due to non-tolerance of oral iron, and associated with significant costs. Randomised trial evidence on lower-alternate-day-dose oral iron vs. standard care for iron-deficiency and anaemia in pregnancy is needed. Activities informing a future trial include consumer and stakeholder engagement; exploring co-design with Māori; team building; surveying maternity carers; establishing data-linkage processes for pregnancy outcomes and IV-iron use; investigating communication tools for women and carers; and presenting the study concept at a trial development workshop. The intended outcome of these activities is a well-developed trial design and team, aiming to improve cost-effective healthcare delivery, outcomes and equity for the prevention and treatment of iron-deficiency and anaemia in pregnancy.