Assessing the need for and impact of use of iron folic acid supplementation in pregnant women: Role of haemoglobin and ferritin
Main Article Content
http://orcid.org/0000-0003-1974-8281
K. Kalaivani
http://orcid.org/0000-0002-9582-4488
Abstract
In India, there are substantial inter-state and urban-rural variations in the prevalence of anaemia and iron, folic acid and vitamin B 12 deficiency in pregnant women as well as the type and dose of micro-nutrient supplements provided in antenatal clinics.
Our institution had conducted two hospital-based randomized studies on treatment of anaemia in pregnant women with Haemoglobin (Hb) between 8.0 to 10.9 g/dL with different doses of iron, folic acid and vitamin (vit) B12. Blood samples were collected at enrolment and after 8 weeks of supplementation and Hb, ferritin, C reactive protein (CRP), folic acid and Vitamin B 12 levels were estimated.
Data were re-analysed to assess:
- prevalence of iron, folic acid and vit B12 deficiency in anaemic pregnant women at enrolment, and
- usefulness of Hb, ferritin, folic acid and vit B12 estimations in assessing the improvement in the Hb and micro-nutrient status after supplementation.
Analysis of data in anaemic pregnant women at the time of enrolment showed that:
- iron deficiency was the most common micro-nutrient deficiency,
- prevalence of folic acid deficiency was low (< 5%), and
- vit B12 deficiency was seen in 40% women.
Paired data analysis of Hb at enrolment and after 8 weeks supplementation showed that:
- there was no difference in Hb response to 60 or 240 mg supplementation for 8 weeks,
- higher dose of folic acid or addition of vitamin B12 did have any impact on Hb, and
- it was possible to identify individual non-responders to supplementation who required referral to higher medical facilities for investigation and treatment.
Mean ferritin improved with supplementation; improvement following 60 mg and 240 mg iron supplementation was similar. Ferritin estimation was not useful in assessing the response to iron supplementation in individuals. Concurrent CRP estimation along with ferritin was not useful in the detection of iron deficiency in women with inflammation because very few women had ferritin levels beyond 70 ng/ml.
Improvement in mean folic acid levels were similar after 5 mg or 1.5 mg of folic acid supplementation; supplementation did not have any impact on reduction in folic acid deficiency because of low folic acid deficiency at enrolment. There was a fall in mean vit B12 levels and an increase in vit B12 deficiency with 5 mg folic acid supplementation. Hence, supplementation with 5 mg of folic acid should not be done. Addition of oral Vit B12 to iron and folic acid supplementation did not improve either Hb or vit B12 level.
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