Prevention and management of Anaemia in Pregnancy in India: Challenges and Opportunities
Main Article Content
Prema Ramachandran
http://orcid.org/0000-0003-1974-8281
K. Kalaivani
http://orcid.org/0000-0002-9582-4488
http://orcid.org/0000-0003-1974-8281
K. Kalaivani
http://orcid.org/0000-0002-9582-4488
Abstract
Seven decades ago, over 80% of Indian pregnant women were anaemic. About 3/4th of anaemia was due to nutritional deficiencies of: iron (most common), folic acid (second) and vitamin B12 (not as common). Anaemia in pregnancy was associated with higher maternal morbidity and mortality, low birth weight and high perinatal mortality. Detection and appropriate management of anaemia, including parenteral iron therapy and intensive care for severe anaemia were important components of antenatal care in India, but only about 10% of women had access to antenatal care. In 1970s the national programme for anaemia in pregnancy focussed on identifying all pregnant women and providing them iron and folic acid (IFA) supplementation. The coverage and compliance with supplementation were low.
In 1990 when the primary health care infrastructure was established, the anaemia control programme embarked on testing and providing appropriate treatment to anaemic women. The tertiary care centres operationalised this “test and treat” strategy. In primary and secondary care settings, accurate test for diagnosis of anaemia was not available. In the absence of accurate Hb estimation at all levels of care, it was not possible to provide appropriate treatment based on Hb levels. So, all pregnant women continued to receive one tablet of IFA throughout pregnancy. Over the next two decades, coverage under antenatal care and IFA supplementation improved but compliance with supplementation was low because about a third of pregnant women had gastrointestinal side effects with IFA. Despite these problems, between 2002 and 2015, there had been a decline in the prevalence of severe and moderate anaemia.
To accelerate the decline in anaemia in pregnancy the country is focusing on the ‘test and treat’ strategy in pregnant women using an accurate method for Hb estimation and providing appropriate treatment. Nutrition education to improve iron intake prior to and during pregnancy, is focussing on dietary diversification and use of iron fortified salt or cereals. Progress will be monitored through national surveys and locale specific appropriate mid-course modifications in the programme will be made.
Article Details
How to Cite
RAMACHANDRAN, Prema; KALAIVANI, K..
Prevention and management of Anaemia in Pregnancy in India: Challenges and Opportunities.
Medical Research Archives, [S.l.], v. 11, n. 9, oct. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4404>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v11i9.4404.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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16. Neufeld LM, Larson LM, Kurpad A, Mburu S, Martorell R, Brown KH. Hemoglobin concentration and anemia diagnosis in venous and capillary blood: biological basis and policy implications. Ann N Y Acad Sci. 2019: 1450(1):172-189
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28. Sharma A, Ravinder P, Nair M K, Kalaivani K, Ramachandran P. Management of anaemia in pregnancy using ‘test and treat’ strategy: hospital based open randomized study. Indian J Obstet Gynecol Res 2023;10(3):1-10.
29. Chaparro CM, Suchdev PS Anaemia epidemiology, pathophysiology, and etiology in low- and middle-income countries Annals of The New York Academy of Sciences Special Issue: Hemoglobin Concentration for Assessing Anaemia Ann. N.Y. Acad. Sci. 2019;1450 15-31
30. Lynch, S., C.M. Pfeiffer, M.K. Georgieff, et al. Biomarkers of Nutrition for Development (BOND) - iron review. J. Nutr. 2018;148: 1001s–1067s
31. WHO Assessing the iron status of populations, 2nd ed including literature reviews. Report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level, Geneva, Switzerland 6–8 April 2004. Geneva: World Health Organization; 2007 Accessed July 09 2023. https://apps.who.int/iris/bitstream/handle/10665/75368/9789241596107_eng.pdf,
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33. Suchdev, P.S., A.M. Williams, Z. Mei, et al. Assessment of iron status in settings of inflammation: challenges and potential approaches. Am. J. Clin. Nutr. 2017 106: 1626s– 1633s.
34. Engle-Stone, R., G.J. Aaron, J. Huang, et al.. Predictors of anaemia among preschool children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) project. Am. J. Clin. Nutr. 2017;106: 402S–415S.
35. Sharma A, Nair KM, Garg S, Ramachandran P: Impact of IM iron therapy in pregnant women with moderate anaemia Indian J Obstet Gynecol Res 2022;9(3):361–368
36. Muthayya S, Kurpad AV, Duggan CP, Bosch RJ, Dwarkanath P, 5 Mhaskar A, et al. Low maternal vitamin B12 status is associated with 6 intrauterine growth retardation in urban South Indians. Eur J Clin 7 Nutr. 2006;60(6):791–801.
37. Katre P, Bhat D, Lubree H, Otiv S, Joshi S, Joglekar C, et al. Vitamin B12 and folic acid supplementation and plasma total homocysteine concentrations in pregnant Indian women with low B12 and high folate status. Asia Pac J Clin Nutr. 2010;19(3):335–43.
38. Yajnik CS, Deshpande SS, Jackson AA, Refsum H, Rao S, Fisher DJ, et al. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study. 15 Diabetologia. 2008;51(1):29–38.
39. Vijayaraghavan K, Brahmam GNV, Nair MK, Akbar D, Rao NP. Evaluation of national nutritional anaemia prophylaxis programme. Indian J Pediatr 1990;57: 183-90
40. ICMR: Evaluation of National Nutritional Anaemia Prophylaxis Programme: Report of a Task Force Study, Indian Council of Medical Research, New Delhi, 1989
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48. MOHFW. Anaemia Mukt Bharat initiative integrated with Intensified National Iron Plus Initiative (INIPI) and POSHAN Abhiyaan. Ministry of Health and Family Welfare, Government of India. April, 2018. Accessed July 20 2023. https://anemiamuktbharat.info/
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