Aim: This study aimed to compare the efficacy and safety of intravenous iron sucrose (IS) versus ferric carboxymaltose (FCM) in the management of iron deficiency anemia (IDA) in pregnancy by assessing hemoglobin and serum ferritin improvements along with adverse drug reactions. Materials and Methods: This hospital-based comparative, prospective study was conducted at the Department of Obstetrics and Gynaecology, A.N.M.M.C.H., Gaya, over a one-year period (August 2023 – July 2024). A total of 120 pregnant women diagnosed with IDA were randomly assigned into two groups: Group A (Iron Sucrose, n=60) and Group B (Ferric Carboxymaltose, n=60). Hemoglobin and ferritin levels were recorded at baseline, 2 weeks, 4 weeks, and 8 weeks post-treatment. Adverse effects were monitored, and statistical analysis was performed using SPSS 25.0, with a significance level set at p < 0.05. Results: Both groups were homogeneous at baseline, with no significant differences in age, hemoglobin, ferritin, or other hematological parameters (p > 0.05). However, post-treatment, the FCM group showed significantly greater improvements in hemoglobin levels (3.25 ± 0.65 g/dL vs. 2.70 ± 0.60 g/dL, p = 0.003) and serum ferritin levels (107.20 ± 7.25 ng/mL vs. 72.20 ± 6.80 ng/mL, p = 0.0001) at 8 weeks. The adverse reaction rate was lower in the FCM group (6.67%) compared to the IS group (11.67%, p = 0.05). Conclusion: Ferric carboxymaltose was found to be more effective and better tolerated than iron sucrose in treating iron deficiency anemia in pregnancy. FCM led to faster and more sustained increases in hemoglobin and ferritin levels, along with a lower incidence of adverse effects. Given its single-dose administration, improved safety, and higher efficacy, FCM should be preferred over iron sucrose for managing IDA in pregnant women.