Management of anaemia in pregnancy using ‘test and treat’ strategy: hospital based open randomized study

Abstract

In India, prevalence of nutritional anaemia due to iron, folic acid and vitamin B12 deficiency is high. National anaemia control programme envisaged detection and treatment of anaemic pregnant women. Prevalence of anaemia continues to be high because this strategy was not operationalised and coverage and compliance with iron folic acid supplementation remains low. : The present study aimed at: 1. Operationalizing Hb estimation in urban maternity center, 2. assessing prevalence of iron, folic acid and vitamin B12 deficiency, 3. undertaking an open randomized study in women with Hb between 8.0 and 10.9 g/dL to assess impact of supplementation with iron and folic acid (Group 1) or iron, folic acid and vitamin B 12 (Group 2). The ‘Test and treat’ strategy was operationalized in urban maternity center. At enrolment 100% of women were anaemic, 60% had ferritin <12ng/ml, 5% had folic acid <3ng/ml and 1/3 had vitamin B12 <200pg/ml. After eight weeks of supplementation, there was an increase in mean Hb (>1.0 g/dL), mean ferritin and folic acid in both Gr 1 and 2. There was a fall in mean vitamin B12 at 8 weeks in Gr 1 women who received 5 mg folic acid. Addition of vitamin B12 to IFA does not improve mean Hb or vitamin B12.With assured regular supply and supportive supervision, iron folic acid supplementation for 8 weeks reduces prevalence of anaemia in pregnancy by 50%; with continued supplementation till 38 weeks of pregnancy, there was 70% reduction in prevalence of anaemia.