HAEMATOLOGICAL RESPONSE TO DAILY VERSUS INTERMITTENT IRON SUPPLEMENTATION IN MILD TO MODERATE IRON DEFICIENCY ANAEMIA DURING PREGNANCY: A PROSPECTIVE COMPARATIVE STUDY
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Keywords
Iron deficiency anaemia, Pregnancy, Daily iron supplementation, Twice-weekly iron, Hematological response, Hemoglobin, Antenatal care
Abstract
Iron deficiency anaemia (IDA) is one of the most common medical disorders encountered during pregnancy and remains a major contributor to maternal morbidity in low- and middle-income countries. In India, more than half of pregnant women are anaemic, necessitating effective and acceptable iron supplementation strategies. Daily oral iron is the standard regimen; however, gastrointestinal side effects and poor adherence have prompted interest in intermittent dosing. Evaluating hematological response to different supplementation schedules is essential for optimising antenatal care.
Objectives: To compare the hematological response—specifically changes in hemoglobin and hematocrit—to daily versus twice-weekly oral iron supplementation among pregnant women with mild to moderate IDA.
Methods: This prospective, randomized comparative study was conducted at the Department of Obstetrics and Gynaecology, PGIMS Rohtak, Haryana, over 14 months. A total of 200 antenatal women between 14–24 weeks of gestation with mild to moderate IDA were enrolled and randomized into two groups: Group A received daily oral iron (100 mg elemental iron + 500 mcg folic acid), and Group B received twice-weekly supplementation with the same formulation. Clinical evaluation and laboratory investigations, including hemoglobin and hematocrit estimation, were performed at enrolment and every 4 weeks until delivery. Compliance and adverse effects were assessed at each visit. Data were analysed using unpaired t-test and Chi-square test, with p < 0.05 considered statistically significant.
Results: Baseline characteristics were comparable between groups. Hemoglobin increased steadily in both groups, with no statistically significant difference at any time point (p > 0.05). Percentage improvement in hemoglobin was also similar across follow-ups. Hematocrit showed a parallel rising trend in both groups, with a significant difference observed only at 16 weeks, where Group B demonstrated a higher percentage increase (p = 0.013). Overall, both regimens produced comparable hematological improvement, indicating non-inferiority of twice-weekly dosing.
Conclusion: Daily and twice-weekly oral iron supplementation regimens yield similar hematological outcomes in pregnant women with mild to moderate IDA. Given comparable efficacy, reduced pill burden, and potential for improved adherence, twice-weekly iron supplementation presents a practical alternative to daily dosing in antenatal care programs, particularly in resource-limited settings.
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Dr Patel Anupam Gangwar
Consultant Gynaecology, City Hospital, Haridwar, Uttarakhand, India
Dr Nirmala Duhan
Professor, Department of Obstetrics and Gynaecology, Pt. BD Sharma PGIMS, Rohtak, Haryana, India
Dr Devvrat Sai
Consultant Cardiology, City Hospital, Haridwar, Uttarakhand, India
Dr Jatin Prajapati
Post Graduate Student, Department of Community Medicine, RNT Medical College, Udaipur, Rajasthan, India