Objective: Routine high-dose Fe supplementation in non-anaemic pregnant women may induce oxidative stress and eventually affect birth outcomes. The aim of the present study was to measure oxidative stress markers in pregnant women with low/normal and high Hb values in trimester 1 (Hb 1 ) and to relate these to birth weight. Design: A cross-sectional study where selected oxidative stress markers were analysed in both maternal (trimester 1; T1) and cord blood samples and correlated with birth weight. Setting: A tertiary hospital in urban South India. Subjects: One hundred women were chosen based on their Hb 1 values (forty women with low/normal Hb 1 (<110 g/l) and sixty women with high Hb 1 (≥120 g/l)). Results: In T1, women with high Hb 1 values were found to have lower paraoxonase-1 (PON-1) activity (424·7 (SD 163·7) v. 532·9 (SD 144·7) pmol p-nitrophenol formed/min per ml plasma, P = 0·002) and higher lipid peroxides compared with women with low/normal Hb 1 . Routine supplementation of Fe to these women resulted in persistent lower PON-1 activity in cord blood (P = 0·02) and directionally lower (P = 0·142) birth weights. Furthermore, women with high Hb 1 who delivered low-birth-weight babies were observed to have lowest PON-1 activity in T1. No changes were observed in other markers (myeloperoxidase activity and total antioxidant levels). Conclusions: Routine Fe supplementation in pregnant women with high Hb 1 associated with increased oxidative stress, as reflected by low PON-1 activity in T1, could potentially lead to deleterious effects on birth weight.