Trajectory of Iron and Red Cell Parameters in Moderately Anemic Iron-Deficient Pregnant Women Receiving Daily Iron-Folic Acid Supplementation: A Prospective Cohort Study.

Background/

Objectives

The objective is to study the trajectories of hematologic and biochemical markers in moderately anemic pregnant women receiving oral iron supplementation throughout pregnancy.

Methods

This prospective cohort study was conducted from August 2021 to September 2023 involving 315 pregnant women from rural areas of Belgaum, Karnataka, India, with hemoglobin levels between 7.0 and 9.9 g/dL and serum ferritin < 30 ng/mL and/or TSAT < 20%. Participants received iron-folic acid supplementation (IFAS) as per Anaemia Mukt Bharat guidelines. Blood samples were collected to measure various hematologic and iron markers and compared across each visits.

Results

We report a complete adherence rate of 95.3% for iron and 97.8% for folic acid supplementation throughout pregnancy and also observed significant improvements in hemoglobin (9.36 (8.55, 9.74) to 12.03 (11.49, 12.72)) g/dL, hematocrit (29.93 ± 2.87 to 33.71 ± 3.69) %, MCV (72.16 ± 7.90 to 83.47 ± 7.65) fL, MCH (22.44 ± 3.01 to 26.77 ± 3.08) pg levels from the early second to the early third trimester of pregnancy with significant difference (<0.001). Increased erythropoiesis was reported by a higher reticulocyte hemoglobin (23.30 ± 3.03 to 27.84 ± 3.83) pg and immature reticulocyte fractions (6.90 (4.30, 9.50) to 7.30 (4.3, 11.0)) %. Initially, iron, ferritin and TSAT levels increased but later stabilized or slightly declined towards the end of pregnancy.

Conclusions

Daily IFAS in moderately anemic pregnant women improved the trajectory of iron parameters, with peak gains in early third trimester. High adherence via counselling supports targeted monitoring and trimester-specific strategies to reduce maternal anemia and may improve outcomes.